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USHL NEWS & Updates

On March 5, 2014, CMS announced that it would allow insurers to extend some health plans until October 2016 even if the plans do not meet new healthcare reform standards.

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Healthcare Subsidies At Risk - Pending Legislation Could Deny Subsidies In States Utilizing National Exchange

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Standard Analytical Service, Inc. (SAS), publishers of independent insurance reports, recently released its 2014 annual comparative report of the 25 leading domestic health insurance providers. USHL received a favorable ranking.

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USHL recently introduced its Wellness Resources Center, a convenient one-stop health and wellness information library on the USHL website which visitors can reference for a variety of objectives.

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  • Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived

    While Ebola stokes public anxiety, more than one in six hospitals — including some top medical centers — are having trouble stamping out less exotic but sometimes deadly infections, federal records show.

    Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined. A Kaiser Health News analysis found 695 hospitals with higher than expected rates for at least one of the six types of infections tracked by the federal Centers for Disease Control and Prevention.  In 13 states and the District of Columbia, a quarter or more of hospitals that the government evaluated were rated worse than average for at least one infection category, the KHN analysis found.

    The missteps Texas Health Presbyterian Hospital made this month in handling an Ebola patient echo mistakes hospitals across the nation have made in dealing with homegrown infections. Dr. Kevin Kavanagh, a patient safety expert from Kentucky, said hospitals too often don't strictly follow protocols to deal with infectious diseases, and the government's standard responses are not specific enough. "Right now there are too many recommendations on how to handle infectious diseases, too much leeway," he said. 

    A 2011 study in the New England Journal of Medicine underscored the problem, observing that while hospitals have reduced the frequency of many infections over the last decade, they could do better if staff complied with recommendations. Those include always washing their hands and using maximal barrier procedures when tubes are being inserted, such as covering patients from head to toe with a sterile drape and wearing sterile caps, masks gowns and gloves. 

    "The percentage of time that health care providers do all of the things they are supposed to do when caring for a patient with a contagious disease can be pretty low," said one of the authors, Dr. Don Goldmann, chief medical and science officer at the Institute for Healthcare Improvement, a nonprofit in Cambridge, Mass. "There’s a lot of room for improvement."

    Goldmann said that hospitals tend to become more focused on following procedures when facing novel, highly publicized outbreaks such as Ebola. "When [an infection risk has] been around for a long time, it kind of becomes part of the background," he said.

    Since 2012 the federal government has been analyzing and publishing the CDC rates for specific hospitals on Medicare’s Hospital Compare website. Starting this fall, Medicare is considering infection rates when deciding how much to pay hospitals.

    The CDC reports six categories of infections: those from flexible tubes inserted into veins to deliver medicines or nutrients; infections from catheters that drain bladders; two antibiotic resistant germs, Clostridium difficile (C. diff) and Methicillin-resistant Staphylococcus aureus (MRSA); and two surgical site infections after hysterectomies and colon operations. 

    States with more than a quarter of hospitals having at least one high infection rate in the CDC data were Arizona, California, Colorado, Connecticut, Florida, Massachusetts, Montana, Nevada, New Jersey, New York, Rhode Island, South Carolina and Utah, according to the KHN analysis of the most current CDC records. 

    Infections In Hospitals

    Three highly regarded institutions—New York-Presbyterian Hospital in Manhattan, Geisinger Medical Center in Danville, Pa., and the University of Michigan Health System in Ann Arbor—were among seven hospitals the CDC rated as having worse than average rates for four of the six infections, KHN found.

    The CDC data, based on reports hospitals submit, are considered the most reliable assessments that exist. Still, many hospitals the CDC judged as having worse than average rates disputed those verdicts. They said that they look bad because they are more vigilant in identifying and reporting infections, or because they handle very sick patients who are more prone to catching a bug. 

    For instance, Dr. Darrell Campbell Jr., chief medical officer at the University of Michigan Health System, said hysterectomies are performed on cancer patients at four times the rate than at other Michigan hospitals that compare information with each other. Because cancer surgeries take longer than regular hysterectomies, often involving removal of pelvic lymph nodes, the chances of infection are greater, he said. 

    "When you adjusted for the cancer, we don't look different from any of the hospitals," he said. Campbell said none of Michigan’s infection rates deserved being rated poorly.  "Eventually, we'll get where we are more comfortable with this data, but we’re not there now," he said.

