Archive for September, 2010

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Six months in: The new health law gives us the key to better care

Thursday, September 23rd, 2010

Our fourth post celebrating the six month anniversary of the Affordable Care Act.

Six months ago today, the Affordable Care Act was signed into law. Since then, the new health law has offered some concrete advances, including some that go into effect today and it’s laying the groundwork for even more.

By 2030, it is estimated that 72.1 million people in the United States will be age 65 or older, more than twice the number of older adults in 2000. As our population ages, it is vital that we improve how the system cares for and engages with patients who have multiple chronic conditions so they get care that’s tailored to their individual needs, receive clear information from their doctors, don’t have to repeat tests, and get the supports and services they need to stay in their homes and out of the hospital.

So far, the Affordable Care Act has helped to close the donut hole for Medicare beneficiaries, created new patient protections, made it possible for people to get better information and compare health insurance plans online. But we know much more is needed to provide quality, coordinated care for millions of vulnerable patients and their family caregivers — the people who need help the most. And there is more to come.

Starting next year, preventive services and annual check-ups will be free for Medicare beneficiaries, hospitals will receive more funding to help provide a smoother transition from hospital to home, and primary care providers in Medicare and Medicaid will receive increased payment — to make sure that everyone has access to primary care.

Perhaps most importantly, the ACA offers unprecedented opportunities to improve the poor coordination that plagues our health care system — one of the core issues we and our partners at the Campaign for Better Care are working to address. These include:

– A new Center at CMS designed to promote innovative ways of providing care, such as using team-based primary care
– A new option for states to create medical homes
– Incentives for hospitals to reduce preventable infections and readmissions

These and other ACA reforms give us the tools to create sustainable, effective coordinated care programs that can provide patients and their families with better care and better outcomes. The ACA can bring the improvements we urgently need — but only if it is implemented with patients and their family caregivers as the focal point. Making that happen is the mission of the Campaign for Better Care.

Community Catalyst has been working toward this mission since it helped create the Commonwealth Care Alliance, and we are proud to bring the lessons from CCA and others to the work of the national Campaign and to the six state Campaigns in Maine, Massachusetts, North Carolina, Ohio, Pennsylvania and Wisconsin. In each of these states, advocates are at the table where decisions are being made to implement key ACA delivery system reforms. We applaud this critical work and urge Hub readers to join existing Campaign efforts or to learn how to get involved in their own states.

Happy Half-Birthday, ACA!

– Renée Markus Hodin, Director Integrated Care Advocacy Project

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Tipping our caps to health care that lasts a lifetime

Wednesday, September 22nd, 2010

The third post in our series highlighting the benefits of the Affordable Care Act.

Most of us don’t think much about the fine print in our health insurance, especially something like a lifetime cap on our benefits.

But the majority of us – an estimated 55 percent of people with insurance through an employer – have health plans that are subject to lifetime caps. This means that once a family member spends up to a certain amount on health benefits, the insurer will no longer pay for any health services – the family must pay all health expenses out of pocket.

Most families only realize they have a lifetime cap on their health plan because of a serious illness that becomes very expensive. A family may run out of their health benefits at precisely the time they are most needed. This places an enormous burden on those already dealing with a serious illness, and can lead to a family going into debt to pay for necessary care. A recent national survey found that one out of six nonelderly adults—about twenty-nine million people—had medical debt.

Diane and Bill Pickles of Haverhill, Massachusetts know how terrifying the idea of a lifetime cap can be. The couple had a policy with a $1 million lifetime cap when their son, Jake, was born with severe heart damage. In his first two years of life, Jake required three open heart surgeries, countless tests, doctors’ visits and prescription drugs. By the time he was 4 years old, Jake was already halfway to his $1 million dollar benefit cap. Diane remembers making the awful realization that they could easily hit Jake’s lifetime cap within a few years and be left with no protection for Jake’s life-saving medical treatments.

Fortunately, after Jake’s three surgeries, Diane was able to return to work and was offered the opportunity to switch to her new employer’s insurance plan with no lifetime limit. “I never thought we would need a million dollars in medical care,” she said, “but all it takes is one diagnosis like Jake’s before you realize one million might not take you so far.”

