Reaction to health care decidion

  • Updated June 28, 2012, 1:21 p.m. ET

Americans react to historic health care decision

 

Associated Press

CHICAGO — The mother of two disabled teens called Thursday’s Supreme Court ruling on the health care law wonderful because it bars insurance companies from setting lifetime limits for medical expenses — a big help to her family.

But a retiree on Medicare called it a “sad day” and worries that the law’s new rules coming in 2015 will interfere with treatments doctors can provide.

Across the country, some Americans haven’t been dramatically affected yet by the law, which will take a few years to reach full force. But many others say they have felt its effects already and have strong opinions about it.

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Name: Becky Morefield

Home: Mahomet, Ill.

Age: 51

Occupation: Stay-at-home mom of two disabled teenagers

Insurance coverage: Private insurance through husband’s employer

As Morefield sees it, the health law allowed her son Tucker to die peacefully at home with private health insurance covering his care.

Tucker, one of three triplets with cerebral palsy, was always the most fragile of the siblings, Morefield said. Five years ago, he maxed out the $1 million lifetime limit in his family’s policy when he went into respiratory failure and was hospitalized for 12 weeks.

Hitting the lifetime limit meant the insurance company would no longer pay Tucker’s medical bills. The state of Illinois picked up the slack through a program for children with special health care needs. But the program put strict limits on certain medical supplies, leading the family to wash and reuse equipment meant for single use.

Tucker’s coverage was reinstated Jan. 1, 2011, because the health law barred lifetime dollar limits on coverage. He lived another 15 months covered by private insurance. At the end, he had doctor visits at home, oxygen and enough pain medication — all care that Morefield said would have been restricted under the state program.

“It was a blessing for us,” Morefield said. “People who’ve not had the ongoing medical things we’ve had don’t understand.”

Morefield reacted to the Supreme Court decision on Thursday, her birthday, with joy. She called it a great gift that will grant her and her husband peace of mind.

“It’s wonderful,” she said.

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Name: Margo Criscuola

Home: Chicago

Age: 66

Occupation: Education consultant

Insurance coverage: Medicare

Criscuola is worried that a controversial board created by President Barack Obama’s health overhaul will ration health care and also dictate treatments to doctors. She has family members with a rare genetic condition that she said requires experimental therapies.

“I was listening to the radio this morning and heard the news. I think it’s a very sad day for this country, for our medical industry and for our health in this country,” Criscuola said.

“If you have a law that requires doctors’ treatments to be approved on the basis of their general effectiveness and doctors are not permitted to experiment with other kinds of approaches, that makes it very difficult for special diseases like these to be treated.”

The board, called the Independent Payment Advisory Board, is meant to hold down Medicare costs, beginning in 2015. Republicans are targeting the provision for repeal. Criscuola fears the board’s influence will go beyond Medicare and permeate the health care system. The White House has said the board is crucial to holding down costs and is barred by the law from rationing care.

The law also encourages a payment model for hospitals, insurers and doctors called “accountable care organizations,” which Criscuola believes also will limit doctors’ choices in treating patients.

Criscuola has benefited from a provision in the health care law that provides free annual wellness exams to people with Medicare.

“Do I use it? Yeah. Is the benefit I receive from it more than if I had kept the money I paid into Social Security and Medicare payroll taxes and invested it myself? No. It’s considerably less,” she said. “Will it be around in 15, 20 years? Probably not.”

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Name: Bev Veals

Home: Near Wilmington, N.C.

Age: 48

Occupation: Stay-at-home mom of a 17-year-old and a 20-year-old

Insurance coverage: Coverage under the new law for people with pre-existing conditions

On Thursday morning, waiting for the news, Veals was watching CNN, which initially reported incorrectly that the law had been overturned. She was tense with worry that she would lose her coverage.

“I’m totally, absolutely right now dazed because they first, initially said it had been overturned,” Veals said. “I’m sitting here gasping for breath. … Now they’re saying it’s being upheld.” She added: “It’s a relief.”