    New York-Presbyterian said in a statement it has made "significant improvements." Geisinger said in a statement that its infection rates have dropped since 2012 and that its MRSA rate appeared high because the hospital made a "data entry error" when it reported cases to the government. Geisinger also noted that many patients who test positive for C. diff never develop any symptoms, but hospitals still must report it as an infection.

    Some major teaching hospitals, like Denver Health Medical Center, Duke University Hospital in Durham, N.C., and Mayo Clinic’s hospitals in Rochester, Minn., have been able to maintain low infection rates, the KHN analysis shows. 

    Others are succeeding in controlling some infection types but not others, according to the CDC data. Yale-New Haven Hospital had lower than average rates of bloodstream infections caused by central lines, but higher than average rates of infections from catheters inserted into the bladder to remove urine. Since one of the main ways to avoid such infections is to remove the catheter as soon as it is not essential, the hospital now allows nurses to take them out without a physician’s order under certain conditions, said Dr. John Boyce, the hospital’s director of epidemiology and infection control. "Busy physicians sometimes forget their patient has a catheter in, but the nurses know," he said.

    Nationally, surgical site infections dropped by a fifth and central-line infections decreased by 44 percent between 2008 and 2012. MRSA decreased by a third during that period. 

    Battling C. diff is very different than fighting Ebola and in some ways harder, because it requires hospitals to restrain use of the antibiotics necessary for so many patients. When those drugs eliminate weaker bacteria from the intestines, C. diff is able to prosper. Patients can get massive diarrhea and, while C. diff can be treated, the worse cases may require surgery to remove the infected part of the intestines.

    Other infections for which the CDC tracks but does not yet publish hospital-specific rates, known as gram negative, are impervious to nearly all antibiotics.

    Reducing the frequency of C. diff and these kinds of infections requires hospitals to become more judicious in deploying antibiotics. But only about half of hospitals have established stewardship programs that help doctors use the appropriate antibiotics in the most effective doses without overdoing it, researchers say.

    "We have increasing amounts of data that thirty to fifty percent of the antibiotics we are prescribing are inappropriate," said Dr. Kavita Trivedi, a consultant and former infection control official for California. "It sounds crazy to people who are not in medicine: Why would a patient be prescribed an antibiotic they don’t need? But it happens frequently because we don’t know what they need."

    Data for individual hospitals is available as a Printable PDF and as a CSV spreadsheet, and you can also view infections rates by state.


  • High Infection Rates Vary By State

    This chart shows what proportion of hospitals in each state had higher than average infection rates for at least one type of infection publicly reported by the Centers for Disease Control and Prevention. The rates are based on infections contracted in the first nine months of 2013 and, for some of the infections, also the last three months of 2012. KHN excluded from the calculations hospitals that did not report any infection rates to the CDC or did not have enough cases for the CDC to evaluate.

    << Back To Main Story: Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived

  • Kasich Retreats From Politically Charged Health Law Comments

    After telling the Associated Press that he didn't think a repeal of the health law was going to happen, Ohio Gov. John Kasich, a Republican, took aggressive steps to attempt to correct the record. His statement, he said, was meant only about attempts to repeal the Medicaid expansion, which Ohio has implemented. 

    Politico: Gov. John Kasich: Repeal Obamacare, But Not All Of It
    A political firestorm broke out Monday when The Associated Press quoted Kasich as saying that Obamacare repeal was “not gonna happen.” That view is almost unheard of — at least in public — among most Republicans, let alone those who might run for the White House in 2016. Kasich said AP got it wrong, and he called POLITICO Monday night to correct the record. He said he was talking specifically about repeal of the expansion of Medicaid — which Ohio has implemented — and not of the Affordable Care Act more broadly (Wheaton, 10/21).

    The New York Times: Ohio Governor Backpedals On Repeal Of Health Law
    Wait, that’s not what I really meant. Gov. John Kasich of Ohio said his comments about a Republican-led Congress being unlikely to repeal the Affordable Care Act — which commentators on the right and left pounced upon Monday — were taken out of context. Mr. Kasich, a Republican mentioned as a 2016 presidential hopeful, in an interview distanced himself from the notion that he had accepted the health care law as a fait accompli. The idea is anathema to almost all Republican officials, and especially the party’s base (Gabriel, 10/20).

