HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Saturday, October 25, 2008

Medicare Officials to Review Insurers' Commissions

The Washington Post reports that federal health officials, on Friday, said that they will soon address growing concerns about the lucrative commissions that some Medicare insurers plan to pay their agents and brokers this year.  Kevin Freking writes,

Medicare_2In Medicare, the elderly and disabled can enroll in private insurance plans that assume responsibility for covering a participant's health benefits. Those plans get a generous government subsidy and now serve roughly 10 million people. The program is called Medicare Advantage.

Documents obtained from some companies participating in Medicare Advantage show that their agents stand to make $500 to $550 this year for enrolling a beneficiary into one of their plans. In subsequent years, the agents could make another $500 for every year the beneficiary stays with the plan. After five years, an agent could have made more than $2,500, which is quite a jump from previous years.

Such a financial reward is raising concerns that agents and brokers will work too aggressively to enroll people into plans that don't meet their health needs.

"Medicare Advantage plans that have nearly quadrupled agent commissions are putting profits before patients and that's wrong," Sen. Max Baucus, D-Mont., said in a news release Friday. "We can't let seniors remain at risk of being targeted by predatory sales agents looking to make a quick buck."

The Centers for Medicare and Medicaid Services recently issued regulations designed to curb abusive sales tactics in the Medicare Advantage program. The regulations went into effect Oct. 1, the start of the new marketing season. Plans can't begin enrolling new beneficiaries for their 2009 coverage until Nov. 15.

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October 25, 2008 | Permalink | Comments (0) | TrackBack (1)

Kennedy Focuses from Home on Health Care Overhaul

The Washington Post reports that Sen. Edward Kennedy is trying to lay the groundwork for a breakthrough on health care reform next year, though many believe the enormous undertaking has been made even more difficult by the troubled economy.  Kevin Freking writes,

Wwwwashingtonpostcom_edward_kennedyKennedy, aides say, has held several video conferences with lawmakers and staff in recent months as he fights from home to overcome brain cancer. His staff has held more than a dozen meetings in recent weeks with various advocacy and interest groups that will help influence the debate.

"We're carrying it out in his absence, but this is his doing," said an aide who was not identified because he was not authorized to speak publicly. "He's in constant touch with leaders in this effort. This is Senator Kennedy at the helm." The story was first reported by The Washington Times.

Kennedy doesn't want to repeat the steps that some say doomed health care reform under former President Clinton. That means acting quickly when Congress returns to Washington after the election and the holidays. Some say Clinton's political honeymoon was over by the time Congress took up his health care plan.

Kennedy is chairman of the Senate Committee on Health, Education, Labor and Pensions. Sen. Barack Obama's health care plan will be the starting point in Kennedy's efforts. That's a big assumption given that the presidential race is far from over. The Obama plan features many changes that Massachusetts enacted in 2006, such as greater use of government subsidies to help people afford coverage. However, Obama would not require adults to buy health insurance, as Massachusetts did. Obama does have a requirement that children be insured.

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October 25, 2008 | Permalink | Comments (0) | TrackBack (2)

Friday, October 24, 2008

On Health Plans, the Numbers Fly

The New York Times questions whether the statistics and forecasts cited by both presidential candidates in their proposals will carry any weight in the future.  Kevin Sack writes,

StethescopeEconomics, it is said, is the dismal science. Anyone paying close attention to the campaign debate over the economics of health care might wonder about the science part.

As Senators Barack Obama and John McCain battle over how best to control spending and cover the uninsured, they are both filling their speeches, advertisements and debating points with authoritative-sounding statistics about the money they would save and the millions of Americans they would cover.

But the figures they cite are invariably the roughest of estimates, often derived by health economists with ideological leanings or financial conflicts. Over time, these forecasts have become so disparate and contradictory as to be almost meaningless.

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October 24, 2008 | Permalink | Comments (0) | TrackBack (1)

Prescription Drug Injuries and Deaths Reach Record Levels

The Los Angeles Times reports that a watchdog group reports that 4,825 deaths and nearly 21,000 injuries occurred in the first three months of 2008. The drugs heparin and varenicline are cited as the most dangerous.  Thomas H. Maugh II writes,

Wwwlatimescom_prescription_drugsThe number of deaths and serious injuries associated with prescription drug use rose to record levels in the first quarter of this year, with 4,825 deaths and nearly 21,000 injuries, a watchdog group said Wednesday.

