Tuesday, January 31, 2012

Tuesday Tidbits

Big meeting with the Insurance Commissioner today, but first, the news:

People with pre-existing conditions are stuck in high risk pools until 2014 -- assuming the health reform law still stands by then. Although the Pre-existing Condition Insurance Plan that was part of health reform provides comprehensive benefits at a reasonable cost, you can only enroll if you've gone without insurance for six month -- so if you were in a state high risk pool, you can't switch to the better, cheaper PCIP unless, of course, you're willing to go without insurance for 6 months, which is a fast track for bankruptcy for people with pre-existing conditions.

Obama Administration lawyers filed their second brief in the Supreme Court's health reform case -- this one on the issue of whether the rest of the law can survive if the individual mandate is struck down.

Aetna has followed WellPoint and will be providing extra payments to doctors to manage and coordinate care in New Jersey and Connecticut. These are the kinds of innovations we need to try to see if we can drive down cost.

New websites allow you to search for side effects of medications. One company is called AdverseEvents. The other is Clarimed. They do charge to sign up for them, but the charge may be worth it.

What's a nurse to do when the patient is violent? Did you know that physical assault is the third most common fear nurses have?

Acupuncture helps control pain. The idea isn't to abandon traditional therapy; it's to supplement it with acupuncture. Interesting. I do know some patients who swear by it.

Utah is considering a surcharge on Medicaid recipients who smoke cigarettes.

Strokes are becoming more common in young people.

An interesting new book says we under-treat the poor and over-treat the wealthy. So what's the solution?

Unexplained high fevers can be a sign of something serious, so don't ignore them.

Fascinating new research on how we humans came to be as we are, and to populate the earth.

An interview with a researcher who has spent his life trying to understand the immune system.

Doctors are migrating to providing services that are lucrative, like cosmetic surgery, which is never covered by insurance. I don't know -- if I were having plastic surgery, I think I'd want an expert plastic surgeon.

A medical mystery that took years to solve, and in the end, no real answers.

Art as a way to deal with emotional trauma due to domestic violence.

Here in Connecticut, the public option - SustiNet -- is still here and its proponents are still pushing.

And that's today's news. Have a great day! Jennifer

Monday, January 30, 2012

Monday Musings

Mondays just come around too fast for me, and I have a busy week this week. So I better get going. Here's the news:

Congress needs to get serious about extending the payroll tax cut, unemployment, and the deferral of the Medicare physician reimbursement cuts. The GOP claims there will be quick action. Of course, there's still no agreement about how to pay for any of this.

Texas will not get a waiver from the medical loss ratio rules that are intended to help bring down premiums. Medical loss ratio is the percentage of premium dollars spent on health care. Health reform says that must be 80 or 85 percent. States were allowed to request waivers if the new rule would destabilize the state's market for health insurance. Texas made a request and the feds said no. Which is good because Texas is one of the states where we hear about the most suffering.

Your blood pressure should be taken in both arms, and if there's a significant difference between the two, that may be a symptom of vascular disease. A very inexpensive way to guard against a killer -- good advice.

Doctors, hospitals still make too many simple mistakes -- as simple as failing to wash their hands. The associated costs are part of the reason for high health care spending.

The Obama Administration's ruling that contraceptives have to be made available by all health plans is getting some push back at Catholic colleges. The church itself is pretty upset, as well. No surprise here.

More about Wellpoint's plan to compensate primary care doctors more to pay for care management. This is a really important experiment at innovation. Will care coordination pay off in the long run? I bet the answer's yes.

You want to know why your Crohn's disease (or any disease related to inflammation) gets worse when you're stressed? Here's a study that shows that stress activates the immune system, causing inflammation. The suggested response? Avoid relationships that are difficult and contentious. Yeah, right.

The wonderful Dr. Pauline Chen writes about how advertising affects the medications we take.

A new diabetes drug injected once a week wins FDA approval.

Here's why states are cracking down on pain meds -- dealers are getting so creative that they are opening their own pharmacies. And so the people who really need meds can't find a legit doctor to prescribe them. What a mess.

A group of workers at the FDA are suing the agency for monitoring their personal email. They were looking for communications with Congress. As a general rule, no employee has a right to privacy when using a work computer. Keep that in mind.

A blog may be therapeutic for teenagers. I know it is for me.

Caffeine may alter estrogen levels, although its effect is different depending on race and the researchers don't fully understand why.

And that's it for this morning. Have a great day. Jennifer

Friday, January 27, 2012

Finally Friday Edition

No matter how fast I work, there's always too much to be done. But first, the news:

Getting caught in the broken health care system, finding care to be elusive. This woman is scheduled for cataract surgery, but her insurance company and the hospital haven't reached a contract, so the insurance company won't pay for the surgery. This story is mild. I've been working with a man who's scheduled for a liver transplant and, for awhile, the insurer was saying he couldn't have it where all of his doctors are because they hadn't reached a deal on reimbursement rates. We finally got it resolved, but these are the kinds of pot-holes that mar the health care system in America.

