Category: Health Care Access

Senate Dems: Get Pregnant, Then Get Health Insurance

Women joggingWhile everyone else is wondering whether the Supreme Court will replace Obamacare in 37 states with the actual Affordable Care Act as written, some Democratic U.S. Senators are urging women to dive deeper into Obamacare’s perverse incentives by encouraging them to delay getting health insurance until after they become pregnant.

As reported by Lydia Wheeler in The Hill, Senator Patty Murray has round up 36 signatures on a letter addressed to U.S. Health & Human Services Secretary Sylvia Burwell urging her to pull yet another “special enrollment period” out of her bag of tricks.

In a statement, Christina Postolowski, health policy manager of Young Invincibles, said she’s thrilled to see a growing chorus of leaders calling on the administration to create a special open enrollment period to make maternity coverage available to pregnant women year-round.

According to Postolowski’s December 2014 report “Without Maternity Coverage” maternity care and delivery ranges from $10,000 to $20,000 without complications.

FDA Allows Direct-To-Consumer Genetic Tests

One year after a very public squabble with genetic-testing company 23andMe, the Food and Drug Administration has decided not only to allow 23andMe to directly market its genetic test to consumer as a diagnostic device, but to free other genetic-testing companies from pre-market review or prescription status:

“The FDA believes that in many circumstances it is not necessary for consumers to go through a licensed practitioner to have direct access to their personal genetic information. Today’s authorization and accompanying classification, along with FDA’s intent to exempt these devices from FDA premarket review, supports innovation and will ultimately benefit consumers,” said Alberto Gutierrez, Ph.D., director of the Office of in Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health. “These tests have the potential to provide people with information about possible mutations in their genes that could be passed on to their children.”

Obamacare Increases ED Use in Los Angeles County

Los Angeles County, Obamacare’s Ground Zero (so described because of the huge number of its residents enrolled in Obamacare’s health insurance exchange) is seeing an influx of patients into hospitals’ emergency departments:

Data hospitals report to the state show that as insurance coverage was extended to hundreds of thousands of residents, ER visits for ailments not serious enough to require an admission grew 3.9% in the county in the first half of 2014, compared with the same period the previous year. The growth is in line with annual increases of 3% to 5% in the three years prior to the federal healthcare overhaul. (Los Angeles Times)

This is no surprise to readers of NCPA’s Health Policy Blog. We have always appreciated the evidence that increases in government-funded health coverage lead to increased ED use.

What is interesting about the data from LA County is that ED use in public hospitals declined, while use in private hospitals increased. That might indicate something about the characteristics of the patients newly insured under Obamacare.

Questioning the State’s Power over Patients

Here’s a tough issue:

A court will determine whether a 17-year-old girl, under something called the “mature minor doctrine,” can be forced to undergo chemotherapy after she refused treatment for her cancer.

Cassandra underwent two chemotherapy treatments in November and then ran away from home and refused to continue treatments, according to the court summary.

A court hearing ensued in which Cassandra’s doctors testified, and she was removed from her mother’s home and placed in state custody so that the state could make medical decisions for her.

She has been has been living at Connecticut Children’s Medical Center and forced to undergo chemotherapy for about three weeks.

The Hartford Courant reported that Cassandra has an 80 to 85 percent chance of surviving her cancer if she continues with her chemotherapy.

The article does not report religious objections to the treatment, but notes that Cassandra’s mother now supports her decision not to undergo chemotherapy.

High Taxes, Lack of Federal Bailout Make Vermont Cancel Single-Payer Plan

Vermont Governor Peter Shumlin has cancelled his longstanding plan to impose government-monopoly health care in the Canadian border state:

Tax hikes required to pay for the system would include a 11.5 percent payroll tax as well as an additional income tax ranging all the way up to 9.5 percent. Shumlin admitted that in the current climate, such a precipitous hike would be disastrous for Vermont’s economy.

“Pushing for single payer health care when the time isn’t right and it might hurt our economy would not be good for Vermont and it would not be good for true health care reform,” Shumlin said. “It could set back for years all of our hard work toward the important goal of universal, publicly-financed health care for all.”

The state had been anticipating $267 million in federal funding to revamp its system, courtesy of a 2013 Obamacare waiver — but the current estimate has fallen to $106 million. Vermont also overestimated by $150 million in federal Medicaid funding. (Daily Caller)

Wait Times for Health Care in Canada Doubled Since 1993

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This blog has discussed the evidence that Obamacare is reducing access to medical care. For those interested in the future of American health care, a look north of the border may be in order.

Your Kaiser Permanente Doctor Will See You Now – at Target

You probably won’t find more criticism of large health systems on any other health policy blog than you will here. Nevertheless, we like innovation wherever we find it happening, and it is happening in some large health systems:

In a move that reflects the increasing wave of consumer-driven healthcare, Target Corporation is teaming up with Kaiser Permanente to open four in-store Target Clinics in Southern California, taking a host of services directly to thousands of customers.

The clinics opened at Target stores in Vista, San Diego and Fontana, and a fourth clinic will open in West Fullerton Dec. 6. They will be staffed by nurse practitioners from Kaiser.

While Target has maintained clinics for the past 10 years at a number of stores, the partnership will allow for a much broader array of services than it typically offered at retail outlets. Expanded services include telemedicine consultations, prescription reviews, pediatric primary care visits, OB-GYN services, vaccinations and flu shots, pediatric and adolescent care and management of chronic illnesses like diabetes and high blood pressure, according to John Holcomb, vice president of healthcare for Target. (Dan Verel, MEDCity News)

Reducing Readmissions Under Obamacare: Doctor’s Orders?

Last month I wrote about the rise of hospital readmission penalties in fiscal 2015 and questioned the Hospital Readmissions Reductions Program’s effectiveness in increasing quality of care, in part due to factors independent of the hospital that lead to readmission.

Hospitals attempt to combat readmissions by implementing transitional care interventions. The American Journal of Managed Care conducted a controlled trial to evaluate the impact of such programs. Patients were randomly assigned to either standard care or a 90-day hospital-based transitional care program featuring patient education ahead of discharge, post-discharge follow-up, an available hotline and additional interview sessions and symptom checks. No statistical difference in readmission rates between the standard care and intervention group was found. Their findings are consistent with other trials, which have shown that even robust and comprehensive interventions are ineffective in slowing readmissions.

Government Buries Evidence of Poor Access to Care under Obamacare

Thank providence for USA Today, which has given us yet another story describing how poor access to health care is under Obamacare.

People who fell for navigators’ sales pitches and signed up for Obamacare are discovering that it is junk insurance:

“The exchanges have become very much like Medicaid,” says Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. “Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they’re not going to be in business very long.”

Kleinman says his members complain rates can be 50% lower than commercial plans.

“I definitely feel like a bad person who is leeching off the system when I call the doctors’ offices,” she says. Shawn Smith of Seymour, Ind., spent about five months trying to find a primary care doctor on the network who would take her with a new, subsidized silver-level ACA insurance plan.

Veterans Wait 3 Months for Primary-Care Appointment vs. 3 Days for Private Patients

I have noted with dismay that the U.S. government is trying to fix the Veterans Health Administration scandal over wait times by throwing more money at a fundamentally broken system.

Jonathan Bush, CEO of athenaHealth, a leading provider of cloud-base electronic health records (EHR’s) has researched his firm’s database to arrive at a shocking conclusion: Patients wait three days, on average, for a primary-care appointment. And that was for well patients: Sick patients got in in one day.

Bush concludes that veterans trapped in the Veterans Health Administration should be able to shop for care outside the VHA.