    The Washington Post: Kasich: I ‘Don’t Back Obamacare’ And I ‘Want It To Be Repealed’
    Ohio Gov. John Kasich (R) is pushing back on reports that he'd said Obamacare was here to stay, saying Monday night that he opposes the federal health care law and believes it could be repealed and replaced under a Republican president and GOP-controlled Congress. "I don't back Obamacare. I never have. I want it to be repealed," he told The Washington Post in a telephone interview (Sullivan, 10/20).

    CNN: Kasich In Interview: Obamacare Has To Stay
    A repeal of President Barack Obama's signature health care law is "not gonna happen" even if the GOP takes the Senate, Ohio Gov. John Kasich said. The Republican governor's comments, in an interview with The Associated Press published Monday, are a major departure from the rest of his party -- and stunning for a potential 2016 presidential contender (Bradner, 10/20).

    Cleveland Plain Dealer: Does John Kasich Still Want To Repeal Obamacare?
    So it was surprising Monday to see Kasich quoted in an Associated Press story that characterizes his position as shifting even farther to the left. "That's not gonna happen," Kasich reportedly told the AP when asked about a repeal of Obamacare, something many GOP candidates for president and Congress favor. ... But when it comes to the Affordable Care Act in its entirety, Kasich has in the past expressed support for "repeal and replace" -- a standard Republican stance. What's changed? Nothing, said Kasich press secretary Rob Nichols. "He's for repeal and replace," Nichols said Monday afternoon. "He always has been." Nichols said Kasich was speaking specifically about Medicaid expansion when interviewed by the AP (Gomez, 10/20).

    The AP story that quoted Kasich also looks at other GOP governors who face a similar pull between their choice to expand Medicaid and their positions on the overall health law -

    The Associated Press: GOP Governors Don’t See ‘Obamacare’ Going Away
    While Republicans in Congress shout, “Repeal Obamacare,” GOP governors in many states have quietly accepted the law’s major Medicaid expansion. Even if their party wins control of the Senate in the upcoming elections, they just don’t see the law going away. Nine Republican governors have expanded Medicaid for low-income people in their states, despite their own misgivings and adamant opposition from conservative legislators. Three more governors are negotiating with the Democratic administration in Washington (Alonso-Zaldivar, 10/20).

  • ACA Knowledge Gap Greatest Among Uninsured

    Most of the uninsured know little about the online insurance marketplaces, or that financial help is available for those with low incomes, finds a poll. Meanwhile, a West Virginia Medicaid official says new enrollees "come in with baggage," such as a history of using free drug samples that aren't covered by the program and The Washington Post looks at continuing legal challenges to the law.

    Politico Pro: ACA Knowledge Gaps Loom Before Second Enrollment Season
    Here comes another bit of trouble for the Affordable Care Act: Most of the uninsured don’t know that open enrollment starts next month. And they don’t know much about the marketplaces. Or that financial assistance is available for low-income consumers, according to the Kaiser Family Foundation’s latest Tracking Poll, released Tuesday. The poll found that 89 percent of the uninsured don’t know that the second season of enrollment begins on Nov. 15. Two-thirds said they know “only a little” or “nothing at all” about the marketplaces or exchanges and over half (53 percent) of the uninsured don’t know about the subsidies (Villacorta, 10/21).

    Kaiser Health News: Capsules: Uninsured Still Know Little About Health Law As 2nd Enrollment Period Draws Near
    Health law? What health law? Almost nine of 10 uninsured Americans – the group most likely to benefit — don’t know that the law’s second open enrollment period begins Nov. 15, according to a poll released Tuesday. Two-thirds of the uninsured say they know “only a little” or “nothing at all” about the law’s online insurance marketplaces where they can buy coverage if they don’t get it through their jobs. Just over half are unaware the law might give them financial help to buy coverage, according to a new poll (Carey, 10/21).

    Charleston (W.Va.) Gazette: New Medicaid Patients ‘Come In With Baggage’
    With 155,000 people added to West Virginia’s Medicaid program following a major expansion, the state’s family practice doctors are seeing more patients whose medical care requires a complete overhaul, a state Medicaid official told lawmakers Monday. “The problem is patients who come from an uninsured status to a suddenly insured status frequently come in with baggage,” said Dr. James Becker, medical director for West Virginia’s Medicaid program. Some new Medicaid patients show up at doctors’ offices with medical treatment plans that don’t comply with program standards. Other patients are taking free drug samples not on the Medicaid program’s preferred medication list. Becker said primary care doctors are helping patients switch gradually to state-approved prescription drugs (Eyre, 10/20).

