By Ricardo Alonso-Zalvidar, Associated Press States will receive more than $9 in federal money for every $1 they spend to cover low-income residents under President Barack Obama's health care law, according to a nonpartisan analysis released Monday.
Expanding Medicaid to cover about 20 million more low-income people will cost over $1 trillion nationally from 2013 to 2022, said the joint report from the Kaiser Family Foundation and the Urban Institute. But the analysis found that states will pay just $76 billion of that, a combined share of roughly 7 percent. The feds will pay the other $952 billion.
Republican governors have resisted the Medicaid expansion, saying it adds an unacceptable burden to already strained budgets. And the Supreme Court handed the governors a victory this summer, ruling that states are free to reject the Medicaid deal.
Medicaid is one of the two main ways that Obama's law expands coverage to most of the 50 million uninsured U.S. residents. As a broader Medicaid safety net picks up more low-income people, new health insurance markets called exchanges will offer subsidized private coverage to the middle class. Both parts of the strategy take effect in 2014, at the same time that most Americans will be required to carry health insurance or pay a fine.
The new analysis was unlikely to change the minds of state leaders who have already rejected the Medicaid expansion, but it may help shape the debate in a majority of states still on the fence.
Among those refusing are Texas Gov. Rick Perry, South Carolina Gov. Nikki Haley, and Louisiana Gov. Bobby Jindal. For most others, the choice will come into sharp focus early next year as state legislatures meet.
"It's hard to conclude anything other than this is pretty attractive and should be pretty hard for states to walk away from," said John Holahan, head of the Urban Institute's Health Policy Research Center and the main author of the study, which used computer models of population, income and insurance coverage.
Under the law, Medicaid will be expanded to cover people up to 138 percent of the federal poverty line, or about $15,400 for an individual. It's mainly geared to low-income adults with no children at home, who currently cannot get Medicaid coverage in most states. Washington pays all of the cost for the first three years, gradually phasing down to 90 percent.
Some of the main findings:
— States that reject the expansion could still face a substantial increase in their Medicaid costs, as people already eligible for the program but not currently enrolled are prompted to sign up.
— States will save $18 billion from no longer having to offset the cost of charity for low-income uninsured people.
— Some states will actually come out ahead. New York, Massachusetts, Wisconsin and others that already cover low-income childless adults will be able to reap a more generous federal matching rate than they currently get.
— Texas, the state with the highest percentage of uninsured residents, would see a 6 percent increase in Medicaid spending. About 2.4 million residents would be added to the Medicaid rolls.
Medicaid is a federal-state partnership that varies from state to state. So the consequences for state budgets will be different in each case.
Not so for the uninsured, said Alan Weil, executive director of the National Academy for State Health Policy, an independent research and policy group. "This is more than a fiscal exercise," said Weil. "There is a human dimension that needs to be part of the discussion far beyond just the dollars."
McDonald’s restaurants in the United States will soon get a new menu addition: the number of calories in the chain’s burgers and fries.
The world’s biggest hamburger chain announced today that it will post calorie information on restaurant and drive-thru menus nationwide starting Monday. But the four Lawrence-area restaurants will have new menus Thursday.
Customers will know that ordering a Big Mac and medium fries, for example, will add up to 920 calories. Add a 16-ounce Coca-Cola and the count rises to 1,140 calories.
The move comes ahead of a regulation that could require major chains to post the information as early as next year.
“We want to voluntarily do this,” said Jan Fields, president of McDonald’s USA. “We believe it will help educate customers.”
In cities such as New York and Philadelphia where posting calorie information is already required, however, Fields notes that the information has not changed what customers choose to order.
“When it’s all said and done, the menu mix doesn’t change,” she said. “But I do think people feel better knowing this information.”
The decision to post calorie information in the U.S. follows the Supreme Court’s decision this summer to uphold President Barack Obama’s health care overhaul, which includes a regulation that would require restaurant chains with more than 20 locations to post calorie information. The timetable for carrying out that requirement is being worked out.
— The Associated Press contributed to this report.
Dr. Kipp Van Camp, an interventional radiologist in Topeka, is frustrated with the health care system and instead of just grumbling about it, he decided to write a book.
Among his frustrations are the high costs for care and the need for tort reform. He’s really irked about global health care rankings. He said often organizations are not comparing apples to apples, especially for infant mortality and life expectancy. He said the U.S. should be near the top in both categories.
