Entries in Health Care (57)


Obama Health Care Law Funds $1B Push for ‘Innovation,’ Jobs

Hemera/Thinkstock(WASHINGTON) -- The Obama administration Monday rolled out a new billion-dollar initiative that will reward the “most compelling new ideas” for lowering costs and improving care of Medicare and Medicaid patients with lucrative federal grants.

The Health Care Innovation Challenge, to be run by the Department of Health and Human Services, will provide between $1 million and $30 million over three years to individual organizations or coalitions that develop sustainable, new approaches to boosting health care quality and efficiency.

Funding for the program was included as part of the 2010 Affordable Care Act, parts of which are now slated for a review by the Supreme Court.

Officials cast the announcement as part of President Obama’s “We Can’t Wait” campaign to help the economy, independent of congressional action, since special consideration will be given to proposals that “rapidly hire, train and deploy health care workers.”

HHS Secretary Kathleen Sebelius said only projects that can begin within six months will be eligible to receive funds.  A final list of sponsored projects will be announced in March.

While the agency says it will closely monitor grantees’ progress on improving care and measure overall savings yielded to taxpayers, Republican critics of the program called it a “$1 billion experiment.”

“On the day the Supreme Court decided to review the constitutionality of ‘Obamacare,’ the president is asking for another $1 billion in taxpayer dollars to pay for another health care experiment that will continue taking us in the wrong direction,” said RNC spokeswoman Kirsten Kukowski in a statement. “We already spent $2.6 trillion on his job-killing health care bill. Another $1 billion Executive Order is just more words for a president more interested in campaign talking points than creating jobs.”

Copyright 2011 ABC News Radio


Could Health Care Cuts Curtail Fastest Growing Jobs Sector?

Creatas Images/Thinkstock(WASHINGTON) -- As the Super Committee combs the federal budget for health savings, potential cuts to health aide providers could also curtail one of America’s fastest growing job sectors.

The Bureau of Labor Statistics projects job growth for home health aides to increase by 46 percent according to their 20 year outlook.

The bureau also projects that the home health aide sector alone will add half a million jobs by 2018.

But those numbers rely on current levels of government spending as budget cutters in Washington are looking for innovative ways to cut health care spending while dampening the blow back from any unpopular decisions.

One way that the government can choose to reduce spending without directly affecting access for those Medicare beneficiaries is to cut payments to providers.

“You have to weigh all of these considerations,” said Edwin Park who is the Vice President for Health Policy at the left leaning Center on Budget and Policy Priorities.  ”You have to try to reduce the federal deficit and gleam possible efficiencies in the programs without affecting beneficiary care.  Looking at provider rates is one way to go.”

While there is no specific indication as to what the Super Committee has in store for Medicare payments, a report by the Medicare Payment Advisory Commission released in March does point to home health care as an area where efficiencies could be released.

“The Commission finds that the home health benefit has significant vulnerabilities that need to be addressed urgently and recommends policies to strengthen program integrity, improve payment accuracy, and establish beneficiary incentives.”

Specifically, the commission found that providers frequently encouraged patients to make multiple visits as a way to increase the number of times that the provider could bill Medicare for treating one condition.

The commission also pointed to the fact that recipients of government subsidized home health care aide do not contribute in any way towards the expense of the visit leading the commission to question the patients incentive to ration care.

Still some advocates say that forcing seniors to cost share with Medicare would be unfair especially when so much money is lost to Medicare fraud.

“Our approach there is avoiding across the board cuts that hurt everyone and the only people that are advantaged by across the board cuts are pirates and the crooks,” said Val Halamandaris who is the President of the National Association of Home Care & Hospice.

The 2010 health care law already slashes provider payments but more could be on the way.

Many home health care providers are looking to the future, have accepted the need for reform and are bracing for a new payment structures.

Copyright 2011 ABC News Radio


Budget Cuts Threaten Mental Health Services

iStockphoto/Thinkstock(WASHINGTON) -- With the U.S. economy in crisis, health care budget cuts are rampant and mental health services are suffering.

In March, the National Alliance on Mental Illness (NAMI), released a report detailing the tremendous state cuts to mental health care for children and adults.  However, by June more cuts were underway, and NAMI has now released an updated report looking at the continuing crisis through 2012.

“[At the time of our last report], states were just starting to work on their budgets.  We wanted to assess what they were doing in terms of continued cuts, and give people on the ground information that they might be able to use to advocate for no further cuts when legislatures start to convene in January [of 2012],” said Ronald Honberg, director of legal and policy affairs for NAMI.

