Health Policy Briefs
Compiled by Benita M. Dodd
Individual mandate update: Under proposed rules for the individual mandate under the federal health law, individuals who have to pay more than 9.5 percent of their income for their employer-sponsored health plan are eligible for subsidies through the online health insurance exchanges, but the subsidies would not apply to family plans, which are likely to cost more. Also, according to the rules proposed by the Department of Health and Human Services and the Internal Revenue Service, Americans whose incomes fall below 133 percent of the federal poverty line — and who live in a state that will not expand Medicaid — are also exempt from the individual mandate’s penalty.
Your deadlines, our suggested guidelines: The Obama administration has missed deadlines to implement several provisions of ObamaCare intended to improve access to care and lower costs, Kaiser Health News reports. The programs, slated to take effect Jan. 1, were supposed to increase fees to primary care doctors who treat Medicaid patients, give states more federal funding if they eliminate Medicaid co-pays for preventive services and experiment with changes to how doctors and hospitals are paid by Medicare. The administration also has not yet given states guidance on a new coverage option known as the “basic health program,” designed to help low and moderate-income people who don’t qualify for Medicaid.
Meanwhile, in the states: The December 14 deadline for states to declare their intentions regarding health insurance exchanges passed, with the federal government now being forced to run an exchange in the majority of states. The next deadline is February 15, when states must declare whether they want to partner with the government in the exchange. If a state selects a partnership exchange and decides to convert to a state-based exchange in 2015, it must submit its blueprint to the federal government by November 18. So far, Arkansas, Delaware, Illinois, Iowa, Michigan, North Carolina and West Virginia have announced plans for a partnership exchange.
Trust us, we’re from the government … Ohio Gov. John Kasich this week joined more than 20 other U.S. governors, including four Republicans, announcing they would expand their states’ Medicaid rolls under the federal Patient Protection and Affordable Care Act. At least nine governors have chosen to support the Medicaid expansion, including the Republican governors of Arizona, Ohio, Nevada, New Mexico and North Dakota. Five Republicans, including Georgia Governor Nathan Deal, have rejected expanding Medicaid. Ohio’s Kasich said that state officials stood ready to repeal the expansion if the federal government were to alter the reimbursement plan to states. Good luck with that one.
Telehealth’s advantages: Eighty-five percent of health care consumers believe that high-tech communications such as email, text messages and voicemails are as helpful, if not more helpful, than in-person or phone conversations with their health care provider, according to a new report, “Technology Beyond the Exam Room: How Digital Media is Helping Doctors Deliver the Highest Level of Care,” by Televox. Of the 66 percent of patients who have received a voicemail, text or email from a provider, 51 percent reported feeling more valued as a patient; 35 percent said digital communication improved their opinion of their provider; and 34 percent reported feeling more certain about visiting that provider again. Given a choice, 59 percent of patients would most like to be contacted via e-mail when receiving feedback after initial face-to-face visits with their doctors.
Everything old is new again I: To keep patients out of the hospital, many health-care providers are going back to the days of yore, according to The Wall Street Journal. The house call is back in fashion, albeit reworked. A growing number of doctors treat frail patients at home, and insurers and health systems are sending teams of doctors, nurses, physician assistants and pharmacists into homes to monitor patients, administer treatments, ensure medications are being taken properly and assess risks.
Everything old is new again II: Could scientists be onto a “fountain of youth?” Biologists say they have turned back the “molecular clock” in old mice by placing a “longevity” gene into their blood stem cells. The gene, called SIRT3, belongs to a class of proteins called sirtuins, which help aged blood stem cells handle stress. Placing SIRT3 into the blood stem cells of old mice increased the formation of new blood cells, which researchers say is evidence of a reversal in the age-related decline in the old stem cells’ function. “The question is whether we can understand the process well enough so that we can actually develop a molecular fountain of youth,” said principal investigator Danica Chenof the University of California, Berkeley. Source: HealthDay
A woman’s job is never done: Ninety percent of adult women in the United States are responsible for making the health-care decisions for themselves and their family members, according to a study conducted on behalf of the American Academy of Family Physicians. This includes spouses, children and other relatives such as parents and grandparents. Source: Televox
Grassroots campaign: Organizing for Action, the successor to President Obama’s presidential campaign, and Enroll America, a group led by two former Obama staffers that features several insurance company on its board, are planning to promote ObamaCare by using the same grass-roots mobilization and sophisticated micro-targeting tactics seen in the 2012 presidential campaign, according to a Politico report. And they’re funding it with millions of dollars in secret corporate and union cash, according to the report.
Health, wealth and truth in reporting: The Institute of Medicine issued a comprehensive report last month saying that “Other high-income countries outrank the United States on most measures of health.” According to the report, America “is among the wealthiest nations in the world, but it is far from the healthiest.” Writing in today’s Wall Street Journal, Sally Pipes of the Pacific Research Institute points out that lower life expectancy and high infant mortaility are not a good measure of this country’s health care. “In fact, the study’s lead author …recently told reporters that life expectancy and other noted health outcomes are determined ‘by much more than health care.’ He added: ‘Much of our health disadvantage comes from factors outside of the clinical system and outside of what doctors and hospitals can do.’ For instance, a comparatively high rate of fatal car accidents and murders in the U.S. diminishes overall life expectancy.” As for the elevated U.S. infant mortality rate, Pipes calls it “a function of both the technological advancement of American hospitals and discrepancies in how different countries define a live birth. … Thousands of babies that would have been declared stillborn in other countries and never given a chance at life are saved in the U.S. As a result, the percentage of preterm births in America is exceptionally high – 65 percent higher than in Britain, and about double the rates in Finland and Greece.”
Quotes of Note
“I learned a long time ago that minor surgery is when they do the operation on someone else, not you.” – Bill Walton
“Medicine is the only profession that labors incessantly to destroy the reason for its own existence.” – James Bryce
The Foundation’s Criminal Justice Initiative pushed the problems to the forefront, proposed practical solutions, brought in leaders from other states to share examples, and created this nonpartisan opportunity. (At the signing of the 2012 Criminal Justice Reform bill.)