“That’s been insulting. Health care in America is good and someone needs to talk about this stuff,” he said.
Van Camp said the book, “Misdiagnosis: A Practicing Physician’s Case Study in Health Care Reform,” covers the history of how we got to where we are, identifies what’s wrong and right with the system, provides details about the Affordable Care Act, and provides solutions.
“My goal is to bring about an awareness, to educate, and to debunk some myths,” he said.
Van Camp, 48, grew up in Colby and graduated from Kansas City University of Medicine and Biosciences. For three years, he was a family doctor in Weston, Mo., were he did everything from deliver babies to appendectomies. He decided to go back to school because he didn’t like the demanding hours and pushing paperwork instead of caring for patients. He became a radiologist and then an interventional radiologist, who does image-guided procedures. For example, if a woman finds a lump in her breast, an interventional radiologist does the biopsy to see if it’s cancerous.
Van Camp owns a radiology company called Critical Imaging Associates in Topeka. He’s also one of two hosts on a medical radio talk show called Doctor’s Orders, which airs on stations in Topeka and Kansas City.
In a 45-minute telephone interview this week, Van Camp covered a variety of topics contained in his book. Here are a few of the highlights:
• Pushing paperwork — He said navigating the increasing mandates for insurance coverage is reducing the time doctors are caring for patients. In 1979, there were 252 state mandates in place across the country, an average of five requirements per state. By 2009, there were 2,133, an average of 42 per state. “Patients are noticing the impact when they are increasingly being treated by nurse practitioners and not physicians,” he said. “It’s a trend that’s not going away.
• Tort reform — He said Congress should have included tort reform in the Affordable Care Act. “There are so many frivolous lawsuits that come in this country that it’s absolutely ridiculous,” Van Camp said. He said doctors are afraid they will get sued if they don’t do every high-tech test possible, which drives up costs. He said Texas has done an overhaul of their legal system and studies have shown it’s lowered health costs and drawn more doctors to the state. “Tort reform affects everyone because of the unnecessary costs it adds to already costly health care.”
• High-tech generation — Van Camp also blames the high cost of health care on society. He said Americans want the latest, greatest technology and medicine and as quickly as possible, but they aren’t willing to pay for it. “When you have high technology, you are going to spend a whole lot of money and America wants technology,” he said.
• Decision-making — While everyone wants the best medicine and tests, not everyone gets it. He said insurance companies have started making those decisions instead of doctors and patients. Van Camp said if an insurance company won’t pay for a drug, we have the ability to appeal it at the state level. He fears with health reform that appeals process will be taken away.
• Mandating insurance —He believes there is merit to a mandate because there are Americans who can afford insurance, but choose to spend their money elsewhere. When those Americans end up in the emergency room, hospitals are required to care for them. He said there may be years of wrangling over the bill but if it’s not paid, it costs the taxpayers. Under health reform, Van Camp thinks there should be an option to buy just catastrophic coverage.
He’s also concerned about the exemptions that fall under the Affordable Care Act. Among them: Christian scientists, American Indians, Muslims and Scientology. “I could claim Scientology and not have to buy insurance. That’s ridiculous,” he said.
• Insurance portability — Under health care reform, insurance will become portable, meaning if you have insurance in Kansas and move to Missouri, providers have to accept your insurance. That’s a good thing, he said.
• All or nothing — Instead of passing the Affordable Care Act, he said the country should have tried changing just one area, like tort reform or outlining what’s considered basic health care under insurance. Does it include: all vaccines, high blood pressure, smoking cessation and weight loss? That’s still to be determined.
“We never do anything in steps. We didn’t try something in one area, instead we pass this monstrous bill that’s out of control and affects the whole country,” he said.
SOLUTION: LESS GOVERNMENT
Van Camp, a Republican, said he tried not to play politics in his book, although he does “throw stones” at Congress for a lot of problems. “I tried to be as objective as a person can be carrying with them all of their biases,” he said.
Van Camp believes less government involvement is one of the keys to fixing the broken system. “My philosophy and my belief is that the private sector works. Get out of the way and don’t regulate too much and they will find the most cost-effective way to get things done,” he said.
He thinks people should be able to put money into health savings accounts for medications and procedures without being taxed for it.