NAMI’s new report focuses on individual state allocations for mental health services such as community centers, access to psychiatric medications and housing provisions.  It found that while some states have increased funding of these services, the numbers are small in comparison to the deep cuts other states are implementing.

California and New York have the largest mental health budgets, but between 2011 and 2012, California cut its funding by $177.4 million and New York by $95.2 million.

Between 2009 and 2012, South Carolina cut 40 percent of its mental health allocations, and Alabama, Alaska, Illinois and Nevada weren’t far behind.  Alaska and Nevada have the highest and second highest suicide rates in the country, respectively.

And the cuts are wreaking havoc on much more than mental health services.

“Patients in crisis have nowhere to go and so they end up in emergency rooms.  The ER can’t dump people, but they have nowhere to put them, so patients are boarded in emergency rooms,” Honberg told ABC News.

Law enforcement officials are also getting involved.  Police have become first-line responders to mental health crises they aren’t trained to deal with, and prisons, already overcrowded, are the new psychiatric hospitals.

“State [mental health] facilities are closing and there is nowhere for people to get treatment.  [The consequences of the budget cuts] are turning out to be more expensive than simply providing people with mental health services,” said Honberg.

Copyright 2011 ABC News Radio


Support for Health Care Law Reaches New Low

Comstock/Thinkstock(WASHINGTON) -- The Kaiser Family Foundation released a new poll finding a significant drop in favorable views of the new federal health care law to their lowest since the law was passed in March 2010.

Just 34 percent of Americans now view the Affordable Care Act favorably, down seven points from last month.  It was about this low, 35 percent, in July 2010. Fifty-one percent now view the law unfavorably, numerically a new high.

Kaiser says the drop occurred mainly among Democrats, who, while they still are more supportive of the law than are other Americans, have grown less so. It suggests glum economic views are a factor and also notes persistent criticism of the law in the GOP debates.

Just 18 percent of Americans now think the law will improve things for them personally, down from 27 percent in September. And just 28 percent think it’ll make things better for the country - another new low, and down from 38 percent.

Copyright 2011 ABC News Radio


Study: Government Should Prepare for Contingencies in Medicaid Expansion

Comstock/Thinksto(WASHINGTON) -- The federal government will bear a heavier financial load when it comes to Medicaid as the number of Americans who receive aid jumps under the Obama administration’s health care plan, according to a new study.

The research, published in Health Affairs, found that the number of additional people enrolling in Medicaid may vary by more than 10 million, which would require federal government to spend an additional $58 billion on the program annually. According to the report, more than 7,000 new doctors could be needed because of the expansion.

“Our results indicate that policy makers should prepare to handle a broad range of contingencies in the Medicaid expansion under health reform,” the report concluded.

The report’s figures vary slightly from those of the Congressional Budget Office, which estimated that 16 million individuals will enroll in Medicaid in 2019, and those of the Centers for Medicare and Medicaid Services, which put the figure at 18 million.

“Research indicates that extending Medicaid coverage to uninsured people increases their access to care,” the report stated. “However, because of low provider reimbursement rates, people who shift from private coverage to Medicaid may actually experience greater difficulty finding providers willing to treat them.”

The Affordable Care Act requires states to expand Medicaid eligibility by 2014 to all Americans whose incomes are at or below 133 percent of the federal poverty line. The federal government will bankroll much of the initial costs.

Another study published in the same journal found that even without the individual mandate -- perhaps the most controversial aspect of the bill -- the health care law would still cover 23 million Americans that wouldn’t have had insurance without the law, and insurance premiums would rise less than projected.

If the mandate was lifted, premiums in the individual market would increase by 12.6 percent, with 7.8 million people losing coverage, according to the study.

The Democrats’ health care law has come under increased scrutiny by critics. Most Republican presidential candidates support repealing the entire law, even Mitt Romney, under whose governorship Massachusetts passed a law that became the model for the national bill.

Several programs in the Affordable Care Act have also run into hurdles. Earlier this month, the Obama administration announced it would drop the provision that would have provided long-term care insurance. The plan would’ve eased the burden on Medicaid but officials said they could not come up with a viable, financially sustainable model for it.

Copyright 2011 ABC News Radio


Greek Debt Crisis Spurring Serious Health Consequences

Jupiterimages/Thinkstock(CAMBRIDGE, England) -- Greece’s debt crisis is bringing on dire health consequences that, researchers say, might soon turn into a modern-day Greek tragedy, according to a new study.

The study, published in The Lancet, found that rising unemployment and staggering debt in the past four years have led to serious health issues among the most vulnerable Greeks.

Many Greeks have been unable to get medical care because of hospital budget cuts and staffing problems and, in general, health has worsened since the financial crisis began.