    The Washington Post’s Wonkblog: How The Supreme Court Could Still Wreak Havoc On Obamacare
    Obamacare may not be the political issue it was this time last year, when a faltering Web site threatened to derail the program, but that doesn't mean it's in the clear. Ongoing legal challenges to one aspect of the law could still put its coverage expansion in serious jeopardy. The dispute has to do with whether the subsidies can be provided through public health insurance marketplaces in states that refused to set up their own, instead leaving the job to the feds. The administration and Obamacare supporters say the law was designed to provide premium subsidies to all states, regardless of who runs the marketplace (Millman, 10/21).

    Fiscal Times: Ebola: Obamacare’s Ultimate Pre-Existing Condition
    With the new Obamacare enrollment period scheduled to begin on November 15, here’s an intriguing question: If you’re one of the rare Americans to have the misfortune of contracting Ebola, can you apply for a new insurance policy on one of the government-run health exchanges without being rejected (Pianin and Ehley, 10/21)?

  • Few California Inmates With Hepatitis C Get Costly Sovaldi

    The drug is being given to fewer than 1 percent of the 17,000 inmates with the virus in California prisons, reports the San Francisco Chronicle. Meanwhile, a Senate Democrat plans a hearing on how VA hospitals are coping with its high cost.

    San Francisco Chronicle: Prisons Balk At Sovaldi’s $84,000 Cost For Hepatitis C Treatment
    In San Francisco’s jails, no inmates with hepatitis C are receiving Sovaldi, the breakthrough pill that can cure most patients in an unprecedented amount of time. In California’s prisons, the drug, made by Gilead Sciences of Foster City, is being given to less than 1 percent of the 17,000 inmates with the virus. Sovaldi could wipe out what has long been an intractable disease. But its $84,000 cost for a 12-week supply doesn’t fit into lean government budgets (Lee and Garofoli, 10/20).

    The Wall Street Journal’s Pharmalot: Senate Lawmaker Eyes Hearing On The Cost Of Hepatitis C Treatments
    Responding to the ongoing controversy over the prices for new hepatitis C treatments, U.S. Sen. Bernard Sanders (I-Vt.) will probably hold a hearing -- possibly before the year ends -- to examine how the cost is affecting the U.S. Department of Veterans Affairs, according to his spokesman. Sanders is chairman of the Senate Committee on Veterans’ Affairs (Silverman, 10/20).

  • Just In Time For Open Enrollment, A New Physician Rating Site

    USA Today reports that the website uses about 500 million federal and private claims and patient reviews to rank doctors. Meanwhile, the failure of the $30 billion federal program to create interoperable electronic health record systems is examined by Politico.

    USA Today: New Doctors Site Rates For Experience, Quality
    The first comprehensive physician rating and comparison database launches Monday in time for open enrollment on federal and state health exchanges, as well as for many employer-provided plans. The new version of the website Healthgrades.com uses about 500 million claims from federal and private sources and patient reviews to rate and rank doctors based on their experience, complication rates at the hospitals where they practice and patient satisfaction (O’Donnell, 10/20).

    Politico: Few Motives To Fix Busted Health Data
    Someday, doctors will have our data at their fingertips and will use it to prevent drug reactions, nip diabetes and cancers in the bud and lengthen our lives while preventing unpleasant and costly hospital stays. But for most doctors, that free-flowing information highway is a beautiful dream that doesn’t pay the bills (Allen, 10/20).

    The role of primary care doctors in lowering health care costs is also examined -

    Milwaukee Journal-Sentinel: More Efficient Health Care Generates Savings
    The potential to lower health care costs by focusing on primary care can be seen in the example of a patient with diabetes who had been to an emergency department or hospitalized 30 times in roughly a year. The patient then developed a relationship with a primary care physician who closely monitored his health. The next year, he didn't seek care at an emergency room and wasn't hospitalized once (Boulton, 10/20).

  • Medicare, Health Care Getting Attention In Senate, Congressional Races

    In Louisiana's Senate race, Medicare is grabbing the spotlight. The powerful issue is also popping up in North Carolina and Iowa. Meanwhile, Michigan's Senate race references to Medicare and the health law are checked for accuracy. And Obamacare is the subject of ads in an increasingly high-profile California House contest.   