Van Camp said he’s spent his medical career — 25 years — working on the book, but it only took six weeks to write.
“What I’ve realized is the system is broken but what I’ve been so upset about is that the system isn’t broken because the quality of care is bad,” he said.
The book is available online at www.drkipp.com.
Dr. Kipp Van Camp, an interventional radiologist in Topeka, will be available Jan. 11 to discuss his new book, “Misdiagnosis: A Practicing Physician’s Case Study in Health Care Reform.”
Van Camp will be participating in an online chat at 3 p.m. Jan. 11 on WellCommons.com. And, you can submit your questions anonymously at anytime at WellCommons/chats. Make sure to log back to WellCommons.com during or after the chat to see if your questions were answered.
Dr. Van Camp owns a radiology company called Critical Imaging Associates in Topeka. He also is owner and medical director of Rejuvenate Medical Spa, providing minimally invasive cosmetic medical procedures. He serves as an adjunct professor at Washburn University and Kansas University.
Van Camp is one of two hosts on a medical radio talk show called Doctor’s Orders, which airs on stations in Topeka and Kansas City.
Health and Human Services Secretary Kathleen Sebelius announced today $40 million in grant funding to enhance the nation’s public health infrastructure and strengthen the public health work force.
Nearly every state received funding, which is partly supported by the Affordable Care Act.
The Kansas Department of Health and Environment received $300,000.
“These funds will help health departments around the country maximize the impact of the essential services they provide every day and build the public health work force to ensure we’re ready to meet the public health challenges of tomorrow."
— HHS Secretary Kathleen Sebelius
The grants will fund key state and local public health programs in Kansas supported through the Centers for Disease Control and Prevention. Most of these grant dollars come from the Prevention and Public Health Fund created by the Affordable Care Act.
This is the second year of CDC’s 5-year program known as the National Public Health Improvement Initiative (NPHII) Strengthening Public Health Infrastructure for Improved Health Outcomes grant program. More than 100 people across the country have already been hired through the NPHII, and additional positions are expected to be filled through the awards.
For a full list of grantees, visit: www.hhs.gov/news/press/2011pres/08/state_workforce_grants.html.
Those two words came up time and again during an informal luncheon Thursday at Lawrence Memorial Hospital, where city leaders learned about the hospital and asked questions like “How can we help control health care costs?”
LMH President and CEO Gene Meyer said studies show that the best way is to practice preventive care instead of acute care.
It’s about changing behaviors: quitting smoking, reducing alcohol intake, exercising, eating right, and getting vaccinations and health screenings.
“It’s all about personal accountability,” he said.
Meyer said the hospital works closely with businesses throughout the county to promote wellness in workplaces. He suggested that the city have a nurse practitioner who is readily available to help its employees — not only when a need arises but to prevent the need from ever happening.
City leaders in attendance were City Manager David Corliss, Commissioners Hugh Carter, Mike Amyx, Bob Schumm and Mike Dever, and Assistant City Manager Cynthia Wagner.
Meyer gave an overview of the hospital and talked about some of his concerns:
• Medicaid population. He said there already is a shortage of doctors who accept Medicaid in Lawrence, and he expects that it will only be exacerbated with health reform. He expects those patients who don’t find care will end up in the emergency room instead of having a medical home.
• Internal medicine doctors. Lawrence needs one or two more internal medicine doctors now. He estimates the city will need 10 more in the next five to seven years. He also said more primary doctors are referring their elderly patients to internal medicine doctors.
Amyx asked why these doctors are so hard to recruit. Meyer replied with three main reasons: not enough are being trained, more are becoming hospitalists where they have control over their hours, and salary expectations are high. Practices simply can’t afford to pay the wages they are seeking. LMH is acquiring Internal Medicine Group on July 1 to help recruit doctors.
• Health reform. Meyer said the Affordable Care Act is the biggest change in health care in 50 years. It will change the system from paying for volume to paying for value. “We welcome that change,” he said. Health reform will bring financial penalties for: excessive readmissions, hospital-acquired condition, infection rates and patient safety incidents.
Meyer said LMH is preparing for health reform as the rules are still being written. “Are we ready? No. Is anybody ready? No,” he said.