As of Thursday, September 23rd, lifetime caps will be prohibited in ALL health plans – whether offered by small or large (or self-insured) employers, or purchased directly by an individual. This means the next time your health plan is renewed it will no longer have any lifetime cap. Families like Diane’s – and the estimated 20,000 others who reach their lifetime caps in one year – no longer have to worry about their health benefits running out when they most need them.

– Christine Barber, Senior Policy Analyst

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Expanded Dependent Coverage Will Make a Difference

Tuesday, September 21st, 2010

This is the second in a series of posts on the benefits of the Affordable Care Act.

As you’ve probably seen over the course of the last few days, in celebration of the six month mark since the signing of the Affordable Care Act, Community Catalyst is highlighting the provisions that take effect starting on September 23, 2010. We’ve previously posted about one of the most important of these provisions—the expansion of dependent coverage to young adults up to age 26. However, given that this improvement in coverage takes effect on Thursday, we wanted to again call attention to the key aspects of this reform.

In short, young adults are now generally eligible for coverage under their parents’ health plan as long as they are under age 26 and have a parent with a plan that offers dependent coverage. This provision fully applies to all health plans (including self-insured plans) with the exception of grandfathered plans (those in existence prior to March 23, 2010). Grandfathered plans have the option of excluding young adults who have access to other employer-sponsored coverage but this exception goes away in 2014.

Another important point about this expansion of dependent coverage is that you don’t have to be tax dependent to qualify. It also doesn’t matter if you are married or single, in school or not, or employed or not. The point of the provision is to serve as a tool to expand coverage as widely as possible to young adults under age 26.

Young adults are among the most likely to be uninsured, since many of them work in jobs without benefits. This is why this provision is such an important step forward and this becomes even clearer when you realize that in 2011 alone, as many as 2.12 million young adults could have new dependent coverage as a result of this provision.

Wondering if you or someone you know is eligible? Our partners at Young Invincibles have developed a quick and easy online tool to help you answer that question. You can access this tool here. By asking a few short questions, this resource provides the information that young adults need to find out about their health insurance options in the wake of national health reform. And be sure to check out the rest of the site, Getting Covered, for even more information about the dependent coverage expansion.

We tip our hats to all those who worked so hard to make this provision broadly inclusive. Millions of young adults will benefit from increased health care security and the freedom to pursue their dreams without the worry of whether or not that will mean risking their health to do so.

— Kris Bloch, Survey Analyst
— Patrick Tigue, Children’s Health Care Coordinator, New England Alliance for Children’s Health

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Takin’ it to the States

Monday, September 20th, 2010

This week marks the six month milestone of the passage of the Affordable Care Act. This is the first in a series of posts on the benefits of the law for the public.

It’s almost Sept. 23 – the six month milestone of the Affordable Care Act, and state advocates are out in full force, educating the public about the law, and what the Patient’s Bill of Rights will mean for people in their communities.

After their tireless work to represent consumers during the health reform debate, state consumer health advocates continue to impress and inspire us with their fall public education activities, including:

•    Advocates in Pennsylvania who are training their supporters to talk to their neighbors and communities, giving concerned citizens an active role to play.
•    Minnesota advocates will hold a “farewell” party to say goodbye to lifetime limits on coverage and denying insurance coverage when consumers need it most.
•    Advocates in Illinois, Utah, North Carolina and California are using Twitter, Facebook, blogs and online videos to educate people about the ACA and share stories from consumers.
•    Across the country, advocates are going ‘back to school,’ hitting college campuses to let students know they can now be covered on their parents’ insurance even after college. Many are teaming up with the Young Invincibles or PIRG to host events.
•    Ohio advocates are meeting with older adults to talk about how the ACA will benefit them.

Passage of ACA was historic, and its promise will be realized through the efforts of advocates across the country. They are using the Sept. 23 milestone to invigorate public education efforts. They know that on and around Sept. 23 there will be a lot of buzz from the media, policy wonks and elected officials, but the most important audience is the individuals and families who want to know what the ACA means for them.