The expense of her breast cancer treatments led to bankruptcy and foreclosure for her family over a horrific 10-year period. Finally, it cost so much that she could no longer afford health insurance. She and her self-employed husband decided to drop her from the family’s insurance plan four years ago to reduce their monthly premiums from $1,700 to $400 a month.

She spent the next 27 months uninsured. Then in 2011 she signed up for insurance made possible by the new law. The program helps people who have been turned away by insurance companies because of pre-existing medical conditions. She now pays $377 a month for her insurance with a $1,000 deductible, meaning she pays that much out of pocket before the coverage starts.

“It has only been a little over a year for me, but I can’t tell you the dignity being covered brings,” Veals said. “My biggest fear was I would have to beg for help to cover medical bills. Panhandling to pay a doctor’s bill … not my idea of the American Dream.”

Though raised as a Republican, Veals said her politics are changing.

“As a conservative, I believed if you can’t make your way, you don’t get your way. Now I’ve cost more medically than I will ever be able to make. I’ve changed my political stance because of this,” she said. “It doesn’t do our economy any good when we have so many people having to file for medical bankruptcy.”

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Name: Carlton Grimmett

Home: Atlanta

Age: 43

Employment: Night security guard at upscale apartment complex

Coverage: Uninsured

Two years ago, Grimmett had a job with good insurance and a wife with diabetes and other health problems. But then his job, doing plumbing and HVAC work at an Atlanta university, was outsourced and he no longer could cover his wife’s medical bills.

His wife had to stop going to the private doctors she was seeing, and her husband tried to get her into care elsewhere. But at other facilities, they encountered paperwork, delays and foot dragging, he said. Her health deteriorated.

“When you don’t have insurance, they treat you different,” he said.

In January 2011, Mary Grimmett started struggling to breathe and was rushed to Grady Memorial, Atlanta’s safety net hospital. She qualified for a program that provides discounted and even free care to uninsured people who qualify. But by that time she had pneumonia (as well as a broken ankle that needed surgery) and was very sick.

She spent two weeks in the hospital and then died of congestive heart failure — a complication of her other illnesses. She was 39.

Today, Grimmett has a job, making $25,000 a year, but he still has no insurance. Under the new health care law, he will be eligible for a government tax credit to help with the cost of buying private health insurance.

That would reduce his estimated annual premiums for health coverage from $5,054 to $1,726. He might have to pay additional copays for doctor visits, but his income would make him eligible for modest subsidies to help with those out-of-pocket expenses.

He is healthy, but the loss of his wife was a tragic lesson in the importance of coverage, he said. When he heard about the Supreme Court ruling from others at a nonprofit where he was volunteering, he said he felt grateful to Obama for helping the poor.

“He’s listening to the voice of Jehovah God,” he said. He added: “I’m grateful for the hope and opportunity to have health insurance, not just myself but all people who can’t afford health insurance. It’s a great thing that has taken place today.”

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Name: Jim Schreiber

Home: New York City

Age: 26

Occupation: Works for small beverage business

Insurance coverage: Private insurance through his employer

Schreiber’s young and healthy, but still had reason to worry about the Supreme Court decision. He works for a small business and is responsible for switching the company to a new health insurance plan. He has found a plan at a reasonable price, but that price won’t be locked in until August.

Early Thursday, he was concerned that the price would jump with a confusing decision on the health care law, or if the court overturned it. Like many other Americans, he saw contradictory news reports about the ruling and “my heart dropped.”

He repeatedly refreshed the Web pages on his computer screen and, finally, when the ruling became clear, “it was a relief.”

The company is among the 30 percent of businesses with fewer than 10 employees that offer health coverage. Small businesses often pay more for insurance than large companies.

Schreiber is hoping his company can qualify for a tax credit made available by the health care law for small businesses that provide health insurance. The tax credit is one of the most popular ideas in the health law, according to opinion polls, but only about 4 percent of potentially eligible businesses claimed it in 2010.

Before he turned 26, Schreiber was insured for a year on his mother’s health plan because of another provision in the health care law. The law isn’t perfect, Schreiber said, but “it’s a starting point to move forward.”

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AP Medical Writer Mike Stobbe contributed from Atlanta.