Wellpoint (Anthem Blue Cross) is trying a new system of paying doctors that will increase reimbursement rates to primary care providers dramatically in the hope that this will improve patients' overall health. We need to watch this innovation and see if it helps to curb costs.

The House GOP is waiting to see what the Supreme Court does before making any more efforts to repeal health reform. We're all waiting for this. Meanwhile, a majority of Americans expect the Justices to vote based on ideology rather than law. Very sad.

Providers are supposed to switch to ICD-10 codes this year, but doctors are lobbying Congress to put it off. The change would be very expensive, as they go from 13,000 codes to 68,000 codes.

The General Accountability Office says Medicare Advantage Plans are still raking it in. More cuts?

An investigation in California found that nursing homes were making serious errors in dispensing prescription drugs. This is really scary.

About 7% of Americans have the human papilloma virus in their mouths, indicating it is spread by oral sex.

Bill Gates donated $750 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Here's how pharmaceutical companies use symptom checklists to get you to try their drugs.

Do you think it's legit for NY City to use this doctored photo in an anti-diabetes ad?

Remember Erin Brokovich? She's now investigating a mystery ailment affecting teens near a possible contamination site. Great!

And interesting study shows that a virus that affects e coli bacteria found a new way into thriving after its usual pathway was closed off. The point is that it was resilient and wouldn't stay dead.

And that's today's news. Have a great day. Jennifer

Thursday, January 26, 2012

Connecticut Excludes the Disabled -- Again

Connecticut is well into the planning stages of health reform implementation. That means setting up a bunch of advisory committees, including committees that will give consumers a voice in health reform. Since we have worked so hard on health reform on both the federal and state levels, we hoped to be on the Health Reform Consumer Advisory Board. Indeed, according to the official vote tally, we were among four people voted first by the Health Care Cabinet. However, we were not selected.

Instead, Jeannette DeJesus, the Governor's Special Advisor on Health Reform, chose people further down on the list. She claimed to have done so in the name of diversity. However, since I am a person with a disability under the ADA, and there are no other people with disabilities on the Committee, you'd think that including me would have promoted diversity, no?

Apparently not in Connecticut. Jennifer

Thursday Themes

And another day of news:

The House GOP says that it will offer an alternative to health reform after the Supreme Court rules on the constitutionality of the existing law. Instead of requiring coverage of pre-existing conditions, they will offer those of us with pre-existing conditions high risk pools -- extraordinarily expensive, poor coverage, limited choices, and not "insurance" so not regulated. Thanks, but no thanks.

The new Center for Medicare and Medicaid Innovation is expected to release its report today documenting the experiments in care delivery and financing that it is funding now to help find ways to cut the costs of health care.

The Obama Administration released long-awaited regulations for school lunches, which are intended to help fight childhood obesity. If only someone had done this when I was a kid.

A horrible story about a woman whom North Carolina decided should not have children, so she was forcibly sterilized. In the United States this happens? Are you kidding me?

And you think you waited a long time for disability benefits? Here's a story of a man who waited from 1950 to today!

Learn about what it's like to live with hemophilia. The challenges are remarkable.

Pharma has been focusing more on treatments for rare diseases -- finally!

Here's some good advice -- make appointments for health screenings for the year now so they're on your calendar, not to be forgotten.

The CDC has failed to determine the cause of Morgellon's, a rare skin disease.

And that's it for this morning. Have a great day! Jennifer

Wednesday, January 25, 2012

Hump Day Headlines

It's a good thing that I recorded the State of the Union because I got in bed and fell asleep immediately after a very satisfying dinner with my Dad and his significant other. So I can't tell you yet what the President said, although I can tell you that he didn't say much about health care. But I can do as I do every day and give you the health news:

Here are the health-related excerpts from the speech. "I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny your coverage, or charge women differently than men. ..." Sounds good to me.

Under health reform, each insurer is required to produce a summary of benefits and coverage in a uniform format so people can understand and compare plans. Yesterday, several consumer advocacy organization asked the President to stand firm on that new rule, despite industry criticism.

Remember when everybody said fixing the payroll tax cut, unemployment and the Medicare reimbursement rate cuts was going to be easy? Well, now the headline reads "the two sides are far apart." Why aren't I even slightly surprised?

HHS Secretary Kathleen Sebelius says health reform will continue even if the Supreme Court strikes down the individual mandate.

The American Psychiatric Association is considering adding "grief" as a mental health disorder. It's a type of depression. I can buy that.

Ever hear of brown fat? Well, apparently, brown fat burns calories like crazy, and cold weather can stimulate that. I think I'll move my office outside for the winter.

A lovely story -- the best man donates a kidney to the bride. Now, that's a wedding gift!

And that's the news. Have a great day. Jennifer

Tuesday, January 24, 2012

Tuesday Tidbits

A whole day without a computer malfunction. Of course, my computer will never be the same. Can't even get the colors right. But it works. And here's the news:

The number of people without insurance rose again in 2011. While young adults were more likely to be insured, baby boomers are feeling the pinch, as are those earning under $36,000. What we can see from our work is that people are unemployed, can't afford COBRA, have no options with pre-existing conditions, and can't get Medicaid in most states without a child living in the household. It's a hard world out there.