– Reena Singh, Field Coordinator

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The Future of Health Care

Friday, September 17th, 2010

How are we going to change the cost curve in health care and provide the highest quality of care? Dr. Bob Master – one of the country’s leading health care visionaries – has a great answer.

Six years ago, Bob came to Community Catalyst as a fellow of the Institute of Medicine as a Profession. Our idea was that he would use the fellowship to incubate a care delivery system that would serve Massachusetts’ most vulnerable people, including frail older adults with chronic conditions, people with significant physical disabilities and people who are dually eligible for Medicaid and Medicare. By focusing on primary care and prevention, this system would deliver high quality care and reduce costs.

After two years at Community Catalyst, Bob launched the Commonwealth Care Alliance (CCA) upstairs from our offices on 30 Winter Street. We wanted to ground CCA closely to consumers, so Health Care For All and the Boston Independent Living Center became CCA’s corporate members and I became president of the board.

Six years later, Bob and his committed staff at CCA have created a comprehensive system of care that not only improves their members’ health, but also has been proven to lower costs by keeping people out of the hospital and out of nursing homes. Last year, NCQA, widely viewed as a national leader in driving healthcare improvement and quality, honored Bob for his efforts to successfully reform health care delivery by improving quality and reducing cost for Medicare and Medicaid Patients.

Recently, WBUR’s (Boston’s National Public Radio affiliate) CommonHealth blog ran a nice piece on Bob and CCA. So what does CCA’S care model look like? Here’s how the WBUR bloggers describe it:

The organization is essentially a full-service provider of medical care and social support for chronically sick, elderly and sometimes disabled people on Medicare, Medicaid, or both. From the moment a patient signs on, he or she has access — 24 hours a day, 7 days a week — to a nurse practitioner who is armed with up-to-date electronic medical records and has the authority to call in other specialists as needed. Patients can choose from 25 primary care sites around the state, and for the homebound, house calls are also part of the plan. For those who need to get to the hospital, Commonwealth Care contracts with 8 hospitals in the state, but will only use providers who agree to Medicare reimbursement rates.

Continuity of care is essential. So the program offers non-traditional assistance to patients at no extra cost, including transportation to medical appointments and help with daily chores and activities. Commonwealth Care tries to rescue patients from the kind of fragmented, procedure-driven care that can leave them feeling like “an anonymous piece of baggage on a never ending airport conveyor belt, always tagged for the wrong destination,” as one senior put it.

This is precisely the kind of care that Community Catalyst and our partners at the Campaign for Better Care are pursuing as the Campaign works to implement the delivery and payment reform provisions of the new health law in ways that benefit older adults and their families.

Community Catalyst is proud to be able to highlight the good work at CCA, and we encourage Hub readers to get to know them better. To paraphrase an old saying, “We’ve seen the future of health care, and it is CCA.”

– Robert Restuccia, Executive Director

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Posted in affordability, care coordination/quality | 1 Comment »

Prevention Fund Saved!

Wednesday, September 15th, 2010

Through the collective efforts of advocates of many different stripes across the country, we staved off an attempt yesterday to gut the new Prevention and Public Health Fund, a critical part of national health reform.

An amendment from U.S. Senator Mike Johanns, a Nebraska Republican, was defeated 46-52 in a procedural vote on the Senate floor. That amendment to the Small Business Jobs and Credit Act would have used the bulk of the $15 billion Prevention Fund to pay for a change in business tax-reporting rules.

As a result, the Prevention Fund will be available to support national, state and local programs to make Americans healthier, reduce racial and ethnic health disparities, and to help control soaring health costs in the long run. President Obama has already allocated $500 million from the fund and another $750 million is slated to be spent in the 2011 fiscal year. The Community Transformation Grants, designed to help local communities address the social and economic causes of poor health, are one of the innovative programs slated to be supported through the Prevention Fund.

We thank the hundreds of national and state organizations that raised their voices in support of the Prevention Fund. We will likely need to remain vigilant to protect the fund from future attempts to grab it for other purposes. But for now, we can celebrate.

