With 50 Days to Enrollment, a Focus on 10 States

By Christine Vestal, Staff Writer | pewstates.org

Obamacare’s new health insurance exchanges are scheduled to open for business Oct. 1. But a recent survey shows that nearly 80 percent of those who stand to benefit have no idea what an exchange is or how to get the health insurance subsidies they will offer.

That’s where the private nonprofit Enroll America comes in. The group, which has strong ties to the Obama administration, has been using more than 100 staff and about 3,000 volunteers to go door-to-door and to stage community events this summer to inform people about the opportunities for health care coverage on the exchanges.

Its president, Anne Filipic, announced Monday that the group would focus most of its effort on 10 states with the largest number of uninsured and the lowest level of state-funded outreach: Arizona, Florida, Georgia, Illinois, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania and Texas. All but Illinois have Republican governors.

California was left off of the list even though it has the most uninsured residents and among the highest percentage of uninsured population in the country at 20 percent. But with more than $600 million expected in state and nonprofit funding to support outreach efforts locally, Filipic said her group chose to support California’s efforts rather than launch its own.

“Our focus,” she said, “is on states that do not have a robust infusion of resources.” In the remaining 40 states, the group’s regional directors will be working without staff to support state-led and other local efforts.

When the exchanges open, anyone who does not already have employer-sponsored insurance will be able to comparison shop for coverage and find out whether they qualify for federal subsidies to help pay for their policies. Visitors to federally funded websites and call centers will also find out whether they qualify for Medicaid or the Children’s Health Insurance Program, and they’ll be able to sign up for that coverage immediately. Policies purchased on the exchange will take effect Jan. 1, 2014.

Enroll America stressed that it is not helping people sign up for insurance but informing them of their options. In the 10 target states, Filipic said the goal is to recruit and train volunteers and work with existing organizations, such as schools, churches, community health centers and other groups to build an infrastructure that will spread the word on Obamacare starting now.

The Obama administration is scheduled to announce Thursday how it will dole out $54 million in federal money to hire so-called “navigators” who will help people actually sign up.

Article Link: http://www.pewstates.org/projects/stateline/headlines/with-50-days-to-enrollment-a-focus-on-10-states-85899496903

AMA to close news magazine

By Andrew L. Wang, Crain’s Chicago Business

Posted: August 12, 2013 – 6:45 pm ET

Tags: American Medical Association (AMA), Physicians

The American Medical Association, the country’s largest professional organization for physicians, is shutting down the news magazine it has published for 55 years.

The publication, which also operates a website at AmedNews.com, has a print circulation of about 230,000 but has had trouble turning a profit over the last decade, amid declining ad revenue from drug companies, increased competition from other news sources and a steady migration of readers to the Internet.

“Over the last 10 years, AM News has been unable to generate an operating surplus. We’ve analyzed the situation exhaustively and do not foresee the trend improving,” said Thomas Easley, the association’s senior vice president and publisher of periodic publications, in a statement. “Despite the editorial excellence AM News consistently provides, it is not immune to the changes in the market, and we reached a point where we cannot continue down a path that is not sustainable from a business perspective.”

AM News will stop publication on Sept. 9, according to the statement. Its website also is shutting down, but the content will be available until the end of the year. The shutdown will affect 20 employees.

Revenue for AM News is about a third what it was a decade ago, Mr. Easley said in an interview. He declined to give specific figures on the publication.

According to the AMA’s latest annual report, publishing brought in $55.8 million in revenue for the organization in 2012, down from $65.2 million a year before. The decrease was due to an $8.7 million tumble in print display advertising, the annual report says.

Even so, publishing revenue, which includes proceeds from AM News and the Journal of the American Medical Association, still accounted for a larger percentage—about 20%—of the association’s total revenue last year, $273.9 million, than membership dues, which, at $38.6 million, made up just 14 percent.

Pharmaceutical advertising accounted for the bulk of revenue for AM News, Mr. Easley said. In addition to having to compete harder for ad dollars, AM News saw revenue slow to a trickle in recent years as several big-selling drugs went off patent and as drugmakers shifted focus to specialty products, rather than more broad-based blockbuster drugs, he added.

The shutdown does not affect JAMA, a research publication.

That publication and its related journals offer content unavailable elsewhere, as opposed to AM News, which occupied an increasingly crowded marketplace of health and medical news.

As such, Mr. Easley said, JAMA is on surer financial footing because most of its revenue comes from institutional subscriptions, with advertising only a secondary revenue source.

Mr. Easley said the AMA will make efforts to keep its membership up to speed on issues affecting their profession through two emails.

AMA Morning Rounds is a daily email that links to news stories from various news organizations, while AMA Wire is a weekly electronic newsletter geared to medical practice.