Some states are not moving forward with exchanges, taking a wait and see approach to the Supreme Court and the Presidential election. If they bet wrong and can't get up and running in time, the feds will take over their exchange and they won't be happy with that, either.

The Supreme Court rejected a request for debate over whether Justice Kagan should hear the health reform law in the face of claims of conflict of interest from her work as Obama's Solicitor General.

John Stewart interviews HHS Secretary Kathleen Sebelius on health reform. I'll try to find video later. (Update: video is here).

The Patient Centered Outcomes Research Institute came out with its draft priorities on Monday and didn't chose particular diseases -- instead, they focused on broad topics such as comparing medical options.

As we come to realize that we may not need all of those tests for things like bone density, how do we know what's legit and what's not?

Women rate their pain higher than men. Why? Are they really in more pain? Is it all subjective? The guess is that there's a biological difference -- more things we need to try to understand.

When is stress good for you? It's good to get the surge of adrenaline, the juices flowing, the motor running -- but when it is too much, and how do we turn it down?

Pre-diabetes, when you can see it coming and maybe even stop it.

Should we be funding alternative medicine to see if it works, or is it a waste of dollars?

Hospitals are offering free parking, discount shopping, all to woo patients.

Long-term care insurance -- is it for you? It's definitely not for everyone. Is it right for you?

Food allergies are not as rampant as we thought, and they change over time. But allergy to the cold? That's actually real!

A new, broader definition of rape to include male victims.

A stem cell study shows promise in treating macular degeneration.

Older people benefit from virtual brain exercise as well as physical exercise.

Childhood obesity NOT due to those vending machines?!!!

"Cupping" -- sort of like acupuncture -- begins to catch on in America.

That's it. Have a great day. Jennifer

Monday, January 23, 2012

Breaking News?

I don't know if this should really count as breaking news, but...

POLITICO Breaking News
The Supreme Court has denied a request for debate over whether Justice Elena Kagan should recuse herself from the health care reform case due to be argued in March.

For more information... http://www.politico.com

Of course, any other decision would have subjected each of them to this sort of inquiry in this and other cases, so of course, they decided no on this. J

Monday Musings

For some reason, Gabrielle Giffords's decision to resign has me all teary. So here's the news, minus comment:

The State of the Union is tomorrow. Everybody already hates it.

Should health insurance be required? Read two views.

Obama Administration rules that contraceptives are covered for free under health reform. Religious employers have a year to get on board. They're going to sue.

The GOP pushed Obama to make a decision on the Keystone pipeline. He made a decision: NO. But Speaker Boehner says he may try to get it attached to the payroll tax cut again.

Should doctors communicate via email? Yes, but only if the emails end up in the patient's medical record.

Student with autism is beat up on video and nobody steps in to help. Disgusting.

How to be a good patient and make your doctor like you. I'd add one more: Never show up with something they can't figure out or fix.

Advocates demand clarity about charity care. Some people don't know it exists or they can apply for it. Nobody knows the standards you have to meet to qualify for it. It's a mess, and it must be made transparent.

In effort to grow, Catholic Hospital Systems pares its ties to the church.

The rich get fancy hospital rooms.

New nursing training.

Study of chelation therapy to combat heart disease continues despite the lack of indication that it works.

Studies funded on "energy healing." Should we be funding studies of alternative treatments? Here's one you can skip -- coffee enemas.

Exercise caution when choosing health apps.

A certain treatment improves the chances of brain tumor patients.

Statins might fight breast cancer.

That's all. Have a great day. Jennifer

Friday, January 20, 2012

New Guidance on School Anti-Discrimination Laws

Yesterday, the US Department of Education issued new guidance on how the 2008 Amendments to the Americans with Disabilities Act impact the reach of Section 504, which is the law that requires that students with disabilities be provided with reasonable accommodations.

This new guidance states that a student need not have a problem with the "major life activity" of learning; substantial impairment of any of a whole host of major life activities is sufficient to establish that a student has a disability under Section 504. The guidance also confirms that, for a student with an episodic illness, if it would be disabling when flaring, it's considered a disability under Section 504 at all times.

In addition, the guidance makes clear that, even if the student doesn't need special education and related services, the school may have to provide accommodations -- use of an elevator for a student with a lung disease; the ability to make up assignments without penalty if a student has missed a lot of school; and so on.

In other words, we were right all along about what we've been saying to school districts. Now, we have additional ammunition to prove it. Jennifer

Finally Friday "Oh, man" Edition

Oh, man. I spent over $1000 fixing my work computer after it was attacked by perverse malware, and now I can't log on remotely from home, which means something's wrong on the work computer STILL. Oh, man.

And yet, I'm still here with the news.