– Alice Dembner, Policy Manager

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Posted in Health disparities, national health reform | 1 Comment »

Florida’s McCollum gets his day in court

Wednesday, September 15th, 2010

Despite taking a beating in the Florida Republican primary for Governor, Attorney General Bob McCollum(R) continues to pursue a legal strategy against the federal government. Hopeful that the nationwide legal strategy against health reform would win him the gubernatorial race, McCollum is now left with simply a legal strategy. But alas, he’s not giving up! Yesterday, Judge Roger Vinson held a hearing on the AG lawsuit in federal court in Pensacola. Vinson, a Ronald Reagan appointee, signaled to his audience that he intended to allow pieces of the legal argument to progress to the next phase. The judge stated that his decision regarding dismissal would be issued no later than October 14th and oral arguments would begin on December 16th.

For those closely watching this lawsuit, this is not a surprising outcome. If you take stock of the situation, it shapes up as more of a political tantrum than a legal travesty. The plaintiffs are 16 Attorneys General (all Republican save Louisiana) and 4 Republican Governors. They appear to be part of a larger Republican strategy to attack health reform at all fronts and at all costs — this is evident in the Johanns (R-NE) amendment that failed this week, an attempt to gut funding for the prevention fund, a cornerstone of health reform. Tactically, McCollum chose well — beginning the hearings in Pensacola and progressing to a conservative bench in Atlanta — both clearly afford the anti-reform AG posse an advantage. Despite the drama of the court proceedings, the legal confrontation should not be brushed off as fodder. Most likely, according to wonks and legal scholars, the lawsuit will land squarely in the laps of the Supreme Court justices. From there, the outcome is not entirely certain.

It is important to remember, however, that the central arguments espoused by McCollum et al. are weak and disingenuous. They boil down to two main issues: is insurance synonymous with commerce AND is a Medicaid expansion the same as coercion? If you want a legal summary, read here.

First, those wishing to dismantle health reform want voters to believe that they are forced to participate in the business of health care by the federal government — demanding they engage in commerce, stripping citizens of their individual liberty. Second, the AGs want voters to believe that the states themselves are victims of too much federal power, coercing states to participate in the public insurance program, Medicaid. Hoping to ride on the tails of a disenchanted electorate, the AGs are touting their steps to the Supreme Court as ‘wins’ against big government.

The arguments against health care reform, however, lack logic. First — for a party that is constantly demanding ‘pay fors’ — they should be in lock step with policy that provides a payment mechanism for health care that all people use and need, regardless of insurance status. The government is not forcing engagement in commerce; it is simply finding a payment mechanism for commerce that already exists. Second, the very idea that the federal government is coercing states to participate in Medicaid is preposterous. States may choose not to participate in the program; in fact, the leading Republican think tank, the Heritage Foundation, encourages states to do so — reminding them, yes, a state may choose to opt out of the program.

This anti-reform posse must be challenged both in court and on ‘main street.’ Advocates are powerful tools in defusing the legal strategy of the far right through educating the public about why health reform is a necessary good. As the Democratic candidate, State Sen. Dan Gelber, running to replace McCollum states, “There are four million people without health care in our state… everybody agrees this was not the most perfect bill that’s ever passed. But I am not going to take the resources of this office that are so desperately needed to solve some of the pressing security issues of our state and dedicate them to what I think ultimately really was a politically motivated lawsuit that was spawned out of a primary battle and that, ultimately, I don’t think has a whole lot of merit when it gets to the Supreme Court, which I think it will…But I do think if you don’t like the bill, Miss Bondi [Pam Bondi (R-FL) AG candidate] should run for the Congress, where she can, as a legislator, fix it in the next legislative session.”

Florida has over 4 million uninsured people – how many does your state have?

– Eva Marie Stahl, Policy Consultant

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Posted in national health reform | No Comments »

What Makes Child Health Advocates Successful?

Monday, September 13th, 2010

In case you missed it, we wanted to call your attention to this post over at Say Ahhh!, the children’s health policy blog run by one of our partners, the Georgetown University Center for Children and Families. In the post, Eugene Lewit and Liane Wong of the David and Lucille Packard Foundation note the release of two issue briefs that report findings gleaned from an evaluation of the Foundation’s Insuring America’s Children: States Leading the Way (IAC) grantmaking program. Both of these briefs help to answer the question of what makes child health advocates successful.