“We noted a significant rise in the prevalence of people reporting that their health was ‘bad” or ‘very bad,’” the authors wrote, led by Cambridge University’s Alexander Kentikelenis.

The number of suicides increased by 17 percent between 2007 and 2009, and the Greek Parliament reported a 25 percent increase between 2009 and 2010.  That number is still rising: the number of suicides was 40 percent higher in the first half of 2011 than during the same period in 2010.

The researchers also expect the number of new HIV infections to increase by 52 percent this year, about half of them among intravenous drug users.  Heroin use, prostitution and unsafe sex practices also increased, but budget cuts have made it difficult for many people to get help from governmental programs.

“Overall, the picture of health in Greece is concerning. It reminds us that, in an effort to finance debts, ordinary people are paying the ultimate price: losing access to care and preventive services, facing higher risks of HIV and sexually transmitted diseases, and in the worst cases losing their lives,” the authors wrote.

In the United States, the economic downturn is also taking a toll on the mental health of many Americans.  One recent study found that suicide rates generally rise and fall depending on the economy.

Depression and anxiety have also increased dramatically, according to experts.

“When people began to get anxious or were worried about losing their jobs, it was clear there was an increased number of individuals that presented with anxiety and depression,” said Dr. Mark Rapaport, chairman of the Department of Psychiatry and Behavioral Sciences at Emory University in Atlanta.

Rapaport also said that difficult economic circumstances have made it tough for people to get the care they need.

“One reason is that individuals are losing their health insurance and another one is the cost of health insurance is increasing radically, so a lot of people are electing to have care with very high deductibles, so they are unable or unwilling to seek care,” he said.

Budget cuts, he said, have also decreased access to public programs.

While there are no data yet to suggest that drug use is on the rise, Rapaport said that trend wouldn’t surprise him. “In times of stress, there are many problems,” he said, “so people tend to use coping strategies like using alcohol and drugs.”

Copyright 2011 ABC News Radio


Bitter Pill for Obama: New Study Underlines Unfulfilled Promises of Health Care Law

Hemera/Thinkstock(WASHINGTON) -- A new study by the Kaiser Family Foundation underlines that many of the promises surrounding President Obama’s health care law remain unfulfilled, though the White House argues that change is coming.

Obama and his supporters like then-House Speaker Nancy Pelosi insisted passage of the Affordable Care Act would cause health care premiums to drop, but the independent group's findings mirror predictions made by the measure's critics.

The Kaiser study shows family premiums topped $15,000 a year for the first time in 2011, increasing a whopping 9% this year, three times more than the increase the year before. The study says that up to 2% of that increase is because of the health care law’s provisions, such as allowing families to add grown children up to 26 years old to their policies.

So what about that $2,500 in savings the president pledged in 2008? White House deputy chief of staff Nancy-Ann DeParle insists families will see that savings -- by 2019.

"Many of the changes in the Affordable Care Act are starting this year, and in succeeding years," DeParle told ABC News, "and by 2019 we estimate that the average family will save around $2,000."

DeParle said that the "big increases that occurred last year were probably driven by insurance plans overestimating what the impact would be and maybe trying to take some profits upfront before some of the changes in the Affordable Care Act occur.

The Kaiser study also indicates employers are switching plans and shifting costs onto employees. Half of workers in smaller firms now face “deductibles of at least $1,000, including 28 percent facing deductibles of $2,000 or more,” according to the study.

For example, Flora Venture’s new policy increased the deductible employees pay to $5,000.

“What the president promised is that under health care reform, that he would make it more possible for people to have choices in these (health insurance) exchanges,” DeParle said. “And that’s going to be what will help businesses bring costs down. Right now, they’re just struggling. That’s one reason why they’re shifting costs to employees.”

DeParle said that “once health care reform fully takes hold in 2014 and beyond, employers will have more tools and more ability to help bring down costs,” she said, including the new health insurance exchanges.

Before it was passed by Democratic majorities in the House and Senate, critics of the then-bill slammed the 2014 start date as a way to hide the Affordable Care Act's deleterious effects on the economy -- and on Americans -- until after a possible re-election of President Obama.

Copyright 2011 ABC News Radio


Arizona: Comatose Illegal Immigrant’s Wife Fights For Care

Pixland/Thinkstock(PHOENIX) -- An Arizona woman is fighting for the life of her comatose husband, a Mexican immigrant in the process of becoming a citizen who collapsed playing soccer last week and fell into a coma. Since he is not a citizen, he is facing the prospect of being kicked out of the hospital.