    The Associated Press: In Louisiana, Both Sides Claim Defense Of Medicare
    An old political standby — the future of Medicare — is emerging as the go-to issue in Louisiana’s bitter Senate race as the candidates woo seniors who typically wield strong influence in midterm elections. The challenge for voters is to figure out which side, if either, is telling the whole truth about who would cut and who would protect the popular insurance program. Medicare serves more than 50 million people and accounts for about 15 percent of federal spending, with about 10,000 new beneficiaries added daily as baby boomers reach age 65. The issue is so powerful that it’s cropping up in North Carolina and Iowa, too, amid a national battle for control of the Senate (Barrow and Deslatte, 10/21).

    Politico: Fact-Checking The Michigan Senate Race
    The Michigan Senate race pits Democratic Rep. Gary Peters against Republican Terri Lynn Land, a former Michigan secretary of state, to replace the retiring Sen. Carl Levin. The two candidates have faced plenty of attacks from outside spending groups, who have poured enough money into the race to make it the seventh costliest in terms of outside dollars. In fact, those groups — not the candidates themselves — have so far been the focus of our fact-checking efforts. False and misleading claims have centered on taxes, equal pay for women, health care, outsourcing jobs, Medicare and energy (Factcheck.org, 10/21).

    Sacramento Bee: Ad Watch: Democrats Use Obamacare Against Ose
    House Majority PAC, a Democratic group, has criticized Republican congressional challenger Doug Ose for his stances on veterans and Social Security. Now, in a new television ad, the group is targeting the former congressman for his pledge to repeal the Affordable Care Act and replace it with a new plan (Cadelago, 10/20).

  • Medicaid Expansion, Health Exchanges Dominate Gubernatorial Debates

    In Georgia, where a runoff is considered likely, Gov. Nathan Deal went on the offensive and criticized a third-party candidate's support for expanding Medicaid. In Maryland, Republican candidate Larry Hogan slammed Democratic Lt. Governor Anthony Brown for his role in the state's troubled health exchange launch.

    Atlanta Journal-Constitution: Georgia Candidates Are Ready For A Runoff … But Not Happy About It
    If you needed any proof that Republicans are worried about a looming runoff, look no further than Sunday’s gubernatorial debate. That’s when Gov. Nathan Deal, instead of lobbing a softball at his Libertarian rival, unloaded a double-barreled attack questioning his support for a Medicaid expansion and criticizing the millions of dollars in federal grants his technology firms accepted (Bluestein and Malloy, 10/20).

    Baltimore Sun: Hogan Slams Brown, O’Malley Administration On Health Care Lawsuit Delay
    Reppublican gubernatorial candidate Larry Hogan criticized the O'Malley administration Monday over its decision to delay a lawsuit against the contractor it has blamed for the failed launch of the state's health exchange web site.  Hogan, locked in a battle with Democratic Lt. Gov. Anthony G. Brown with two weeks to go before Election Day, accused the administration of putting politics ahead of the taxpayers by delaying court action against Noridian Healthcare Solutions. The state fired Noridian in April for poor performance and vowed to recover $55 million it spent on the web site, which crashed on its first day of operation last October. Maryland decided early this year to scrap the web site and develop a new one based on software used on the more successful Connecticut site (Dresser, 10/20).

  • State Highlights: Calif. Ballot Measure Updates; Va. Prison Health Care Budget Shortfall

    A selection of health policy stories from California, Arizona, Maine, South Dakota, Virginia, Maryland, Louisiana, Pennsylvania, Massachusetts, North Carolina, Texas, Washington state and Missouri.

    CQ Healthbeat: California Leads States In Ballot Measures That Could Influence Health Care
    They’ll vote on whether to upend decades-old policies and give the state insurance commissioner the power to deny health insurer requests for rate increases. Another question on the ballot could significantly increase medical malpractice award caps set in 1975 and impose the first requirements in the nation that doctors get tested for illegal drug use. California’s measures stand out as the most significant health-related ballot initiatives in front of voters in the November elections. Elsewhere, Arizonans will vote on whether terminally ill people in the state can use drugs that aren’t yet approved by the Food and Drug Administration. In Maine, voters will decide whether to spend millions to encourage the development of a genomic industry, while South Dakotans will vote on whether to join at least 33 other states that require health insurers to have a contracting process that will consider requests to participate from all interested and licensed providers (Adams, 10/20).