The first of these briefs, State-Based Advocacy as a Tool for Expanding Children’s Coverage: Lessons from Site Visits to Six IAC Grantee States, takes a broad view and explores what strategies are used by effective state-based child health advocates. These strategies include:

  1. Building and involving a broad-based coalition of stakeholders
  2. Identifying and cultivating diverse, respected champions for children’s coverage
  3. Using effective and impactful message strategies and using strategies in flexible ways
  4. Working to encourage a cultural shift among health program administrators
  5. Establishing themselves as respected go-to organizations for credible information and data
  6. Taking advantage of recent federal changes

The brief goes into each of these strategies in significant detail and demonstrates that the right advocacy strategies can achieve gains for our children, even during a period of severe economic crisis. Impressively, each of the six states depicted in the issue brief were successful in either achieving an increase in eligibility for children or in having their state enact policies to make enrollment and retention easier in public health insurance programs.

The second brief, Strategic Engagement of Policymakers is Key to Advancing a Children’s Health Care Coverage Policy Agenda, takes a deeper look at a specific strategy described in the first issue brief — identifying and building relationships with champions for children’s coverage. To build a successful relationship with champions for children’s coverage, the second brief shows that advocates who successfully employ this strategy use the following methods to do so:

  1. Identifying, nurturing, and supporting political champions
  2. Creating critical links between grassroots advocacy and policymakers
  3. Using effective messages to appeal to policymakers
  4. Establishing state-based advocacy as go-to organizations for policymakers
  5. Sharing ownership of agendas and successes with policymakers

This second brief also goes into significant detail about each of these methods but also emphasizes that each state’s specific political environment needs to shape the particular methods advocates use to cultivate champions for children’s coverage. However, what does not change across states is the critical importance of developing political champions as allies in the effort to advance children’s health insurance coverage.

Given the wealth of valuable information contained in both of these briefs, we believe that taking the time to read both in full would be time well spent for all state advocates focused on child health and even for those who are not solely focused on children. This research ultimately confirms what advocates across the nation have always known — that they can and do make a difference in the lives of children and families.

—Patrick Tigue, Children’s Health Care Coordinator, New England Alliance for Children’s Health

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Posted in children's health | 2 Comments »

Senate fix on pay-for-delay vital after Court denies hearing

Thursday, September 9th, 2010

A negative court decision this week underscores the importance of passing federal legislation to ban ‘pay-for-delay’ settlements in order to preserve access to affordable, quality prescription drug benefits. At issue is the drug industry practice of paying off generic competitors of expensive brand-name drugs to delay access to low-cost generics.

On Tuesday, the Second Circuit issued a decision on the legality of pay-for-delay settlements concerning the drug Cipro that dealt a blow to consumer advocates and consumer protection attorneys challenging these collusive agreements in court. The decision rebuffed the Federal Trade Commission, the Department of Justice, and a group of State Attorneys-General, all of whom asked the Court to re-evaluate an earlier precedent from 2005 that allowed such ‘pay-for-delay’ settlements. For more background on the legal aspects of this issue, visit an earlier blog by our Prescription Access Litigation project.

While the attorneys ponder whether to appeal the case to the Supreme Court, the importance of a legislative solution to this problem becomes even clearer.

Current legislation before the U.S. Senate proposed by Senators Herb Kohl (D-WI) and Richard Durbin (D-IL) would create a presumption that any drug patent settlement that exchanges a payment in return for an agreement to delay bringing a generic to the market is a violation of anti-trust law. The bill gives the FTC the tools to challenge such settlements. However, it still allows the drug companies to prove that a settlement is not a collusive agreement, but a legitimate effort to avoid the time and costs of litigation.