A subscription to AM News is a benefit of membership in the association. AM News’ print edition is published 24 times a year and focuses on news geared toward physicians, who make up 90% of its circulation. It started publication in 1958.

AMA to close news magazine” originally appeared in Crain’s Chicago Business.

Read more: AMA to close news magazine | Modern Healthcare http://www.modernhealthcare.com/article/20130812/INFO/308129991#ixzz2bsfjTVzO?trk=tynt 

Sebelius: Medicaid expansion no ‘bait and switch’

Aug 12, 2013, 2:13pm EDT Updated: Aug 12, 2013, 3:27pm EDT


Source Link: http://www.bizjournals.com/atlanta/news/2013/08/12/sibelius-medicaid-expansion-no-bait.html?s=print

Dave Williams

Staff Writer- Atlanta Business Chronicle

States shouldn’t let politics get in the way of a Medicaid expansion that’s a “pretty good” economic deal, U.S. Health and Human Services Secretary Kathleen Sebelius said in Atlanta Monday.

Georgia and 20 other mostly Republican states are taking advantage of a portion of last year’s U.S. Supreme Court decision on the federal health-care law that allows states to opt out of expanding Medicaid eligibility.

Under “Obamacare,” the federal government ­­­– which currently covers about two-thirds of the state-federal health insurance program for the poor and disabled ­– would pick up 100 percent of the costs of the additional Medicaid enrollees for three years.

After that, the feds’ share would decline but still would be at 90 percent after 10 years.

“No one’s health care should be determined by their zip code,” Sebelius told an audience of state lawmakers from around the country gathered in downtown Atlanta for the National Conference of State Legislatures’ annual convention.

“There is an offer on the table.”

Sebelius said the Patient Protection and Affordable Care Act, which President Barack Obama pushed through a then-Democratic Congress in 2010, has yielded many positive results, including covering 3 million young Americans under age 26, providing free preventive care to nearly 71 million adults and saving about 3.5 million seniors an average of $700 last year on prescription drugs.

Sebelius said the last piece of the law, due to take effect Jan. 1, will help provide health insurance to the 15 percent of Americans who don’t have coverage now or buy it on the individual market.

She predicted most individuals and small business owners will save money on insurance because of the subsidies the new law provides.

She said health-care providers in states that do decide to expand Medicaid will see lower costs for uncompensated care, while governors and lawmakers in those states will be able to free tax dollars they now spend on caring for the uninsured for other priorities.

Following last year’s Supreme Court ruling, Gov. Nathan Deal cited cost considerations in deciding not to expand Medicaid eligibility in Georgia. He said enrolling individuals with incomes up to 138 percent of the federal poverty level in Medicaid would cost the state an estimated $4.5 billion during the next decade.

Deal and others also expressed concern over whether the federal government would live up to its pledge to cover all of the costs of the expansion.

But on Monday, Sebelius said some states taking part in the expansion have addressed the “bait-and-switch” issue by reserving the right to drop out of the program if the feds renege.

“There is no timeline for accepting this … or for leaving,” she told the legislators. “If you want a healthier population, looking at Medicaid expansion has got to be a piece of the puzzle.”

Medicaid-Funded Nursing Home Residents are Getting Younger

Elizabeth Ecker | August 7, 2013 | Comments (0)


Those residents of nursing homes who rely on Medicaid funding are getting younger by the year, indicating that an aging population does not necessarily mean growth in the number of Medicaid beneficiaries, according to the Centers for Medicare and Medicaid services.

“Clearly, older people have not shifted responsibility for their care onto the Medicaid program in significant numbers,” AARP stated in reporting the data last month.

AARP called the trend “encouraging,” citing an increase in the use of home and community-based services as an alternative to Medicaid-funded nursing home stays.

“A major factor in these encouraging trends in Medicaid use among aged beneficiaries is the increased use of home and community-based service (HCBS) options, both private pay and Medicaid-funded. A just-released report from the Congressional Budget Office notes that increased HCBS have contributed to the declining use of institutional services and flat spending growth in that sector.”

Shifting resources to HCBS will further help turn reliance away from nursing home services funded by Medicaid, AARP writes in its analysis.

These data suggest that the most effective way to further limit expenditures among older Medicaid beneficiaries is not by stringent measures to restrict participation, but by implementing more balanced programs that shift resources from institutional services to HCBS. Older people continue to lag far behind their younger counterparts in their access to HCBS that can enhance independence and generally have lower per-person costs.”

Affordable Care Act Boosts Status Of Alternative Medicine — At Least On Paper

Posted: 08/05/2013 10:02 am EDT

By Ankita Rao, KHN Staff Writer

Kaiser Health News

Jane Guiltinan said the husbands are usually the stubborn ones.