    Los Angeles Times: Health Insurers Boost No On 45 Funding
    California insurers have pumped more than $12 million over the last five days into a campaign to defeat Proposition 45, an initiative on the Nov. 4 ballot that would regulate health insurance rates. Blue Shield gave $2.66 million, WellPoint $6 million, Kaiser Permanente $3.73 million and Health Net $350,000, according to late filings at the secretary of state's office (Lifsher, 10/20).

    Richmond Times-Dispatch: Va. Prison System Faces $45 Million Shortfall In Inmate Health Care
    Virginia’s prison system faces a $45 million shortfall in inmate health care through next year, even as the corrections department bears the brunt of the latest round of cuts in the two-year state budget. The shortfall emerged this year after a private company that had provided health care to inmates at 17 prisons in hard-to-serve areas ended its contract with the state at the end of September, according to Department of Corrections Director Harold W. Clarke in a presentation Monday to the House Appropriations Committee (Martz, 10/20). 

    The Washington Post: Booz Allen Buys Baltimore-Based Health Division Of Genova Technologies
    Booz Allen Hamilton has acquired the health care division of Genova Technologies, an Iowa-based government contractor, for an undisclosed sum. The health care group, made up of about 40 employees, is based in Baltimore. The office has already been integrated into Booz Allen, said Susan Penfield, executive vice president of Booz’s health business (Jayakumar, 10/20).

    The Associated Press: La. Health Dept. Seeks End To Billing Rape Victims
    Sexual assault victims in Louisiana should not have to pay for their treatment in emergency rooms, the health department said Monday, announcing a proposal that would have a state victims’ assistance board finance the exams (10/20).

    The Wall Street Journal: Judge Blocks Cancellation Of Philadelphia Teachers Contract
    A judge on Monday temporarily blocked the Philadelphia public-school system from canceling the teachers union contract and requiring educators to pay a share of their health insurance premiums starting in December. The union, the Philadelphia Federation of Teachers, sought the injunction, claiming the five-member School Reform Commission that governs the district lacked legal authority to impose the changes. The school district said it would appeal Monday’s ruling (Calvert, 10/20).

    Boston Globe: Mental Health Record May Be Predictor For Baker
    [Charlie] Baker’s blueprint saved Massachusetts millions of dollars at a time when the state was staring at a nearly $2 billion deficit, but it left thousands of mental health patients often waiting weeks for treatments. The controversial approach became his template for rescuing financially ailing Harvard Pilgrim Health Care a decade later. The aftershocks of both initiatives are still being felt as the now 57-year-old Republican runs for governor, and those experiences, say Baker supporters and critics, provide a window into how he might handle similarly fraught and costly issues if elected (Lazar, 10/21).

    Arizona Central-Republic: Phoenix VA Hospital Fails Outside Compliance Review
    The Department of Veterans Affairs health-care system in Phoenix does not comply with U.S. standards for safety, patient care and management, according to a non-profit organization that reviews medical facilities nationwide. In findings published online, The Joint Commission says Carl T. Hayden VA Medical Center failed a July inspection in 13 quality-control categories (Wagner, 10/21).

    California Healthline: New Los Angeles Program Working To Divert Mentally Ill, Homeless From Jail
    Court. Jail. Homelessness. Repeat. That cycle so familiar to many Californians with mental illnesses may soon be interrupted thanks to the new Third District Diversion and Alternative Sentencing Program in Los Angeles County. Designed for adults who are chronically homeless, seriously mentally ill, and who commit specific misdemeanor and low-level felony crimes, the demonstration project could help reduce recidivism by as much as two-thirds, Third District Supervisor Zev Yaroslavsky said (Stephens, 10/20).

    North Carolina Health News: A Rural Practice Fights To Stay Solvent
    By many measures this is a pediatric practice that shouldn’t exist. Ahoskie is home to 5,000 people, only 1,200 of whom are under 18. The median income of the town hovers right around the federal poverty level, and the bulk of the young residents qualify for Medicaid or the state’s children’s health insurance program, free school lunch, and other services. Beverly Edwards, MD, is one of only two pediatricians within a 2-hour drive of Ahoskie, and never has a shortage of patients. Despite the challenging environment, and state bureaucratic changes that have nearly bankrupted her practice, Ahoskie Pediatrics’ sole doctor, Edwards says she’s been living the dream (Ferris, 10/21).