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AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

—Copyright 2012 Associated Press

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Court holds that states have choice whether to join medicaid expansion

The Court’s decision on the constitutionality of the Medicaid expansion is divided and complicated.  The bottom line is that: (1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals; (2) So states can agree to expand coverage in exchange for those new funds; (3) If the state accepts the expansion funds, it must obey by the new rules and expand coverage; (4) but a state can refuse to participate in the expansion without losing all of its Medicaid funds; instead the state will have the option of continue the its current, unexpanded plan as is.

The votes for this outcome are divided among several opinions.  Three Justices – the Chief, Justice Kagan, and Justice Breyer – took the position that depriving a state of all of its Medicaid funding for refusing to agree to the new expansion would exceed Congress’s power under the Spending Clause.  Although Congress may attach conditions to federal funds, they concluded, it may not coerce states into accepting those conditions.  And in this case, taking away all the states’ funds for the entirety of its Medicaid program just because it disagreed with a piece of the program would be coercive.  But the remedy for that constitutional violation is not to declare the expansion unconstitutional – such that even states that want to participate would not have the option.  Instead, the plurality held that the provision of the statute that authorized the Government to cut off all funds for non-compliance with the expansion was unconstitutional.  The result is that states can choose to participate in the expansion, must comply with the conditions attached to the new expansion funds if they take that new money, but states can also choose to continue to participate only in the unexpanded version of the program if they want.

Justices Ginsburg and Sotomayor would have held the entire expansion program constitutional, even the provision threatening to cut off all funding unless states agreed to the expansion.  Their votes created a majority for the proposition that the overall expansion was constitutional, and that states could choose to participate in the expansion and would have to comply with the expansion conditions if they did.

But there was still no majority about what to do about the states that do not want to participate in the expansion – the Chief Justice’s 3-Justice plurality voted to strike down the provision allowing the Government to withhold all funds from states that reject the expansion; Justices Ginsburg and Sotomayor voted to uphold it.

The deadlock was broken by the dissenters.  Justice Scalia – writing on behalf of himself, and Justices Kennedy, Thomas, and Alito – agreed with the Chief’s plurality that the threat to withhold all funds was unconstitutionally coercive.  But they would have held that the consequence is that the entire expansion program should be stricken.  The result would have been that even states that wanted to participate in the program could not.  The plurality’s approach of simply striking down the provision that allowed withholding all funds if the state refused the expansion was, in the dissenters’ view, tantamount to rewriting the statute.

At this point, that meant that there were 2 votes to uphold the expansion in its entirety, 4 votes to strike the entire expansion down, and 3 votes to strike down only the provision withholding all funds for non-compliance with the expansion mandate.  So where does that leave things?

Fortunately (for the sake of clarity at least), Justices Ginsburg and Sotomayor resolved the ambiguity by voting with the plurality on the remedy question.  That is, these Justices voted that if the statute was unconstitutionally coercive, then the remedy would be only to strike down the all-or-nothing sanction.

The consequence was a bottom line of 7 Justices – the Chief, Breyer, Kagan and the four dissenters – finding the expansion unconstitutional.  But a different majority – the Chief, Ginsburg, Breyer, Sotomayor and Kagan – held that the remedy for the violation was to strike down only the provision allowing the federal government to withhold all Medicaid funds unless a state agrees to the expansion.

http://www.scotusblog.com/2012/06/court-holds-that-states-have-choice-whether-to-join-medicaid-expansion/

The court struck down part of the Medicaid expansion.

BREAKING: Supreme Court upholds healthcare reform law

By Joe Carlson

Posted: June 28, 2012 – 10:15 am ET

 

The U.S. Supreme Court ruled that the insurance provisions of the Patient Protection and Affordable Care Act are constitutional, handing President Barack Obama a major election-year victory and shunning 26 states that had sought to overturn the reform law.

The court ruled that Congress has the power to compel individuals to purchase insurance as a tax on people who do not have health insurance.