Some glitches, some failures in the health reform law. The big deal is that Congress failed to include any appropriations for consumer assistance programs all over the country that were supposed to help people find insurance and even appeal insurance denials. Many of those programs are struggling, and Texas has complete closed its program. Then there was the 1099 reporting requirement and a glitch on Medicaid eligibility, both of which were fixed. And the CLASS Act -- long-term care -- has been deemed unaffordable for now. Those are relatively small issues, although the consumer assistance programs are critical. How Congress could have cut funding for something so critical and relatively inexpensive -- $30 million for all 50 states per year, which is a drop in the federal budget bucket -- I don't understand. Oh, man.

The Congressional Budget Office finds that some of the early pilot programs to improve care and cut costs in Medicare have not had any positive effect. Oh, man.

Lack of dental coverage sends patients to the ER for pain. Most people -- including me -- don't have dental coverage. Many go years without seeing a dentist, waiting until they are in pain. Then they go to an ER, which isn't going to do much with a dental problem. Oh, man.

The American Psychiatric Association is tinkering with its definition of autism -- and that may mean kids don't get the treatment and support they need. This is an outrage. It's APA statements that preclude many people from getting insurance coverage of residential treatment programs already. Now autism? Oh, man.

Suicide rates among active duty soldiers are at record highs. We owe these folks the treatment they need before things get this far. Oh, man.

Johnson & Johnson will pay $158 million to settle a case brought by the state of Texas for improperly marketing Risperdol to Medicaid recipients. Big pharma -- oh, man.

Washington Adventist Hospital denied visitation to a same sex partner. Visitation -- that's all. Oh, man.

A new drug combo for Hep C holds promise. And a new program for encouraging HIV testing called Testing Together encourages screening. A good oh, man (just a slight difference in tone).

Food stamp recipients challenge their critics to walk in their shoes. Newt Gingrich has been pounding them, as have others. I often say I wish anti-health reformers would sit in my chair for a day and hear what I hear, the secret tragedies of America. So I get this. Oh, man.

Many teens who got pregnant say they didn't know they could, so they didn't use birth control. Sounds like a failure of education to me. Oh, man.

The Connecticut Health Insurance Exchange board is muddling along, making major decisions without input from consumers. Oh, man.

And that's it for this morning. Let's hope next week is better than this one has been. Oh, man. Jennifer

Thursday, January 19, 2012

Thursday Themes

Well, my computer is finally rid of the virus and I'm here in the office at 5:47 am, so I might as well do the news:

States are running out of money for the Pre-existing Condition Insurance Plan -- the plan that allows people who've been without insurance for 6 months to sign up for affordable, comprehensive insurance. States are looking for some reassurances from the feds about where 2013 funding is going to come from. Of course, this was one of the Republican pieces of health reform, so in a well-functioning Congress, there would be bipartisan support for continued funding. But we have anything but a well-functioning Congress.

Nearly half of Americans live in a household that receives government funding.

Many with mental illness go without care. We need to deal with this. Insurers deny coverage even when people are violent and very disturbed. Providers throw drugs at patients. But often, care is entirely elusive -- one of America's dirty little secrets.

A three year old girl in New Jersey is being denied a kidney transplant because she also has a "mental disability," according to her parents. If this is true, it's a travesty that should concern us all.

Vermont is moving forward with its plan to have single-payer health insurance, with a strong bill creating an exchange that is bold and forward-moving.

Kaiser Permanente is going to use safer, more eco-friendly IV equipment. Of course, since (in our humble experience) they refuse to cover anything more expensive than the flu, I'm not sure how much that will help patients.

There are new questions about whether regular bone density tests are really necessary after a diagnosis of osteoporosis, considering how slowly that disease progresses.

Nearly one quarter of changes to people's intelligence is linked to their genetics. Still, lifestyle is the main influence on how the brain ages.

Abortion rates are higher in countries where abortion is illegal.

Connecticut's Office of the Healthcare Advocate recovered over $11.46 million for consumers last year. If ever there were an argument in favor of consumer assistance programs to help consumers fight their insurance companies, this is it.

And that's today's news. Have a great day! Jennifer

Wednesday, January 18, 2012

Hump Day Headlines

Wednesday already? YAY! So here's the news:

Congress is back. As you may recall, they punted for a short-term fix on three issues -- payroll tax cut, Medicare reimbursement rate hike, and extended unemployment benefits. They seem optimistic about wrapping this up quickly. You wanna bet?

Don't understand health reform? Have questions? Watch this short video. All will be revealed!

What will the Supreme Court do on health reform? The answer isn't as clear as we all once hoped it was. My fear of what happens if we lose the promise of insurance despite pre-existing conditions takes my breath away.

Young adults are making gains under health reform, mostly because they can stay on their parents' policies to age 26.

The Supreme Court has 2 Medicaid cases that could transform the program. First, as part of the health reform case, 26 states challenge the law's Medicaid expansion, even though it will cost them nothing to start with and little thereafter. Second, a California case already argued centers on whether states can be sued because their Medicaid program isn't in full compliance with federal law. These cases, taken together, could result in a Medicaid program in which states have free reign -- and depending on the state, that could be really bad for some.