LMH is hoping to get $1.4 million from the federal government for upgrading to an electronic medical record system. It spent well over that, so it hopes to be reimbursed as the federal government has promised.
Dever asked about the price of care at LMH. He’s heard that services cost more at LMH than in Topeka and Kansas City. Meyer said LMH does a cost study every year and LMH’s prices tend to be in the lower 25 percent of regional hospitals.
Dr. Daniel Dickerson, of Eudora Family Care, says that’s the motto of primary care.
“Our best treatment of a patient is to prevent anything from happening,” he said, in a telephone interview late Thursday.
If people get tests such as mammograms, colonoscopies, cholesterol, high blood pressure and glucose-tolerance (for diabetes), they are likely to have happier, healthier and longer lives. AND….best of all, they will help cut this country’s skyrocketing health care costs.
For example, Dickerson said regular cholesterol and blood pressure tests for one person cost a few hundred dollars a year. But if people opt not to get the tests and wait until they're very sick, they could end up with a $250,000 bill for a coronary artery bypass surgery.
“You can see how the money would add up in huge savings,” he said.
Colonoscopies are another great example, Dickerson said. The screening costs $3,500 every 10 years. If colon cancer is caught early, the treatment is less costly. If not, a person has to undergo an operation, chemotherapy, and, in many cases, ends up with a miserable, and usually shortened, life.
“By the time somebody has any symptoms of colorectol cancer, they are going to die from it. There’s no doubt,” he said. “Once, you have symptoms you’ve waited too long to get a colonoscopy. It’s rare to survive at that point.”
Even though many people have insurance, the expense of many preventive services has discouraged people from using them.
Thanks to the Affordable Care Act passed last year, that's now changed. As of Sept. 23, more people can now get preventive services without having to pay a single dime.
All health insurance plans must cover preventive services for plans that began on or after Sept. 23. That means, for a whole list of services, people do not pay deductibles, co-pays or coinsurance. Here are a few from the list:
• Office visit for a wellness visit.
• Breast and colon screenings.
• Screening for vitamin deficiencies during pregnancy.
• Screenings for diabetes, high cholesterol and high blood pressure.
• Cervical cancer screenings.
• Routine vaccinations.
• Vision and hearing screenings for children.
The full list can be found at healthcare.gov. The guidelines follow recommendations from the U.S. Preventive Services Task Force, Advisory Committee of Immunization Practices, and Health Resources and Services Administration for Preventive Care and Screenings for Infants, Children and Adolescents.
Starting Jan. 1, Medicare beneficiaries also no longer have to pay a deductible, co-insurance or co-payments for an annual wellness visit and many preventive services, including cancer screenings.
There is one big exception to all this, and that is for “grandfathered” insurance plans. These are health plans that have not significantly changed since March 23, 2010. The plans will lose their “grandfather” status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers.
Linda Sheppard, of the Kansas Insurance Department, said they expect these plans will be nonexistent within a few years.
There is no data on how many plans fall under the "grandfathered" status. Check with your insurance provider or company to find out whether your plan is exempt from the new rules.
A doctor’s call
Obviously, not everyone needs all of the preventive services.
Dickerson recommends scheduling a wellness visit with your physician, who will recommend the services appropriate for you based on your medical history and other factors, including your family history, age, and race. It’s also a good time to discuss exercise, diet and mental health.
Patients should not schedule a doctor’s visit when they’re sick or injured (with a cold or broken arm, for example) and then ask for a wellness checkup at the same time. Here’s why:
• If you are sick, the test results may be skewed. Someone with an infection might have a high blood sugar level, which may look like diabetes.
• The doctor isn’t going to have time to cover everything.
• Insurance companies can bill you for the office visit if it includes more than just preventive services.
“The intent of the law was to do something to encourage people to go out and get these preventive tests. So, that they can catch the disease early rather than later, when they are more costly,” Sheppard said. “Obviously, that’s also good for the patient.”
It seems to be working.
As of Feb. 23, more than 150,000 Medicare beneficiaries had a free annual wellness visit, according to the U.S. Department of Health and Human Services. That’s an average of 2,800 people per day since the law took effect Jan. 1.
FOR MORE INFORMATION
Under the Affordable Care Act, there are new guidelines regarding cost-sharing for preventive services.