“The individual mandate cannot be upheld as an exercise of Congress power under the Commerce Clause,” Chief Justice John Roberts wrote in the majority opinion (PDF). “In this case however, it is reasonable to construe what Congress has done is increasing taxes on those who have a certain amount of income but choose to go without health insurance. Such legislation is within Congress’ power to tax.”

The landmark decisions end two years of legal uncertainty and clear the way for full implementation of the 906-page law. That includes establishing insurance exchanges in each state, prohibiting insurance companies from discriminating against the sick, and requiring nearly all Americans to prove on their income taxes that they carry health insurance starting in 2014.

Read more: BREAKING: Supreme Court upholds healthcare reform law – Healthcare business news and research | Modern Healthcare http://www.modernhealthcare.com/article/20120628/NEWS/306259982#ixzz1z6KyDQIq
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Health Care Law Largely Stands

Breaking News Alert
The New York Times
Thursday, June 28, 2012 — 10:43 AM EDT
—–

Supreme Court Allows Health Care Law to Largely Stand

The Supreme Court on Thursday largely let stand President Obama’s health care overhaul, in a mixed ruling that Court observers were rushing to analyze.

The decision was a striking victory for the president and Congressional Democrats, with a majority of the court, including the conservative chief justice, John G. Roberts Jr., affirming the central legislative pillar of Mr. Obama’s term.

Read More:
http://www.nytimes.com/2012/06/29/us/supreme-court-lets-health-law-largely-stand.html?emc=na

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SCOTUS BLOG: ACA RULING

“The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.”

 

http://www.scotusblog.com/cover-it-live/

Ohio judge stops state Medicaid contract process

 

By Ann Sanner on June 27, 2012

COLUMBUS, Ohio (AP) — In a dispute over the scoring of contract applications, a central Ohio judge on Tuesday blocked the state from moving forward with tentative Medicaid contracts it awarded to five health plans.

Franklin County Common Pleas Judge Richard Sheward ordered the contract process halted for now, at the request of Aetna Inc.’s Better Health of Ohio.

Aetna is suing the Ohio Department of Job and Family Services because state officials had selected the company for a contract in April and then revoked the decision earlier this month. Aetna claims the state retroactively changed the definition of certain requirements in its request for contract applications, and the company wants its contract reinstated.

The contract awards are preliminary. The health plans, or managed care organizations, must first pass a state assessment, in which they must prove that they will be ready and able to provide care when Medicaid enrollment under the plans begins in January.

The state had expected to complete its readiness review by the end of August and fully award the contracts. But it’s unclear how the judge’s ruling on Tuesday will affect that timeline.

A spokesman for Job and Family Services says the agency won’t comment on pending litigation.

Sheward has set another hearing for July 23 to decide whether the order should be extended.

The eventual contract winners will provide health care services to more than 1.6 million poor and disabled people, or roughly two-thirds of the state’s Medicaid population. The contracts provide billions in government work to the companies.

The health plans chosen were said to be the highest-scoring applicants in the state’s Medicaid contract process. But five of six companies that lost bids for the contracts had filed formal protests with Ohio officials in April, claiming flawed and inaccurate scoring.

A state review of the contract applications changed how points were scored. And on June 7, state officials said Aetna Better Health of Ohio and Meridian Health Plan of Ohio would no longer get the contracts.

Instead, Molina Healthcare of Ohio Inc., a subsidiary of Molina Healthcare Inc., and Buckeye Community Health Plan, a subsidiary of Centene Corp., were picked.

Ohio has also selected CareSource, Paramount Advantage and United Healthcare Community Plan of Ohio.

The health plans were judged on certain components, including experience, care management and clinical performance. The provider network was also a factor but not as heavily weighted.

The state’s review found that Meridian should have been disqualified because it didn’t have a necessary health-insuring corporation license or an application pending for one at the time of its bid. And Aetna lost many points for experience because the state said it did not provide evidence of full liability for certain plans with other states.

Jan Stallmeyer, a senior vice president for Aetna Medicaid, said Tuesday the state should take time to further re-examine the questions raised about the manner in which the contracts were awarded and re-awarded.