Why is a ban on pay-for-delay settlements important? Since 2005, Congress has responded to concerns about potential collusion by requiring the drug industry to file any settlement of patent litigation concerning a generic drug under seal with the FTC. Since 2004, the FTC has reviewed these settlements, and found that an increasing number of ‘pay-for-delay’ sweetheart deals have been made since the courts started to allow them in 2005. Last fiscal year, a record 19 such pay-for-delay deals were made. By the nine month mark of this fiscal year on June 30, the record was broken, with 21 new pay-for-delay settlements.

These settlements have prevented billions of dollars in possible savings, by preventing generic drugs from being available. At a time when brand-name drugs continue to go up in cost, generic drugs are the best solution. Another report found that every 2 percent increase in generic use saves Medicaid $1 billion a year.

The FTC, which reviews these agreements, reported in January 2010 that $20 billion dollars in annual brand-name drug spending was being insulated from generic competition by pay-for-delay sweetheart deals. Then, in July, the FTC reported that new pay-for-delay deals were shielding another $9 billion in drug spending from market competition.

How does this impact consumers? The FTC reports that pay-for-delay settlements keep a generic drug off the market for an average of 17 months. The FTC estimates that being forced to take a brand-name drug costing $300 per month, instead of a generic costing $30, would increase a consumer’s health cost by $4,590 over that 17-month period. Drugs that cost more, or that have longer delays, will cost even more.

If a robust, competitive market is to play a role in our new health care system, shielding nearly 10 percent of all annual brand-name drug sales from market competition will only allow drug company price increases to continue depleting more and more of our health care resources, while putting more patient care at risk.

In a brief filed with the court, the AMA and AARP described having access to a generic drug improves the quality of patient care:

“The price of a brand drug can be prohibitive for uninsured patients who do not have help covering the cost of their prescription drugs. Even for those patients who are insured but who are on fixed or limited incomes, having a generic option is often the difference between having access to a health care treatment and not having any treatment option at all. And the lawsuit filed by our PAL project’s member AFSCME District Council 37 in 2006 is challenging the pay-for-delay settlements concerning the drug Provigil, used to treat narcolepsy. This lawsuit has revealed how the lack of competition reduces patients’ quality of life or quality of care when an insurance company refuses to pay for a high-cost brand-name drug.”

A pastor from Ohio reports that after “paying almost $17,000 in annual premiums” for his family’s health insurance coverage, he still paid $650 per month for Provigil. Then the price went up even more:

“[Provigil] now costs me $852/month. That is out of pocket money I have to come up with until later in the year when I reach my deductible and I can enjoy a few months of only paying $60/month. I cannot describe to you how much stress and difficulty this has caused for me and my family the last several years. As you can imagine, with my income, I often cannot afford to refill my prescription. I often take 1/2 or 3/4 of my dosage on days I know I won’t be driving much so I can delay getting a refill. But I do a lot of driving for my work, so I am forced to spend lots of money I don’t have just so I can be safe driving.”

To find out how you can support legislation to prevent these pay-for-delay settlements, please contact our Prescription Access Litigation project at
http://www.prescriptionaccess.org/contactus/

– Wells Wilkinson, Director of Prescription Access Litigation at Community Catalyst

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Posted in prescription drugs, Uncategorized | 2 Comments »

Signing on to Advance Child Nutrition

Wednesday, September 8th, 2010

The New England Alliance for Children’s Health is co-sponsoring a sign-on letter with the New England Consortium (NEC) that urges Congress to act swiftly and pass a strong child nutrition reauthorization (CNR) bill. The letter asks the New England delegation in the House of Representatives to work with leadership to ensure that a final bill is passed and ready for the President’s signature by September 30, 2010, when the current law expires.

The federal child nutrition programs that will be reauthorized through this legislation have the potential to promote childhood health, reduce childhood hunger and obesity, and combat the effects of child poverty by greatly improving access to existing child nutrition programs. If you are part of an organization based in any of the New England states, you can sign your organization on to this letter by clicking here. All sign-ons are due by 5:00 P.M. on Thursday, September 9.

Please consider signing on to this letter. We need to urge Congress to act quickly and ensure children have access to high-quality meals at school.

—Patrick Tigue, Children’s Health Care Coordinator, New England Alliance for Children’s Health

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Posted in children's health | No Comments »

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