His lack of health insurance and citizenship have put his wife in a difficult position. The hospital has given her one week to decide whether to take him home for hospice care or take him to Mexico for long-term care, according to ABC Phoenix affiliate KNXV.

Jesus Cornelio, 23, was playing soccer on Sept. 19 when he collapsed on the field and was rushed to Banner Good Samaritan Hospital in Phoenix. His brain was without oxygen for more than 10 minutes, which doctors say caused severe damage to his brain.

At the hospital on Friday, his wife Evelyn Cornelio, a U.S. citizen, was told that her husband did not qualify for long-term care, KNXV reported. He has been in the United States for most of his life and is in the process of becoming a citizen, but is still an undocumented immigrant and not a permanent resident.

On Tuesday, the hospital gave her a one-week extension until Oct. 4 to decide what she will do with her husband.

“I’m not going to give up on him,” Cornelio told KNXV. “I see how much my husband is trying and not giving up, but all I see now is, who is going to pay for all these expenses?”

In a statement, the hospital said the following: “Banner Health continues to work closely with the Cornelio family as they evaluate the best care options for their loved one, Jesus.  Our focus remains on ensuring that Jesus continues to receive the best care possible. With respect to the family’s privacy we are unable to provide any additional information about this case.”

Even though Cornelio is in a difficult situation and does not yet know what she will do, she said she does know that she is not giving up on her husband.

“All his family is here. All his friends are here. He’s the love of my life. He’s my best friend. He’s my everything,” Cornelio said. “He’s healthy and he’s strong and he’s going to make it.”

Copyright 2011 ABC News Radio


Medicare Fraud Bust Nets 91 People, Including Doctors and Nurses

PhotoAlto/Frederic Cirou/Thinkstock(WASHINGTON) -- The Justice Department announced on Wednesday that 91 people allegedly scammed $295 million from Medicare by falsely billing the entitlement program.

To make matters worse, some of the suspected crooks are doctors, nurses and other medical professionals, according to Attorney General Eric Holder.

In announcing the charges, Holder said they were "based on a variety of alleged fraud schemes involving various treatments and services that were not medically necessary -- and, oftentimes, were never even provided."

The crackdown netted 11 doctors, three nurses and 10 licensed health professionals.  The charges were filed in Baton Rouge, Louisiana; Brooklyn, New York; Chicago; Dallas; Detroit; Houston; Los Angeles and Miami.

Half of the defendants came from South Florida, the reputed national leader in Medicare fraud.

Copyright 2011 ABC News Radio


Want a Lower Medical Bill? Just Ask

Comstock/Thinkstock(YONKERS, N.Y.) -- The economy has left millions unemployed and mounting medical costs have put millions in debt. With financial hardships in mind, a new Consumer Reports column suggests ways to become a savvy health care buyer and haggler.

"I have become impressed with how often American households are unable to afford their medical bills and medications, and they're doing various things, like not taking their medications or taking someone else's, because they can't afford them," said Dr. John Santa, director of the Consumer Reports Health Ratings Center and author of the column.

Because of this, Santa noted that the best time to talk to doctors about medical bills and financial limits is before a patient has incurred any costs.

"It helps to know from folks the degree to which financial issues are a stress for them, especially related to health," Santa said.  "This works best if the physician is aware of this from the start.  If you're struggling to keep your head above water, tell the doctor anything he can do to moderate cost is appreciated."

For many medical conditions, there is a wide range of ways to diagnose and treat the problem and the treatments can vary "enormously" in cost, experts said.

"This recommendation makes sense to me in today's world," said Alan Sager, professor of health policy and management at Massachusetts Institute of Technology.  "In a more reasonable world, of course, all patients would be insured and all would pay the same price for the same care.  And doctors and hospitals would be financially neutral, liberating them to recommend care in light of its clinical value."

When an unexpected exorbitant bill gets handed to a patient, Santa recommends speaking with the doctor who recommended the procedure or treatment to understand why the costs are so high.

And don't ever assume the price on the bill is set in stone.  On average, the hospitals' total charges to patients and insurers are triple the average cost of actually delivering hospital care to the patient, Sager noted.  Uninsured patients are usually charged the highest price, which is the hospital's list price for different treatments and tests.

"That's because no big insurance company or Medicare plan is available to negotiate a lower price," Sager said.  "Hospitals usually offer to discount their initial bill by 10 to 20 percent from those very high charges when the patient simply asks.  That can be offered by the billing or patient accounts department."

For patients hit with an extremely high bill, Sager recommended bypassing the billing department and calling the hospital CEO's office directly.  Explain the problem and ask for help, he said.

Copyright 2011 ABC News Radio

ABC News Radio