Tag Archives: affordable care act

Poll: Most Want the Mandate Nixed. Do You?

As the Supreme Court prepares to take on challenges to the Affordable Care Act, new data suggests that Americans remain divided on the constitutionality of the law’s requirement that all Americans purchase health insurance. Little more than half of Americans (54%) think the individual mandate should be ruled unconstitutional and that the Supreme Court will likely agree (55%), according to a recent poll by the Kaiser Family Foundation. The poll was based on telephone interviews with 1,206 adults in the United States from. Jan 12-17.

Courtesy Kaiser Family Foundation

The poll also found that more than half (59%) of Americans think the Supreme Court Justices will base their ruling on their own opinions.  That sentiment is being echoed by the conservative interest group Freedom Watch, which recently filed its second petition to request Justice Elena Kagan to recuse herself. Supporters of the petition take issue with Justice Kagan’s former position as Solicitor General and close adviser to President Obama while the law was being written.

If the mandate were ruled unconstitutional, it’s not clear if the rest of the law would remain solvent. According to the poll, 55% of American thought remaining provisions of the law would survive but 30% said it would mean the end of the law entirely.

Courtesy Kaiser Family Foundation

Further, the Kaiser poll shows that Americans are split on their own opinions of the ACA. According to the poll, 44% are against the law, 37% support the law, and 19% are unsure.

However, a majority (67%) oppose the mandate because it forced American to do something they don’t want to do (30%) or because health insurance is unaffordable (25%). An additional 22% just don’t like the idea of paying a fine for not having insurance.

Those who do support the mandate (30%) said it guarantees that everyone needs health coverage (32%) and that the mandate can guarantee that (17%). Some also said the mandate could control costs (15%).

Do you agree with these findings? Tell us more.

— Frances Correa (FMCReporting)

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Filed under Health Policy, health reform, IMNG, Polls, Practice Trends

Innovation Center Seeks to Renovate Medicare

Government officials have stood before doctors many times and talked about the need to change the perverse incentives that pay them more for caring for sick patients than for keeping people healthy to start. Dr. Richard Gilfillan, who runs the new Center for Medicare and Medicaid Innovation, had a similar pitch when he talked to more than 1,000 people who recently convened at a Washington, D.C. hotel for a day-long summit on health care innovation. The difference is, Dr. Gilfillan has some leverage.

Under the Affordable Care Act, his new center is charged with rapidly testing alternative payment and health care delivery models. If those pilot projects are proven to both improve the quality of care and bring down health care costs, the Secretary of Health and Human Services can roll out the program nationally. There’s a little more paperwork involved, but that’s the general idea.

Dr. Richard Gilfillan (R), with HHS Secretary Kathleen Sebelius and former head of the Centers for Medicare and Medicaid Services, Dr. Don Berwick, in November. HHS Photo by Chris Smith.

What that means is that in a relatively short amount of time, Medicare could fundamentally change the way it pays doctors. That is, if the pilot projects sponsored by the Innovation Center are successful.

Dr. Gilfillan offered an example: Let’s say the Innovation Center launches a project where it pays primary care physicians an extra $10 per patient per month to coordinate care. If officials at the Innovation Center can prove that the project improves outcomes and reduces costs, HHS can publish regulations to roll it out to primary care physicians around the country. “As you can see, this is a powerful tool for changing the way we deliver care,” Dr. Gilfillan said at the summit.

The Innovation Center has been around for about a year and officials there have been busy putting together a set of pilot projects that look at new ways to deliver primary care and home-based care. They are also testing other concepts like bundled payments and accountable care organizations. Check out the Innovation Center’s report on its first year for descriptions of all the projects.

One thing they are trying to do in each of the projects, Dr. Gilfillan said, is to work closely with private payers. The goal, he said, is to make life a little simpler for doctors by ensuring that when they find new payment mechanisms that work, all the payers, both public and private, will adopt it in the same way.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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Filed under Family Medicine, Health Policy, health reform, IMNG, Internal Medicine, Pediatrics, Physician Reimbursement, Practice Trends, Primary care

Liability Reform: A Broken Promise?

Republicans on the House Energy & Commerce Committee took President Obama to task on Tuesday in a short video that accused him of doing nothing to fulfill a promise made in last year’s State of the Union address to address medical liability reform.