When her regular patients, often married women, bring their spouses to the Bastyr Center for Natural Health to try her approach to care, the men are often skeptical of the treatment plan — a mix of herbal remedies, lifestyle changes and sometimes, conventional medicine.

After 31 years of practice, Guiltinan, a naturopathic physician, said it is not uncommon for health providers without the usual nurse or doctor background to confront patients’ doubts. “I think it’s a matter of education and cultural change,” she said.

As for the husbands — they often come around, Guiltinan said, but only after they see that her treatments solve their problems.

Complementary and alternative medicine — a term that encompasses meditation, acupuncture, chiropractic care and homeopathic treatment, among other things — has become increasingly popular. About four in 10 adults (and one in nine children) in the U.S. are using some form of alternative medicine, according to the National Institutes of Health.


And with the implementation of the Affordable Care Act, the field could make even more headway in the mainstream health care system. That is, unless the fine print — in state legislation and insurance plans — falls short because of unclear language and insufficient oversight.

One clause of the health law in particular — Section 2706 — is widely discussed in the alternative medicine community because it requires that insurance companies “shall not discriminate” against any health provider with a state-recognized license. That means a licensed chiropractor treating a patient for back pain, for instance, must be reimbursed the same as medical doctors. In addition, nods to alternative medicine are threaded through other parts of the law in sections on wellness, prevention and research.

“It’s time that our health care system takes an integrative approach … whether conventional or alternative,” said Sen. Tom Harkin, D-Iowa, who authored the anti-discrimination provision, in an e-mail. “Patients want good outcomes with good value, and complementary and alternative therapies can provide both.”

The federal government has, in recent years, tapped providers like Guiltinan, who is also the dean at the Bastyr University College of Naturopathic Medicine, to help advise the federal government and implement legislation that could affect the way they are paid and their disciplines are incorporated into the health care continuum. In 2012, Guiltinan, based in Kenmore, Wash., was appointed to the advisory council of the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health.

Proving that alternative medicine has real, measurable benefits has been key to increasing its role in the system, said John Weeks, editor of the Integrator Blog, an online publication for the alternative medicine community. The Patient-Centered Outcomes Research Institute, created by the health law, is funding studies on alternative medicine treatments to determine their effectiveness.

Weeks said both lawmakers and the general public will soon have access to that research, including the amount of money saved by integrating other forms of medicine into the current health system.

But the challenges of introducing alternative care don’t stop with science.

Because under the health care law each state defines its essential benefits plan — what is covered by insurance — somewhat differently, the language concerning alternative medicine has to be very specific in terms of who gets paid and for what kinds of treatment, said Deborah Senn, the former insurance commissioner in Washington and an advocate for alternative medicine coverage.

She pointed out that California excluded coverage for chiropractic care in its essential benefits plan, requiring patients to pay out of pocket for their treatment. Senn thinks the move was most likely an oversight and an unfavorable one for the profession. Four other states — Colorado, Hawaii, Oregon and Utah — ruled the same way in the past year.

“That’s just an outright violation of the law,” she said, referring to the ACA clause.

Colorado and Oregon are in the process of changing that ruling to allow chiropractic care to be covered, according to researchers at Academic Consortium for Complementary and Alternative Health Care.

Some states, like Washington, are ahead of the rest of the country in embracing alternative practitioners. The Bastyr University system, where Guiltinan works, treats 35,000 patients a year with naturopathic medicine. Sixty percent of the patients billed insurance companies for coverage.

Guiltinan said a change in the system is not only a boon for alternative medicine doctors, but helps families of all income levels access care normally limited to out-of-pocket payment. That’s why some alternative medicine aficionados like Rohit Kumar are hoping the law will increase the ability of his family — and the larger community — to obtain this kind of care.

Kumar, a 26-year-old business owner in Los Angeles, said his parents and brothers have always used herbs and certain foods when they get sick, and regularly see a local naturopath and herbalist. He’s only used antibiotics once, he says, when he caught dengue fever on a trip to India.

While the Kumar family pays for any treatments they need with cash — the only payment both alternative providers accept — they also pay for a high-deductible health plan every month to cover emergencies, like when his brother recently broke his arm falling off a bike.

Paying for a conventional health care plan and maintaining their philosophy of wellness is not cheap.

“We pay a ridiculous amount of money every month,” Kumar said of the high-deductible insurance. “And none of it goes toward any type of medicine we believe in.”

Even so, he said the family will continue to practice a lifestyle that values wellness achieved without a prescription — a philosophy that Guiltinan also adopted in her practice.

As a young medical technician in a San Francisco hospital she decided that the traditional medical system was geared more toward managing diseases and symptoms rather than prevention. Naturopathic medicine, on the other hand, seemed to fit her idea of how a doctor could address the root cause of illness.