The CLASS Act -- part of health reform that would create long-term care insurance -- has been deemed to be unaffordable for now, according to the Obama Administration, but they want to keep it on the books to revisit another day. The GOP is pushing to get rid of it entirely, though.

Tiered insurance. You heard it here first. If you go to one hospital, it's free. If you go to another hospital, you pay 10 percent. If you go to a third hospital, you pay 20 percent. These policies are being sold in Massachusetts as great cost cutters, but do they really save money? Mostly, they're incredibly confusing.

A new drug may treat colon cancer if all alternatives are exhausted.

Diagnostic errors highlight the need for a second opinion.

A heartbreaking decision, but one that brings life. Just read.

Obesity rates have leveled out -- stopped increasing, but no decrease, either.

Check out this video. If you haven't been to the doctor in awhile, this is a cautionary tale. GO TO THE DOCTOR!

Paula Deen just "came out" about her type 2 diabetes -- and now she's a pitchwoman for a diabetes drug. She couldn't have gone public simply to raise awareness? She's not even changing her on-TV fat-laden cooking style. It's all about the green for Deen.

And that, my friends, is the news. Have a great day. Jennifer

Tuesday, January 17, 2012

Tuesday Tidbits

I did take the day off yesterday -- could have kept sleeping, but there were 10 messages on my voicemail at work, so I guess it's good I came to work. First, the news:

Under health reform, insurers and employers have to pay to screen kids for obesity and to counsel those who need it. But how best to help kids who are overweight? Few models exist.

Mitt Romney and health reform -- getting the facts straight.

The Obama Administration is set to require drug companies to disclose payments to physicians. Good.

A new groups will set priorities for Medicare Coverage. Called the Patient Centered Outcomes Research Institute (PCORI), the Institute will give out $3 billion in grants for comparative effectiveness research -- are more expensive treatments really better? Good question. My concern is that different things will work for different people, so while some people may not need the expensive option, some will, and I'm afraid that this research won't allow for that flexibility.

A study shows that patients like being able to read their medical records.

An achy calf may be deadly deep vein thrombosis. Take it seriously. And see an expert in vascular medicine to make sure you get the right care. (Disclosure: I am biased. My brother runs the Vascular Center at Mass General -- so just read the article for yourself.)

Nearly 1/3 of Americans take an aspirin every day -- and that could be doing more harm than good.

What if the doctor is wrong? A good reason to get a second opinion.

Problems in the gut may lead to other problems, some in the brain. Fascinating. Bacteria in the gut may lead to depression and anxiety. Wow.

And deep brain stimulation may also help depression and other illnesses. We got this device for a young man with Tourette's syndrome and it was a life saver.

A DC cardiologist is developing an app to tell if you're having a heart attack.

Brand name drugs may be no better than generics.

Crossword puzzles may hold keys to the subconscious mind. Hmmm -- I always feel pretty conscious when doing crossword puzzles!

Researchers in Israel report that there may be a new weapon against super-bugs thought to be resistant to antibiotics.

Workouts have their limits -- as they should. But not everybody observes those limitations. But don't skip your winter workouts.

Is there an upside to depression? Skepticism is warranted.

The US is launching war on Alzheimer's. Good.

Understand your thyroid gland -- it's small, but it does a big job.

Food myths and truths are revealed in a new book.

Paula Deen goes public with her Type 2 diabetes. And she's cooking differently, too.

And that's today's news. Have a great day! Jennifer

Friday, January 13, 2012

Finally Friday Edition

And another long week-end ahead. I don't usually take off when my office is closed, but this week, I think I will. Still tired from my medication incident, so I can use some extra time for me. But first, the news:

Let's start with good news -- Americans are living longer. But it's all about what you do with that extra time, isn't it?

Yesterday, as previously reported (below), the Obama Administration found rate hikes by Trustmark to be unreasonable, ordering the company to either rescind them or justify them. This is just one way the health reform law is starting to combat high insurance premiums.

A new study shows, though, that premiums could rise as much as 25% without the individual mandate.

A group of patient advocates has asked the Department of Health and Human Services to extend the deadline for comments on the essential health benefits proposal (which would allow states to determine which benefits are essential).

Cigna and Weill Cornell Physicians of New York have agreed to team up to create a new care delivery model, an accountable care organization, with registered nurses performing care coordination tasks.

What's the role of pharmacists in health reform? To encourage people to comply with their medication regimen, which saves money in the long run.

California has county health plans -- a public option of a sort -- profiled today by Kaiser Health News.

Vitamin D levels decrease one marker of inflammation (c-reactive protein), but too much may cause an increase in CRP. How much is enough? Vitamin D has been essential to me in dealing with my Crohn's.

CVS Caremark will pay $5 million to consumers for deceptively advertising costs of medication through one of its Medicare Part D plans.

A new test might someday help spot lung cancer in its earliest stages.

Swedish doctors replaced a cancerous windpipe with an artificial one.