Courtesy Wikimedia Commons/johnfekner/GNU Free Documentation License

With its eery, conspiratorial music and accusatory title fadeouts, I half expected to see Gary Oldman in a bespoke suit proclaim that the Joe Biden is a mole. (That reference may be lost on those of you who have not seen Tinker Tailor Soldier Spy.)

Indeed, in that January 2011 speech, according to a fact sheet issued by the White House,

…the President pledged to work with Republicans to support state reforms of medical malpractice systems to bring down costs and improve care – building on Administration efforts already underway to assess what works in medical malpractice reform.

The House Republicans charge that they’ve reached out to the White House but have had no response.

About 134 House members — Republicans and Democrats — have put their names on a bill to overhaul the medical liability system that was  introduced in Jan. 2011 by Rep. Phil Gingrey (R-Ga.).

Physician organizations have en masse backed that bill, H.R. 5. But it has languished since May last year when it was reported out of the Energy & Commerce Committee.

Meanwhile, the Obama Administration did offer up an olive branch on tort reform in the Affordable Care Act. But nothing has come of that, either.

The ACA authorized $50 million in grants to states looking to demonstrate new models. The Agency for Healthcare Research and Quality was charged with managing the program, and it put out requests for proposal in Nov. 2010. The funds were supposed to be available beginning in Oct. 2011 but, according to an AHRQ spokesperson, Congress has not yet appropriated the funds for the initiative.

That means no grants have been issued under that program, although the AHRQ has funded other liability reform projects through an initiative announced by President Obama in the fall of 2009.

The leading GOP presidential candidates have promised that they will address medical liability reform. But even if a Republican does take the White House in November, the fulfillment of that promise is likely a long way off.

Alicia Ault

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Experts Call on Docs to Lead Cost Control

Doctors must play an integral role in reducing health care costs, health policy experts say. At the annual conference of consumer group Families USA, Dr. Atul Gawande and Dr. Ezekiel J. Emanuel said that doctors participating in reducing costs will have a greater affect than the health care law itself.

Dr. Atul Gawande / Frances Correa/ Elsevier Global Medical News

“Washington will not be able to save the costs. They’ll provide the framework, but in your communities, that’s where you’ll do it,” said Dr. Gawande, a health policy researcher and endocrine surgeon at Brigham and Women’s Hospital in Boston. Dr. Gawande said that the Affordable Care Act will provide the data for doctors to identify where to trim costs. Both Dr. Gawande and Dr. Emanuel said doctors can take a leading role in cost control by focusing on the sickest 5% of patients. According to a 2009 report from the Agency for Healthcare Research and Quality, the sickest 5% of patients account for 50% of national health care expenditures.

Dr. Gawande cited the work of Dr. Jeffrey Brenner. By analyzing medical billing data from practices in Camden, N.J., Dr. Brenner, a primary care physician, was able to map out the most impoverished areas with the highest health care costs. With a focused approach that included home visits and the help of social workers, Dr. Brenner decreased one patient’s inpatient hospital time from 7 months in one year to 3 weeks. While under his care, the patient lost 200 pounds, and quit smoking, drinking, and using cocaine. At the same time, the patient’s hospital costs decreased by 60%. Dr. Gawande wrote about Dr. Brenner’s strategy in a January 2011 article in the New Yorker.

Dr. Emanuel, a recognized expert on health and chair of the department of medical ethics and health policy at the University of Pennsylvania, Philadelphia, said rising health care costs threaten many aspects of American society, particularly education, workers’ wages, and the nation’s position in the world, as well as by putting an economic squeeze on middle class. Dr. Emanuel also served as special adviser for health policy to the director of the White House Office of Management and Budget from January 2009 to January 2011, where he helped craft the Affordable Care Act.

Dr. Ezekiel Emanuel / Frances Correa/Elsevier Global Medical News

“If you care about how our kids are going to educated in the future, you have to care about heath care costs,” Dr. Emanuel said, adding that increased health care costs directly affect tuition rates. For example, from 2001 to 2011, employer contributions to health insurance increased by 113%, according to the Kaiser Family Foundation. Meanwhile, tuition for public universities increased 72% over the past decade, according to the College Board. Dr. Emanuel projected that, as health care costs continue to rise, states will be forced to take the money from other programs, leaving education and health care at the greatest risk.

“We can reduce costs without sacrificing access … [doctors] have to be committed to doing that,” Dr. Emanuel said.

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HHS Cries Foul on Insurance Hikes

Nowhere in the thousands of pages of the Affordable Care Act does it give the federal government the power to stop insurance companies from charging excessive premiums. But the controversial health reform law does grant the Department of the Health and Human Services the right review some large rate increases and to tell consumers when they think health plans are charging too much.