“The body has an innate ability for healing, but we get in its way,” Guiltinan said. “Health is more than the absence of disease.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Link: http://www.huffingtonpost.com/2013/08/05/affordable-care-act-alternative-medicine_n_3707366.html

Health exchange privacy system deadlines missed

Tom Wilemon, The Tennessean9:40 p.m. EDT August 6, 2013 | USATODAY

The Health Insurance Marketplace website will ask for Social Security numbers and income information to help determine whether someone qualifies for subsidies toward buying coverage.


NASHVILLE, Tenn. — The federal health exchange risks missing its Oct. 1 rollout date because it has yet to prove it can protect people’s privacy.

The Office of Inspector General issued a report Monday saying the contractor given the job of developing a system security plan had missed deadlines — the same day the Department of Health and Human Services started allowing people to set up personal accounts and passwords on the website for the federal exchange.

The Health Insurance Marketplace website will ask for Social Security numbers and income information as part of determining whether someone qualifies for subsidies toward buying coverage.

Final security documents were supposed to be submitted to the Inspector General on May 6 and July 1, but a government contractor for the Centers for Medicare and Medicaid Services missed those deadlines, the Inspector General said in its report.

“If there are additional delays in completing the security authorization package, the CMS chief information officer may not have a full assessment of system risks and security controls needed for the security authorization decision by the initial opening period expected to begin Oct. 1,” the report said.

CMS Administrator Marilyn Tavenner responded with a letter stating the agency is “confident” the hub site will be operationally secure and have authority to operate prior to Oct. 1 — the date people can start signing up for and buying insurance on the exchange.

These are not the first deadlines missed. On July 2, the Obama administration announced it was delaying for one year the mandate that employers with 50 or more full-time workers provide coverage. The government is also two months behind in funding and training navigators, which are supposed to do community outreach about the exchange.

“Much remains to be accomplished within a relatively short amount of time,” John E. Dicken, director of health for the U.S. Government Accountability Office, testified last month before a congressional committee.

He said CMS had spent $394 million as of March 31 on contracts to create the data hub and perform other needed services for the exchange. Quality Software Service Inc. got the contract to set up the data hub. Company representatives did not return telephone calls to The Tennessean.

Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology, said the website will not ask for sensitive health information, but it will direct people to answer questions on income and immigration status.

“The security aspects of this data hub are important,” McGraw said. “The spotlight that has been shined on it recently is a good thing because the American public should be reassured that the data they enter into the system in order to apply for health insurance or that gets exchanged by various federal agencies in order to determine eligibility is going to be used appropriately and not fall into the wrong hands.”

Dr. Mark Frisse, a professor of biomedical informatics at Vanderbilt University, said the government is going through a very formal process to identify any possible privacy risk.

“You plan for all kinds of things — every possible thing you can think of — then say, ‘How likely is that to happen?'” Frisse said. “Based on that plan, you then get an approach that minimizes the risk.”



How will Affordable Care Act affect veterans? New VA website has answers

Aug. 9, 2013 – 04:17PM   | Air force Times

By Patricia Kime
Staff writer

The Veterans Affairs Department has launched a new website explaining the likely impact of the Affordable Care Act on former troops and their families.

The site addresses questions such as whether the law affects those already receiving VA health care (it doesn’t), who is eligible for VA care, and options available to uninsured family members.

Under the Affordable Care Act, veterans who qualify for VA health care — including all who fall into the Veterans Affairs Department’s eight health care priority groups — do not have to buy health insurance under the law’s requirement that all individuals must have coverage.

VA wants all eligible veterans who aren’t already in the system to visit the website and sign up.

“VA encourages eligible veterans who are not enrolled in VA?s health care system to take advantage of the world-class care we provide to the men and women who have served this nation in uniform,” VA Secretary Eric Shinseki said.

For eligible veterans, VA health care carries no enrollment fees, monthly premiums or deductibles.

According to VA data, nearly 8.6 million veterans are enrolled in the Veterans Health Administration. An estimated 6.6 million more of the nation’s 23 million veterans are eligible, but many have other insurance.

VA believes that roughly 1.3 million veterans are uninsured and may be eligible for VA care.

Nearly 1 million spouses and children of veterans also do not have health insurance. For them, the law created a health insurance marketplace where the uninsured can shop for a policy.

By law, U.S. citizens who do not have health insurance and do not qualify for government programs could face penalties starting in January. Annual fines would start at $95 for an adult, $47.50 for a child and $285 per family or 1 percent of family income, whichever is greater.

In 2016 and beyond, fines would rise to $695 per adult and $347.50 per child; and $2,085 per family or 2.5 percent of family income, whichever is greater.

The fines would be paid out of an individual’s tax return.

Federal and many state marketplaces or insurance exchanges are set to open for business on Oct. 1.

Visite the site at www.va.gov/health/aca