Health beat: LMH 2010 accomplishments, KCUMB’s gift body program, chiropractors expand to Bonner Springs, Sebelius outlines insurance savings
Here’s a dose of health news from WellCommons, around town and elsewhere:
What a year at LMH!
Lawrence Memorial Hospital leaders recognized some of their 2010 accomplishments during the annual Endowment Association meeting Thursday night at Maceli’s.
• A new Community Care Navigator program. The program follows up with vulnerable patients at risk for complications after going home from the hospital. In the first five months of the program, the readmission rate of the patients contacted by the community care navigator was just 6 percent, compared with the expected readmission rate of nearly 20 percent.
• Better rating. Moody’s Investors Service upgraded LMH’s long-term bond rating from A3 to A2. It noted LMH’s strengths are its dominant market position in a favorable service area and its 10 years of increasing cash flow growth.
• High-tech device. It acquired the Secure Digital Forensic Imaging system to document evidence in abuse cases. It is the first hospital in Northeast Kansas to have this state-of-the-art system.
• Ottawa outreach. It opened Lawrence Specialty Care in Ottawa to offer several specialty services, starting with cardiovascular services. Dr. Darren Klish began providing radiation oncology services at the location.
• High-tech system. It achieved the Stage 6 designation of the HIMSS Analystics Electronic Medical Record adoption model. Only 108 health systems in the nation have achieved the designation. LMH is in the top 1.6 percent of 5,235 hospitals for EMR adoption.
Last month, I wrote a story about how to donate your body to Kansas University’s School of Medicine.
The story included who can donate, the donation process, and what happens to a body after KU is done with its research.
A few weeks later, I received a letter from Barbara Hunsinger, of Lawrence. She wanted to let me know that the Kansas City University of Medicine and Biosciences in Kansas City, Mo., also accepts body donations.
According to its website, KCUMB’s Gift Body Program has advanced the osteopathic medical education of thousands of students since establishment in the early 1960s.
Thanks for the information — Barbara!
The doctors of Advanced Chiropractic Services, 1605 Wakarusa Drive, opened an office in Bonner Springs this month.
It is called Midwest Chiropractic Services and operated by Dr. Beth Carleo. She is a graduate of Cleveland Chiropractic College.
The office is located at the northwest corner of I-70 and Hwy 7-140 North 130th Street. Carleo can be reached at (913) 721-5530.
More affordable insurance
Health and Human Services Secretary Kathleen Sebelius released a new report today showing how much families and businesses can save on health insurance premiums and out-of-pocket costs under the Affordable Care Act in 2014.
The report finds that, compared to what they would have paid without the law:
• Middle-class families purchasing private insurance in the new state-based Health Insurance Exchanges could save as much as $2,300 per year in 2014.
• Tax credits could lead to more savings. For example, a family of four with an income of $33,525 could save as much as $14,900 per year since they will also qualify for tax credits and reduced cost sharing.
• Small businesses, on average, could save up to $350 per family policy and many may be eligible for tax credits of up to 50 percent of their premiums.
• All businesses will likely see lower premiums of $2,000 per family by 2019, which could generate millions of dollars in savings.
These savings are in sharp contrast to the rising insurance costs families and businesses have experienced over the previous decade, she said.
From 1999 to 2009 premiums more than doubled, rising by more than $7,500 for the average family that gets insurance through an employer.
The high cost of health care made it difficult for many small businesses to offer insurance to their workers. The percentage of small employers offering health insurance dropped from 65 to 59 percent between 1999 and 2009.
The report can be found at: www.healthcare.gov/center/reports/premiums01282011a.pdf.
The Lawrence-Douglas County Health Department’s top legislative priority is to preserve the smoking ban.
Dan Partridge, director, said the ban saves the state money in health care costs and, more importantly, it saves lives.
“It’s nonsensical in my mind to even go there,” Partridge said.
The department also supports preservation of the Affordable Care Act. Partridge said he hopes legislators discuss how to implement the bill rather than how to repeal it because it contains much-needed changes. He said the state needs to continue to be proactive in applying for federal grant money and in setting up its own health insurance exchange.
“I hope we, as a state, don’t take a short-sided view of this and try to prove a point politically at the expense of people’s health care,” Partridge said.
David Johnson, CEO of Bert Nash Community Mental Health Center, agrees. One of the hallmarks of the Affordable Care Act is going to be more equal treatment for mental illnesses.
