Checking Up On Health: March 4, 2014

Health Policy News and Views
Compiled by Benita M. Dodd


And you thought it’s about your health care?  Another wave of ObamaCare health-care plan cancellation notices was set to crash on voters this fall. But the Obama administration found a way to shut that whole thing down. According to The Hill: “As early as this week, according to two sources, the White House will announce a new directive allowing insurers to continue offering health plans that do not meet ObamaCare’s minimum coverage requirements. Prolonging the ‘keep your plan’ fix will avoid another wave of health policy cancellations otherwise expected this fall. The cancellations would have created a firestorm for Democratic candidates in the last, crucial weeks before Election Day. The White House is intent on protecting its allies in the Senate, where Democrats face a battle to keep control of the chamber.” In case you forgot: Under the Affordable Care Act, health plans are required to offer 10 medical benefits that the Obama administration deems essential. Some of the services are popular, such as prescription drug coverage, but others, such as maternity and pediatric care, have been criticized as expensive as well as being unnecessary for many policyholders, such as older people.

You like your plan? No me importa. It’s National Latino Enrollment Week for the Affordable Care Act. President Obama has scheduled a town hall meeting for Thursday in partnership with the Asegurate campaign and Univision, Telemundo and impreMedia. NBC shares the story of a young man who turned up at an enrolment fair even though he had insurance coverage – and no problems with it – only to find out it doesn’t fit abovementioned minimum coverage requirements. Daniel Garza, executive director of the LIBRE Initiative )and the keynote speaker at tomorrow night’s Georgia Public Policy Foundation Annual Dinner), points notes “It should come as no surprise to anyone that millions of Latinos are rejecting a one-size-fits-all, government-mandated health insurance system. After all, the ACA has led to higher premiums, cost prohibitive deductibles, and narrower provider networks.”

There are approximately 10.2 million eligible, but uninsured Latinos nationwide, according to the U.S. Department of Health and Human Services. Of the millions of Latinos who are eligible, most qualify for discounted health care coverage.

tortillaAs the Whole Foods Turns:  Last week I shared an article about the pseudoscience at Whole Foods. Don’t get me wrong; it’s free market and I’m happy for them. Now comes another article that has me thinking. … See, I’ve always wondered why most of the environmental activists I encounter come across as such sourpusses. (Maybe it’s me?!)  Shouldn’t your claim to be close to nature at least lift your spirits? Apparently, Whole Foods fundies aren’t much fun, either. In “America’s Angriest Store,” Nils Parker writes, “The problem with Whole Foods is their regular customers. They are, across the board, across the country, useless, ignorant, and miserable. They’re worse than miserable, they’re angry. They are quite literally the opposite of every Whole Foods employee I’ve ever encountered. Walk through any store any time of day – but especially 5:30 p.m. on a weekday or Saturday afternoon during football season – and invariably you will encounter a sneering, disdainful horde of hipster Zombies and entitled 1%ers.” (In my defense, I’m an Aldi shopper. Not only are their prices great and their stores efficient, but the products are named after me!)

Special services come at special prices: Researchers have concluded some hospitals command much higher inpatient prices than other hospitals. (Gasp!) Those with higher prices tend to have specialized service lines other nearby hospitals don’t have, are part of larger health systems with significant bargaining clout, have unusually good reputations and are more likely to be large teaching hospitals, according to a study by researchers at the National Institute for Health Care Reform. If payers exclude high-price hospitals from their provider networks, they risk leaving enrollees without in-network access to needed services, according to the study. The findings echo a study published in Health Affairs last month. That study found high-price hospitals enjoy better reputations than their low-price counterparts but don’t necessarily perform the best on outcome-based quality measures. But, by their very clout, they make it hard for payers to negotiate lower prices, according to the study. Source: Becker’s Hospital Review

Dorminy Medical Center in Fitzgerald, Ga., was one of seven hospitals that agreed to pay fines in 2013 as part of settlements related to physician self-referral and kickback allegations. The hospital paid $50,000 in March. The Office of the Inspector General (OIG) alleged Dorminy paid remuneration to a physician in the form of free use of hospital space, according to Becker’s Hospital Review. Note: All hospitals self-disclosed their conduct to the OIG.


Top 10: AbbVie’s Humira, or adalimumab, topped Genetic Engineering & Biotechnology News’ list of 25 best-selling drugs last year based on publicly available sales figures. Humira (for arthritis, Crohn’s and psoriasis) generated sales of $10.659 billion, up 15 percent over 2012 sales. Johnson & Johnson and Merck & Co.’s Remicade, or infliximab, a competitor, came in second with sales of $8.944 billion, followed by Roche and Biogen Idec’s Rituxan, or rituximab (for hepatitis b), with $8.920 billion. Rounding out the top 10 were Advair, Enbrel, Lantus, Avastin, Herceptin, Crestor and Abilify.

Quotes of Note

“The best way to reform and make changes in your organization is to move very quickly, but incrementally. You implement change where you can predict the outcome, and then move to the next stage. The PPACA dreamed about a global solution to healthcare coverage with no clue about how to get from A to B. My problem with the PPACA is that it was not incremental reform. The consequences were not anticipated, and even those that could have been anticipated were not identified.” – Anthony Spezia, president and CEO of Knoxville, Tenn.-based Covenant Health


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