HHS did just that today when it held a press conference to protest what it said were “unreasonable” rate hikes by Trustmark Life Insurance Company in five states. The company recently proposed premiums hikes of 13% or more for its plan members inAlabama, Arizona, Pennsylvania, Virginia, and Wyoming.

Courtesy Wikimedia Commons/FBI Buffalo Field Office/Public Domain

Gary Cohen, the Acting Director of Oversight at the HHS Center for Consumer Information and Insurance Oversight, said it wasn’t just that the increases were so high. HHS officials, after consulting with a team of outside analysts, concluded the rates were unreasonably high because the health insurance company was spending only a small percentage of its premium dollars on medical care and quality improvements. Trustmark also based its increases on “unreasonable assumptions,” HHS said. You can read more about HHS rate review authority here.

In its challenge to Trustmark, HHS called on the company to immediately rescind the rates, issue refunds to consumers, or publicly explain why they are standing by such a large rate hike.

It looks like Trustmark is going to stand by its rate increase. Following the HHS press conference, Trustmark issued its own statement saying that they disagreed with the federal government’s assumptions and conclusions. “Our premiums are driven by the rising cost and increased utilization of medical services,” the company wrote. “As a smaller carrier, our loss ratios can vary significantly from year to year, and we take that volatility into consideration.” As for spending too little of its premium dollars on medical care, the company said it has been in compliance with the federal Medical Loss Ratio requirements in that area. However, if they should fail to meet the federal standards, they will offer rebates to consumers.

So is this an effective strategy for bringing down health insurance rates? Share your thoughts on whether rate review by HHS and public disclosure will be powerful enough to force companies to keep premiums low or if you think insurers will be willing to ride out some bad press.

— Mary Ellen Schneider

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Fighting Over the SGR: The Policy & Practice Podcast

The Medicare Payment Advisory Commission (MedPAC) is recommending that Congress throw out the Sustainable Growth Rate (SGR) formula currently used in setting Medicare physician payments. Under that formula, physicians are due to have their Medicare payments cut by about 30% on Jan. 1. But while doctors are unanimous in their loathing of the SGR, there are differing opinions about how to solve the problems with how Medicare pays physicians.

Courtesy Wikimedia Commons/Psychonaught/Creative Commons License

Check out the Policy & Practice podcast to hear how MedPAC wants to pay for its SGR fix and what objections physician groups are raising about the plan. This week’s podcast also features news on the Institute of Medicine’s recommendations on what should be included in an essential package of health insurance benefits for health plans operating in the state health insurance exchanges in 2014.

Take a listen:

Join us next week as we follow the deliberations of the Joint Select Committee on Deficit Reduction and what it means for Medicare and other health programs.

— Mary Ellen Schneider  (@MaryEllenNY)

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Supreme Court Bound?: The Policy & Practice Podcast

As the Supreme Court begins its new term today,  speculation begins in earnest about how the high court might rule on the constitutionality of the Affordable Care Act.

Courtesy Wikimedia Commons/Duncan Lock/GNU Free Documentation License

The Obama administration recently filed a petition asking the Supreme Court to review a lower court decision on the constitutionality of the Affordable Care Act. The 11th Circuit Court of Appeals in Atlanta had struck down the law’s requirement that individuals have insurance, because it violated the Commerce Clause of the Constitution. The appeals court decision would allow the rest of the Affordable Care Act to go forward.

Supporters of the Affordable Care Act aren’t the only ones looking to get the Supreme Court involved. A coalition of 26 states  that is challenging the law has also petitioned the high court to review the decision of the 11th Circuit Court of Appeals. Those states want the Supreme Court to throw the health law completely.

The Supreme Court justices haven’t officially decided whether they will review the Affordable Care Act. But if they do take on the case, their decision is likely to come in the middle of the 2012 presidential campaign.

Hear more about the legal wrangling in the Oct. 3 edition of Policy & Practice podcast. This week’s podcast also includes new figures on rising health insurance premiums and the latest on a proposal from the Department of Health and Human Services to offer bonus payments to primary care physicians who spend more time with patients and provide intensive disease management.

Take a listen:

Join us next week to hear how physicians are trying to influence the deliberations of the Joint Committee on Deficit Reduction.

— Mary Ellen Schneider

@MaryEllenNY

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