And that's today's news. Have a great day! Jennifer

Thursday, January 12, 2012

Health Reform Holds Insurers Accountable for Rate Hikes

News Release

January 12, 2012

Health insurance premium increases in five states have been deemed “unreasonable” by the U.S. Department of Health and Human Services, HHS Secretary Kathleen Sebelius announced today.

After independent expert review, HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.

To make these determinations, HHS used its “rate review” authority from the Affordable Care Act (the health care law of 2010) to determine whether premium increases of over 10 percent are reasonable.

"Before the Affordable Care Act, consumers were in the dark about their health insurance premiums because there was no nationwide transparency or accountability," said Secretary Kathleen Sebelius. "Now, insurance companies are required to disclose rate increases over 10 percent and justify these increases. It’s time for Trustmark to immediately rescind the rates, issue refunds to consumers or publicly explain their refusal to do so."

In these five states, Trustmark has raised rates by 13 percent. For small businesses in Alabama and Arizona, when combined with other rate hikes made over the last 12 months, rates have increased by 27.2 percent and 18.1 percent, respectively. These increases were reviewed by independent experts to determine whether they are reasonable. In this case, HHS determined that the rate increases were unreasonable because the insurer would be spending a low percent of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.

In addition to the review of rate increases, many states have the authority to reject unreasonable premium increases. Since the passage of the health care reform law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.

Examples of how states have used this authority include:

  • In New Mexico, the state insurance division denied a request from Presbyterian Healthcare for a 9.7 percent rate hike, lowering it to 4.7 percent;
  • In Connecticut, the state stopped Anthem Blue Cross Blue Shield, the state’s largest insurer, from hiking rates by a proposed 12.9 percent, instead limiting it to a 3.9 percent increase;
  • In Oregon, the state denied a proposed 22.1 percent rate hike by Regence, limiting it to 12.8 percent.
  • In New York, the state denied rate increases from Emblem, Oxford, and Aetna that averaged 12.7 percent, instead holding them to an 8.2 percent increase.
  • In Rhode Island, the state denied rate hikes from United Healthcare of New England ranging from 18 to 20.1 percent, instead seeing them cut to 9.6 to 10.6 percent.
  • In Pennsylvania, the state held Highmark to rate hikes ranging from 4.9 to 8.3 percent, down from 9.9 percent.

Today’s announcement comes the same week that a report showed that health care spending has grown at remarkably low rates. According to an analysis done each year by the Centers for Medicare & Medicaid Services, U.S. health care spending experienced historically low rates of growth in 2009 and 2010. A recent study released by Mercer Consulting also showed a slow-down in the average employee health benefit cost to businesses.

The Affordable Care Act includes several policies, including rate review, to continue this slow growth. By fighting fraud, better coordinating care, preventing disease and illness before they happen and creating a new state-based insurance marketplace, it helps keep health care cost growth low.

For more information on the specific determinations made today, please visit http://companyprofiles.healthcare.gov/

For general information about rate review, visit: http://www.healthcare.gov/law/features/costs/rate-review/


Thursday Themes

Well, turns out my crappy feeling yesterday was an adverse reaction to a new drug. Back to the drawing board -- but a good reminder. If you're taking a new drug and you start to feel unwell, consider whether it's the med doing the damage. The adverse reaction I had was not listed on the label, but when I told my doctor, her response (via email) was STOP! But it's up to us to identify those symptoms and reach out to our doctors and ask -- and not take any more of the medication until we get a response.

And after that cautionary tale, here's the news:

Nearly 500 state legislators will file a brief today in the Supreme Court urging the Court to uphold the individual mandate -- including legislators from the 26 states challenging the law.

Yesterday, the Supreme Court heard argument in a case that asks whether state employees are entitled to the protections of the Family and Medical Leave Act. Let's hope they get this right. Because here's one they got wrong. If you work for a religious institution, you may not have any rights under the Americans With Disabilities Act or other anti-discrimination laws, according to a Supreme Court decision handed down yesterday. The ruling will NOT apply to people who don't do religious-oriented work, but this teacher -- who gave religious instruction for 45 minutes each day, and the rest of her day was spent on secular teaching -- was a "called" teacher, and that was enough for her to fall into the "ministerial exception." This is a huge step backwards for people who work for religious institutions.

5% of patients account for HALF of the health care costs in America in 2009. About $90,000 per person in the top 1%, which accounted for 22% of health care spending. Who are these folks? Women. Elderly. White. People "in poor health" -- people with chronic illnesses.

A report shows that narcotic prescriptions rose sharply in New York and the New York Attorney General is using it to support a narcotic tracking system. Watch out, New Yorkers. If you think it's hard to find a pain management doctor now, and if the experience of other states is any indication, this can cause you real problems. Write your state's Attorney General NOW and make sure that the law includes protections for legitimate pain patients.

Should doctors consider cost when making treatment recommendations? The American College of Physicians says it's the only ethical thing to do. Read what doctors think.

Medicare Advantage Plans are using gym memberships to entice enrollees -- is that cherry-picking the healthy patients, which is against the law?