“Given the size of this contract and the importance of these healthcare services to hundreds of thousands of Ohio citizens, many of whom are in the most vulnerable segments of society, it is in everyone’s best interest to have a thorough and transparent review,” Stallmeyer said in a statement.

About $5.1 billion in state and federal money was paid to all the managed care plans in the fiscal year that ended June 30, 2011, according to Job and Family Services.

Senator Paul Introduces Access to Physicians in Medicare Act

Senator Paul Introduces Access to Physicians in Medicare Act

Published on 26 June 2012 by in Press Releases

Protects seniors from losing access to quality health care

WASHINGTON, D.C. – Sen. Rand Paul today introduced the Access to Physicians in Medicare Act, which aims to reform the current physician reimbursement formula for Medicare patients and replace it with a formula that is similar to the one used to calculate cost-of-living increases for Social Security benefits.

 “As an eye surgeon, many of my patients are seniors, and many of those seniors are Medicare recipients,” Sen. Paul said. “Medicare, in its constant quest to save money, cuts physician reimbursement and in turn puts America’s seniors at risk of losing their access to quality health care. I know the value of quality care and I want to ensure our nation’s seniors continue to get it.”

 

BACKGROUND:

The Access to Physicians in Medicare Act aims to repeal the current reimbursement formula known as the Sustainable Growth Rate (SGR) and replace it with the same formula used to calculate cost-of-living increases for Social Security benefits with a cap set at 3 percent so that physicians will be able to practice medicine without the threat of massive pay cuts each year. This legislation is paid for by repealing the expansion of Medicaid and subsidy payments under Obamacare with any remaining savings going toward deficit reduction.

The legislation:

  • Repeals SGR formula used to calculate physician reimbursement under Medicare and replaces it with a formula based on the U.S. Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W).
  • Prevents a harmful 30 percent cut to physician reimbursement currently set to enact on Jan. 1, 2013, which will jeopardize seniors’ access to quality health care.
  • Provides for an annual increase of not more than 3 percent to physician reimbursement each year beginning in 2013.
  • Paid for by repealing Medicaid expansion and subsidies payments under Obamacare.

###

 

 

Taxpayers paying twice for veterans’ health care plans

 

By Gregg Zoroya, USA TODAY

Updated 4h 30m ago

The Department of Veterans Affairs spent an estimated $13 billion to care for veterans whose health coverage was already paid for by Medicare — a case of the taxpayer paying twice, according to research published Tuesday.

“They pay once to Medicare Advantage plan to deliver all Medicare-covered service and they pay again to the VA to deliver comprehensive care to the same veterans,” said Amal Trivedi, a doctor with the VA and on the faculty with Brown University in Providence.

But Medicare says the $13 billion projection identified in the study, published in the Journal of the American Medical Association, is far too high.

Spokesman Brian Cook said Medicare attempts to reduce managed-care payments to private insurance companies if veterans enrolled in those programs use them less frequently, for example, because they seek treatment from the VA.

Federal law prohibits the VA from recouping expenditures from Medicare-funded health programs. The VA issued a statement Tuesday saying that even if the law were changed, allowing reimbursement would only add administrative complexity that would impede care.

“As an example, VA would have to comply with Medicare rules and policies for Veterans, which would leave VA administering two systems of care: Medicare’s and VA’s,” the statement says.

But without that reimbursement “the government has made two payments for the same services,” the medical study concludes.

Researchers examined records for 1.3 million veterans who were enrolled simultaneously with the VA program and the Medicare Advantage managed-care program between 2004 and 2009.

They found that the number of veterans enrolled in both programs increased during that time frame from 486,000 to 925,000.

In addition, the amount of VA medical care provided to those patients grew from $1.3 billion to $3.2 billion.

Kenneth Kizer, a co-author of the study and director of the Institute for Population Health Improvement at University of California-Davis Health System, said he first became aware of the issue when he was VA undersecretary for health in the 1990s. But Kizer said the study shows the problem has worsened.

Researchers found that veterans remained enrolled in both Medicare Advantage and with the VA for about three years on average. Veterans who are entitled to VA care are also entitled to Medicare after age 65.