“I hope they don’t spend too much time trying to derail health care reform because I don’t think it will happen,” he said.
Johnson was encouraged to hear Gov.-elect Sam Brownback talk about reforming Medicaid.
Johnson said changing Medicaid to more of a managed care program would save money and provide better services.
About 50 percent of the people who get mental health services, first get them at an expensive state hospital because that’s what Medicaid pays for. If Medicaid paid for early intervention, education and prevention, then those high hospitalization costs could be reduced, he said.
When it comes to the budget, he hopes legislators take a look at the specific ramifications of any cuts they make. He said reduced mental health services can cause growing jail populations. It also can affect the economy as workers are unable to get help for their illnesses.
Johnson said mental health services have been cut year after year, and he’s getting an indication that 2011 will be no different.
Mitzi McFatrich, executive director of Kansas Advocates for Better Care, hopes the Legislature doesn’t cut funding for any long-term care services.
She said elders and individuals with disabilities thrive when they have the supports and services that allow them to maintain their highest level of independence and ability. Unless a person requires 24-hour care, in-home services are more economical than care in a nursing home.
McFatrich said a lot of times the Legislature cuts the home health services because they don’t fall under an entitlement program, like nursing homes.
“It just allows people to have more independence, more freedom, and the ability to stay within their social network. That’s where most of us want to get our care, instead of going to a nursing home,” McFatrich said.
Last year, the state passed a nursing home provider fee assessment. The federal government matches $3 for every dollar that is collected on the assessment. She expects it to generate $60 million. She hopes the money is used to increase nursing staff who provide direct care to residents. Nursing homes provide access to care 24/7, but are only required to provide care two hours a day.
“You don’t have to talk to very many people to understand that sometimes they wait 15 minutes and sometimes they wait 45 minutes for somebody to answer their call bell if they need help to the bathroom, getting dressed, or anything else,” she said.
McFatrich also would like to see that two-hour minimum requirement, which has been in place for about 20 years, raised. The U.S. Government Accountability Office did a study and suggested 4.15 or 4.85 hours of care per day per resident.
She also would like to see the state implement an ombudsmen program for community- and home-based services. There is a federal and state mandate that nursing home residents have access to an ombudsman, but that’s not available to people who receive services elsewhere.
McFatrich also would like the Legislature to implement regulations regarding nursing home residents who have a felony background. Currently, nursing homes don’t have to separate the populations or notify other residents. So, a resident may have shot, raped or beaten someone, and others don’t know. McFatrich said other states have taken up the issue legislatively.
Janet Williams, founder of communityworks inc., also hopes funding isn’t cut for home- and community-based services. These services help people get the training to become more independent and, as a result, reduce health care costs.
For example, she said the state is required to pay for traumatic brain injury rehabilitation, which is $25,000 a month more in a hospital than in the community or at home. There are 22 people with brain injuries receiving care at a hospital outside of Kansas. The state is paying about $350,000 a year for each of them.
“So, every time someone comes home or comes out of one of those expensive hospitals, we provide the services in the community and that’s when they get the assistance they need at a much lower cost,” she said. I believe people can come home sooner and even avoid going at all if there is a concerted effort to make it happen. That is one cost saving idea I plan to share with the new administration.”
Williams believes Gov.-elect Sam Brownback understands the importance of home health agencies.
“I think the greatest challenge is going to be educating all of the new legislators about the good that these programs do,” she said.
Lawrence Memorial Hospital President and CEO Gene Meyer hopes the state adequately funds Medicaid, especially with the health reform initiatives and expansion of eligibility for Medicaid.
He said health care providers and the hospital already are not adequately reimbursed for the costs of providing care to Medicaid patients.
“This is huge because if they don’t, the availability of providers who will accept Medicaid becomes limited, thus creating significant backlog in the system,” Meyer said.
Tort reform is another concern. Currently, there is a case before the Kansas Supreme Court that challenges malpractice limits. If the current limits are found to be unconstitutional, he said the Legislature may be forced to make some changes that would expand the limits of awards. And that, he fears, would create significant increases in malpractice premiums for providers.
“Kansas has been able to recruit physicians because of what’s termed a favorable malpractice climate. If this becomes not so favorable by legislative activity, it’s going to be another big problem with development of providers to meet future needs.”