    The Associated Press: Texas Selects Company To Run Psychiatric Facility
    Texas leaders are closer to privatizing a much maligned North Texas psychiatric facility despite concerns from mental health care advocates. The Austin American-Statesman reports state officials announced Monday that Tennessee-based Correct Care Solutions has the winning bid to operate Terrell State Hospital, which employs 980 staffers and serves more than 250 patients. The state and company are negotiating the deal and a decision on whether to move forward with the privatization should be made by the year's end. State health officials said privatization might be the best way to improve the hospital, which was scrutinized following a patient death. A 62-year-old Pittsburg woman died at the facility in 2013 after being restrained for 55 hours. The Centers for Medicare and Medicaid Services shortly thereafter cut off federal funding because of poor conditions at the hospital (10/21).

    Houston Chronicle: Riverside Hospital Ex-CEO, 3 Others Convicted In Medicare Fraud Case
    The former president of historic Riverside Hospital -- along with his son and two other people affiliated with the facility -- were convicted in federal court Monday for their roles in a Medicare scheme to steal $158 million from the U.S. government. The convictions are a hefty blow to the hospital, which has been teetering on financial collapse. Prosecutors said the facility's psychiatric care was a "sham," and that the four convicted - ex-hospital chief Earnest Gibson III; his son Earnest Gibson IV; Regina Askew and Robert Crane - reaped taxpayer money for services that were not provided. Assistant U.S. Attorney General Leslie Caldwell said the defendants treated mentally ill and disabled people "like chits to be traded and cashed out to pad their own pockets (Chiller, 10/20).

    Seattle Times: Washington Insurance Commissioner, Court Bolster Mental Health Coverage
    Washington residents will be able to recover some of their medical costs for certain mental health services. Insurance Commissioner Mike Kreidler is sending letters instructing insurance companies to identify and inform policyholders whose insurance claims were denied for mental-health care that they have a right to have those claims re-evaluated, provided that they were denied under a blanket or categorical exclusion. The letters from Kreidler are being sent in response to a ruling earlier this month by the state Supreme Court. The court determined that insurance companies are required to cover medically necessary neurodevelopmental therapies for patients with mental illness including autism (Stiffler, 10/20).

    St. Louis Post-Dispatch: Home Health Workers In Missouri Fight For Higher Minimum Wage
    For home health attendants and their patients, a push to raise the workers’ hourly minimum wage is a no-brainer. “The people that take care of me deserve a living wage,” said Kyle Auxier, of St. James, Mo., who receives five hours of care at home every day from a home health attendant. “They don’t get what they deserve in my opinion. They can help someone disabled, like me, live their life normally.” But the proposal for an $11 hourly pay floor for those workers in a Medicaid-funded consumer-led health program has been met with skepticism and silence from some state policy makers. Auxier has Duchenne muscular dystrophy, a condition that has progressed as he’s gotten older. He has had a home health care attendant each day for the last four years but said his current worker was considering leaving because she makes only $7.75 an hour (Shapiro, 10/20).

  • Viewpoints: Health Care Opponent's Legal Strategy; The Challenge For This Open Enrollment

    The Wall Street Journal: Carvin's ObamaCare Tour De Force
    In 2011 after the first appeals circuit struck down the Affordable Care Act’s individual mandate, the White House asked the Supreme Court to take the case as soon as possible and "put these challenges to rest." There was no value in waiting on the merits to percolate in other courts, liberals argued then, given the grave practical consequences for this landmark social legislation. So observes Jones Day attorney Michael Carvin in his corker of a reply brief asking the High Court to accept King v. Burwell, an equally consequential challenge to ObamaCare. Yet now the White House is asking the Court to wait, and wait, and wait, which Mr. Carvin calls "irresponsible" and "out of touch with reality." The 12-page document is a master class in legal persuasion and deserves more readers (10/20). 

    The New York Times' The Upshot: Next Open Enrollment For A.C.A. Approaches, But Few Notice
    This year, the big challenge for officials behind the Affordable Care Act may not be making the website work but getting customers to come shop in the first place. A new survey of people without health insurance highlights the challenge: It found that 89 percent of the people surveyed were unaware that open enrollment begins in November, or any time soon (Margot Sanger-Katz, 10/21). 