Contributing: Kelly Kennedy

The truth behind the marketing … Louisville hospitals not as safe as Appalachia

Insider Louisville Guest blogger Dr. Peter Hasselbacher:

 

Hospital grades across Kentucky. (Click to enlarge.)

(Editor’s note: This post originally appeared on the Kentucky Health Policy Institute blog.)

By Dr. Peter Hasselbacher, Kentucky Health Policy Institute

One of the themes presented on my Kentucky Health Policy Institute blog during the last year is that consumers should be careful about uncritical acceptance of unsupported promotional claims of quality by hospitals and other medical providers.

After all, how can every hospital be “the best?” As in Lake Woebegone, at least some hospitals have to be average, and unfortunately, some even less than average when compared to their peers.

The Leapfrog Group is one of the most respected organizations currently measuring and publicizing the safety and quality of care in hospitals. They use publicly available data and information provided voluntary by the hospitals themselves.

Earlier this week, that organization made available their Hospital Safety Score derived from 26 different elements. I have not personally seen a more comprehensive panel of items rigorously assessed for this purpose.

It includes – but is broader than – the “Hospital Compare” scoring system published by Medicare. I would certainly have more confidence in these Hospital Safety Scores than any claims about quality or safety made by the hospitals themselves.

In Leapfrog’s words, “The Hospital Safety Score is an A, B, C, D, or F letter grade reflecting how safe hospitals are for patients.”

I was frankly surprised by the results. You can review the final Safety Scores here, sorted by score and Hospital. However, you should also take a look at the Hospital Safety Score website yourself because it lists all the underlying data for the 49 hospitals studied.

Select Kentucky as the state without any other qualifier. Click the “agree to terms of use” and you will see all the scores and a map. Unfortunately for us, the small federally-designated Critical Access Hospitals, of which there are some 29 in Kentucky, are not required to report publicly their safety statistics. [Who is being served by this rule?]

Here are some of the facts that jumped out at me.

Louisville not so good!

Based on the extensive panel of items measured, the 49 Kentucky Hospitals received scores as follows: ‘A’s- 10, ‘B’s- 11, and ‘C’s- 26.

Both state University Hospitals received an initial score of either a D or an F.

All the (other) hospitals in Louisville received a score of only C.

Compare the hospitals of Louisville to the hospitals of deep Appalachia which earned 4 ‘A’s, 3 ‘B’s, and one ‘C’. To my eye, it seemed that the larger the hospital and the larger the city, the worse the safety score. These rankings seem to fly in the face of accepted, or at least self-proclaimed wisdom.

There is a tremendous amount of additional information underlying these safety scores that might help us better understand their robustness and usefulness to us consumers. I was allowed to reprint the Kentucky scores and map with the permission of the Leapfrog group. I intend to dig into the supporting data more deeply to more fully understand the process and to try to explain the results. In the meantime, I suggest the following.

Conclusions:

1. Start informing yourself. The items measured and discussed by the Safety Scores are becoming the standard panel and vocabulary of hospital quality and safety. We will be presented with these concepts in the future much more often. That is a good thing! We deserve more than just financial transparency and accountability from our healthcare system. It is our job collectively to demand that our hospitals do a better job, or at least explain why they disagree with those who are doing the analysis. We are also obligated to make sure such ratings are reliable.

2. I will begin here myself. All of you hospitals in Louisville that I might have to use personally had only average or worse safety scores. Why is that? Do you disagree? What are you doing about it? Show me how you are getting better. Please do not make any more claims about the excellence of the care that you provide until you can explain why presumably impartial judges rated the safety of your institutions as less even than good.

3. To the University of Louisville I can only repeat my earlier requests. The quality and safety of the medical care you provide as measured here and by others is poor at best. This is unacceptable. How many more outside examinations do you need before you get the message? The most important priority of your School of Medicine and your other health professional schools is to provide the highest quality medical care to the patients you serve.

You cannot even begin to provide high quality medical education unless you succeed in fulfilling this most important responsibility first. Sponsoring research is a luxury to be enjoyed only when you get medicine and education right.