Medical schools are starting to teach alternative medicine. Wonderful!

A hormone secreted during exercise may explain why exercise helps to fight obesity and diabetes.

And that's today's news. Have a great day! Jennifer

Wednesday, January 11, 2012

Hump Day Headlines

It's Wednesday, so here's the news:

We all know about the Supreme Court's case challenging the individual mandate. However, yesterday, 26 states filed a brief challenging the authority of the federal government to require the states to expand Medicaid. It wasn't a good sign when the Supreme Court agreed to consider this question and I'm nervous -- this is so critical for people who can't afford insurance even with a subsidy. In most states, childless adults who are not on Social Security disability cannot get Medicaid. The Medicaid expansion, set to take place in 2014, was supposed to change that, ensuring that poorer adults also would be covered. But Medicaid is funded jointly by the feds and the states, although the feds would pick up the cost of the expansion at least early on. Of course, states can opt out of participating in Medicaid at all, but the states argue that isn't much of a choice since Medicaid is so critical to the health of millions of Americans. This could be the sleeper issue that really hurts health reform.

The Wall St Journal is taking a poll -- should doctors communicate with patients via email? So far, the votes are overwhelmingly yes.

Marijuana does not impair lung function like tobacco does, says a new study.

Americans are stressed, but getting used to it. We've adapted. Hmmm.

This is really interesting. An interactive tool that allows you to calculate your life expectancy so doctors, patients, and families can make better, more informed treatment choices.

Decorative water walls -- you know, those fake indoor waterfalls -- pose a health threat to patients with low immune systems. One appears to have been the trigger for an outbreak of Legionaire's disease.

One in six adults is a binge drinker. This is some serious drinking -- more than once a week, and about 8 drinks at a time.

And that's it -- a slow news day, at least in health care. Have a great day. Jennifer

Tuesday, January 10, 2012

Tuesday Tidbits

Nausea really sucks. But the news keeps coming. Here you go:

David Lazarus of the LA Times says President Obama should be taking a harder line on health reform implementation rather than letting the states do what suits them. I tend to agree.

US healthcare spending rose only 3.9% in 2010 -- the second lowest increase on record as people avoid health care during the recession. So health reform did NOT result in a spike in cost.

And here's a new book on health reform written by the architect of the law, Jonathan Gruber at MIT. It's a book for consumers in comic book form -- like a graphic novel except it's non-fiction.

The research arm of health reform is also getting more play these days. It's all about helping consumers make informed decisions.

What happens when a patient really "owns" his/her own medical record? Doctors worry, but a study is underway to see how it goes.

A diabetes patient talks about the way people respond to her. I think you could take pretty much any chronic illness and it would be about the same. People who don't have it don't "get" it. Do you know about spoons? Read here. This works pretty well. Another study says diabetes can affect jobs and wages for young people. Why do employers even know about it? They aren't allowed to ask.

Meanwhile, post-menopausal women who take statins for cholesterol run a higher risk of Type 2 diabetes.

What personality traits lead to obesity? This is fascinating -- I just have to completely change who I am and I'll be thinner!

Some doctors want a credit card before they will see you. Is going to the doctor like going to the store to buy something? I don't know -- this feels weird to me.

What happens to a relationship when one partner has a brain injury? Tears and courage.

Guess what? Nicotine gum, patches don't work! But you're tough; you can do it. And nicotine patches may boost memory in people with mild cognitive impairment. So it's not for nothing!

Exercise may help Parkinson's patients.

Our friends at New Haven Legal Assistance have sued the Connecticut Department of Social Services for failing to process Medicaid applications in a timely manner. Great job.

And that's today's news. Have a great day! Jennifer

Monday, January 9, 2012

Is Express Scripts your Pharmacy Benefit Manager?

If so, apparently they have not reached a contractual agreement with Walgreen's, so you no longer can fill prescriptions (including refills) at Walgreen's. They're probably going to keep negotiating and this may change, but as of today, you cannot fill a prescription at Walgreen's. Jennifer

Monday Musings

A bit of a struggle this morning. I'm tired. But work comes first, and so here's the news:

As I told you on Friday, the US has filed its brief in the health reform case. As you know, the main part of the case challenges the requirement that people buy insurance. One of the individual plaintiffs is a woman who said it was her right to self-insure rather than buy insurance. The US has been saying all along that folks like these end up shifting the cost to the public. While the case has been pending, the woman racked up a lot of bills -- including medical bills -- and filed for bankruptcy protection. Which served to prove the point that the US has been making all along. It is NOT okay for people to shift the cost of health care to the taxpayers, and the best way to make sure that doesn't happen is to require them to buy insurance. This was one of the most convincing parts of the government's brief. Meanwhile, over 100 Republicans and economists filed an amicus (friend of the court) brief arguing that the Supreme Court should strike down the entire law if they find the individual mandate to be unconstitutional.

The health care sector continues to add jobs.

What's it like to be hearing impaired? Read and maybe you'll understand.

A run of thefts in pharmacies, looking for narcotics.