    The New York Times' Letter From America: Obamacare Losing Power As A Campaign Weapon
    Then there was the disastrous rollout in late 2013, caused by computer glitches that cost the program precious credibility at a critical time. That's what most people remember — which might explain why some Republicans seeking election next month are still running attack ads against the health care law. The problem with that narrative is the program is proving to be a success, and yet the health care initiative — arguably the most significant piece of social legislation in decades — is no longer a prominent part of the Democratic agenda (Celestine Bohlen, 10/20). 

    Los Angeles Times: To Govs. Jindal, Perry: A Travel Ban Won't Save Lives, But Medicaid Will
    For Bobby Jindal of Louisiana and Rick Perry of Texas, two Republican governors thinking about running for president, the Ebola virus has been a heaven-sent opportunity. It has allowed them to swank around as protectors of public health, distracting their audiences from policies they've implemented that really are threats to public health (Michael Hiltzik, 10/20). 

    The New Orleans' Times-Picayune: The Political Gamesmanship Of Opposing Medicaid Expansion
    Sen. David Vitter, who has never been mistaken for a liberal, said in a June speech to the Baton Rouge Press Club that if he's elected governor, he wouldn't rule out Medicaid expansion the way that Gov. Bobby Jindal has. This is noteworthy because the Medicaid expansion is a major component of the Affordable Care Act, also known as Obamacare, and Rep. Bill Cassidy is just about basing his entire campaign on Sen. Mary Landrieu's support of that legislation. ... If Jindal had agreed to an expansion of Medicaid, then Cassidy's argument that the Affordable Care Act has been bad for Louisiana would be more difficult to make. If there were 242,000 people who were granted access to medical coverage, Landrieu could rightly claim credit for that. And what self-respecting Republican is going to let a Democrat claim credit for something as monumental as bring health care access to the masses? (Jarvis DeBerry, 10/20).

    The Hill: ObamaCare — Why, Sure, It's 'Paid For'
    Republican Senate Budget Committee analysts reported last week that the Patient Protection and Affordable Care Act (ACA) — a.k.a. ObamaCare — would increase the federal deficit by $131 billion over the period from 2015 to 2024. Drew Hammill, a senior aide to House Minority Leader Nancy Pelosi (D-Calif.), dismissed the report as "complete garbage." Name-calling is no substitute for analysis. The Senate budget analysts' work is fully transparent. Based on Congressional Budget Office (CBO) data on medical spending and labor market effects, it is quite easy to check out (Robert E. Moffit, 10/20).

    The Wall Street Journal: ObamaCare Shunts My Patients Into Medicaid
    Thirty years of experience in private medical practice uncovers many ironies. For example, recently several of my patients who had been paying for their own individual health insurance informed me that they were forced off private insurance and placed into Medicaid when they signed up for health care at Healthcare.gov. This unwanted change—built into ObamaCare with the intention of helping patients—has harmed them by taking away their freedom to choose a health-care plan that works best for them (Jeffrey A. Singer, 10/20).

    The Washington Post's Volokh Conspiracy: A Recent Poll Shows That Most Doctors Give Obamacare Low Grades – But Should This Influence Voters’ Evaluation Of The Program?
    A recent survey of doctors by the Physicians Foundation finds that most give low grades to Obamacare. Some 46% of the doctors polled gave Obamacare a grade of "D" or "F" and 29% gave it a "C." Only 25 percent give it an "A" or a "B," including just 4% who gave it the highest grade. It’s possible that some of the doctors who chose C really meant to say that it was at least reasonably good. But in modern America, thanks to grade inflation, a C is generally considered a very bad grade. Thus, it seems likely that a large majority of doctors have strongly negative view of the program (Ilya Somin, 10/20).

    Los Angeles Times: What's Behind The Huge Price Jump For Some Generic Drugs?
    Why are the prices of some generic drugs so darn high? That's a question many consumers have been asking lately. And now, a pair of prominent congressmen are demanding an answer from the drug industry. In letters to 14 pharmaceutical companies, the congressmen said they're investigating "the recent staggering price increases for generic drugs used to treat everything from common medical conditions to life-threatening illnesses" (David Lazarus, 10/20).