Putting major efforts into your commercial research enterprise while running a hospital that your own faculty refuses to use in my mind constitutes abandonment of your duty to the Commonwealth. I am holding you responsible.

Our community and governmental leaders should too.

About Dr. Peter Hasselbacher: Peter Hasselbacher MD is Emeritus Professor of Medicine at the University of Louisville.  He has been a medical educator, clinician, scientist, and health care executive for 35 years. Currently, he is president of KHPI.

http://insiderlouisville.com/news/2012/06/26/guest-blogger-dr-peter-hasselbacker-the-truth-behind-the-marketing-louisville-hospitals-not-as-safe-as-appalachia/

What Actually Happens When You Expand Medicaid, as Obamacare Does?

What Actually Happens When You Expand Medicaid, as Obamacare Does?

By Brian Fung

A state-level experiment shines some much-needed light on the longstanding debate over federal aid to low-income families.

Polls have repeatedly shown that when given the Affordable Care Act (ACA) in its constituent pieces, the law’s opponents express overwhelming support for its provisions. Greg Sargent parses the latest numbers, finding that even Republicans approve of the promised changes in large numbers. On one issue, though, conservatives remain unmoved: the part where the ACA expands Medicaid coverage to households making less than $30,000 a year.

Under the healthcare law, Medicaid coverage would be extended in 2014 to cover 16 million low-income Americans, on top of the 60 million it currently serves. Ideological arguments aside, what would such an expansion actually accomplish, and what would its consequences be? This is actually harder to determine than you might think; ethics rules prevent researchers from setting up a study in which they give healthcare benefits to one group while deliberately withholding them from another. Conveniently, though, something resembling that experiment has been performed in real life, under ideal conditions. What we’ve learned is kind of a mixed bag, giving ammunition to both Medicaid’s supporters as well as its detractors.

The experiment began back in 2008, when the state of Oregon offered to extend Medicaid coverage to 10,000 randomly selected applicants. Scientists at Harvard and MIT took that opportunity to find out whathappenedtothose people. One year out, the researchers have come back with some interesting findings. Basically, it’s this: expanding Medicaid leads people to use more healthcare. That, in turn, drives up costs. But it’s also associated with a rise in financial security, as well as improvements in patients’ perceptions of their own health (no data are available yet as to actual health outcomes; it’s too soon to tell).

Here’s how the increased healthcare usage broke down: the new Medicaid beneficiaries were 35 percent more likely to use outpatient services, 15 percent more likely to take advantage of prescription drugs, and 30 percent more likely to check into the hospital — though, curiously, emergency room use remained steady. Under the program, patients did a better job seeking out preventive care; compared to the uninsured, the Medicaid patients were 60 percent more likely to get breast cancer screenings. All this extra activity resulted in a 25 percent hike in costs to Medicaid, the researchers estimate.

There’s more:

We also found that being covered by Medicaid improves self-reported health as compared with being uninsured. Medicaid enrollees are 25 percent more likely to indicate that they’re in good, very good, or excellent health (vs. fair or poor health). They are 25 percent less likely to screen positive for depression. They are even 30 percent more likely to report that they are pretty happy or very happy (vs. not too happy).

Obviously, simply “feeling” healthier does not an argument for expanding Medicaid make. But the drop in depression diagnoses is a promising outcome given the condition’s links to all manner of unpleasant health consequences. Taking greater steps to identify health problems before they happen has also been touted as a key requirement in keeping healthcare costs low over the long term. And improvements in financial security — including a 40 percent drop in the likelihood of having to take out a loan or leave other bills unpaid due to spending on healthcare — are a promising sign if the aim is to make healthcare more affordable.

If we’re judging Medicaid expansion on the merits, where you fall in the debate depends on if you think the increase in healthcare spending is worth it. It’s still unclear whether using more services makes up for the added costs by actually improving Medicaid patients’ health — again, it’s too soon to say. But the answers are out there. The picture may not be nearly as murky as we think.

This article available online at:

http://www.theatlantic.com/health/archive/2012/06/what-actually-happens-when-you-expand-medicaid-as-obamacare-does/258989/