Hope for people with cystic fibrosis.

A small study shows that deep brain stimulation may help people with bipolar disorder.

Robotic devices help paralyzed people.

Poor sleep worsens health in kids with type 1 diabetes.

Should young people be getting obesity surgery? Is caffeine a weight loss aid?

A virtual cadaver for medical students to learn on.

The answer to last week's guess the diagnosis quiz from the NY Times. And once again, a reminder that we should not rest until we find answers to our medical problems.

That's it for this morning. Have a great day. Jennifer

Friday, January 6, 2012

Health Reform Brief

The US Department of Justice filed its brief on the individual mandate in the Supreme Court today. In case you are dying to read all 60 pages, here it is. If there's anything remarkable or unanticipated in it, I'll let you know -- after I've read it. Jennifer

P.S. -- Well, I've read it and it's really remarkably good. It's straightforward, clear, concise, and convincing. There were no surprises, at least in my view. If you're curious, give it a quick read. It's not overly technical -- just skip over the citations. I know I'm convinced, but that's no surprise, I trust. J

Finally Friday Edition

No long week-end this week. Oh, well. But there's still the news:

Most hospital errors go unreported. That's fairly shocking to me considering the number of adverse events that ARE reported. You really should consider taking steps if you are going into the hospital. I just read a new book call the Patient's Checklist. It helps you to remember all the things you need to know to make sure you get in and out of the hospital no worse off than when you began.

How health reform helps to control health care costs, by HHS Secretary Kathleen Sebelius.

The first round of briefs is due today in the health reform Supreme Court case. According to some experts, it will be critical for the government to explain not only why the individual mandate is within Congress's powers, but what the limit on those powers is.

The feds -- both Congress and the White House -- cut funds for heating assistance right at the start of winter, just before they left town for their holiday break. This is an outrage. It's not even a lot of money, as things go. And if you think it's not a health issue, wait until people start getting sick and have no heat.

Collaborative care -- employers, insurers, providers all working together -- may be a more efficient, effective health care delivery system.

States are asking for more funding for the Pre-existing Condition Insurance Plan, which covers people with pre-existing conditions until 2014, when insurers won't be able to exclude people with pre-existing conditions any more.

Arizona passed a law allowing the use of medical marijuana. The (pretty nutty) Governor sued to try to stop it from taking effect. A court threw out her lawsuit.

A Massachusetts court has found that the State cannot exclude legal immigrants from a state health plan. The court based its decision on the State Constitution, so how much this will affect other states is hard to say. But this brings Massachusetts another step closer to truly universal health care.

Shame in filling a prescription? When faced with alleged drug shortages of controlled substances or ADHD drugs, patients have to run in circles to get their meds, and some feel shame for needing them.

Is being fat a destiny? Recent articles, summarized by USA Today, discuss. I particularly recommend the NY Times article from last Sunday's NY Times Magazine.

Some employers are banning smokers from the workplace. Not just smoking, but smokers!

A hepatitis C vaccine is hopeful, but years away. A potential herpes vaccine falls short.

A recent dust up over a study reporting a way to make bird flu airborne raises the question -- how close are terrorists to being able to spread a communicable disease?

Can yoga wreck your body? Surprisingly, yes.

And that's today's news. Have a great day! Jennifer

Thursday, January 5, 2012

Thursday Themes

It's Thursday already and that's a good thing. Here's the news:

Private insurers are profiting from increase roles in Medicare and Medicaid. Despite the poor economy, health insurance is a very profitable business. This is so despite the fact that fewer employers are offering coverage, and those who do are charging employees more for it.

Here's another one of those NY Times puzzles -- guess the diagnosis. I'm totally hooked on these. In this one, one of the doctors is an old friend and colleague of my brother's (Jeff Olin), which really makes me curious. Can't wait for the answer!

HIV/AIDS is increasing within the Navajo Nation, at a time when they are decreasing in the general population.

Food allergies are an increasing problem, and vigilance is required. Not only do you have to be careful about what you eat, but you also have to prepare for slip-ups.

A new study shows that even a small gap in insurance compromises the health of a diabetic. I'm certain the same can be said of other illnesses, as well.

HHS rejected Kansas and Oklahoma's request for a waiver of the medical loss ratio requirement. This means insurers in those states will have to spend 80 or 85 percent of premium dollars on health care. Good.

A whistleblower suit accuses a nationwide hospice company of cycling patients through nursing homes and hospice to maximize profit.

A new study says that, although heart attack victims in the US will spend only 2-3 days in the hospital after the attack, they are more likely than patients in other countries to be readmitted to the hospital within the next month.

Drug shortages are an increasing problem due to hoarding and price gouging.

Will electronic monitors of caloric intake help people lose weight?

Due to concerns about resistance to antibiotics, US officials are further restricting the use of antibiotics in livestock.

The FDA has ordered a study of surgical mesh used to treat urinary incontinence in women due to many reports of injury.

And there you go -- a lot of news for a Thursday. Have a great day! Jennifer