Those numbers represent a nearly threefold increase in deaths from the previous quarter and a 38% increase in injuries from last year's quarterly average, according to the Horsham, Pa.-based Institute for Safe Medication Practices.
The most dangerous medications were the anti-smoking drug varenicline, which was linked to 1,001 injuries and 50 deaths in the three-month period ending in March, and the blood thinner heparin, which was associated with 779 injuries and 102 deaths.

The data came from voluntary reports of adverse effects to the Food and Drug Administration, which made the data public after stripping information that identified victims. Because the reporting is voluntary, researchers have speculated that fewer than 10% of adverse events actually make it into the system.

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October 24, 2008 | Permalink | Comments (1) | TrackBack (1)

Thursday, October 23, 2008

Big Issue: Voters Look for Answers on Health Care

The Washington Post reports on a survey that shows that 78% of voters say health care is a very important or extremely important issue.  Both presidential candidates have proposed significant changes to the way Americans purchase health insurance.  Julie Pace writes,

Stethescope3Even if the issue doesn't often get star billing on the campaign trail, health care remains a huge issue for voters. It seems like everyone's got a story to tell about their medical challenges and how they do, or don't, get insurance coverage.

An Associated Press-Yahoo News survey taken last month shows that 78 percent of voters say health care is a very important or extremely important issue.

Both presidential candidates have promised that, if elected, they'll propose significant changes to the way Americans purchase health insurance, a process that is often cumbersome, confusing, and that has left 47 million people in the Unites States uninsured.

Republican presidential nominee John McCain is proposing a tax credit of up to $2,500 for individuals and $5,000 for families so people can buy the insurance of their choice. That credit would replace the tax break that people currently get when they obtain health coverage through their employer.

Democrat Barack Obama's plan calls for the government to subsidize health coverage for millions of Americans who otherwise could not afford it. He has also proposed a government-run plan that couldn't turn away people with certain pre-existing health problems.

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October 23, 2008 | Permalink | Comments (1) | TrackBack (2)

The Battle of the Medical Bills

The Los Angeles Times reports that doctors and insurers blame each other for an administrative headache that is driving up the nation's healthcare costs.  Daniel J. Costello, Lisa Girion and Michael A. Hiltzik write,

Stethescope2In late 2007, Centinela Hospital in Inglewood was losing nearly $1 million a month and had piled up $15 million in debt. Among the causes of the crisis: $25 million in overdue bills.

Collecting that money would have given Centinela a measure of relief. But the bills went unpaid, and the century-old medical center was sold. The new owners slashed services, closed half the operating rooms and laid off a third of the employees.

Who owed Centinela that elusive $25 million? According to hospital officials, it was health insurance companies.

"Insurers have found a very creative way of denying, delaying or slowing payments in a way that is having a real impact on patient care and some of our survival," said Von Crockett, Centinela's chief executive. "Every single doctor and hospital is writing off money they are legally owed but don't collect. It's an insane situation."

Doctors and hospital executives say collecting payments from insurers has become an expensive headache that is driving up the nation's healthcare costs.

Billing disputes and protracted payment delays are one consequence of a massive consolidation among health insurers that has created de facto monopolies in much of the country, the Los Angeles Times found.

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October 23, 2008 | Permalink | Comments (1) | TrackBack (0)

Wednesday, October 22, 2008

FDA: Incontinence Surgery Linked to Complications

The Washington Post reports that federal officials say a type of mesh used in surgeries to treat severe incontinence, cases of prolapsed uterus and other women's health problems has been linked to serious but infrequent complications.  The Washington Post writes,

SurgeryThe Food and Drug Administration said this week it has received more than 1,000 reports in the last three years of problems with surgical mesh used to repair pelvic organ prolapse and stress urinary incontinence. The mesh is inserted through the vagina, using minimally invasive surgical techniques.

The complications include erosion of the mesh through vaginal tissue, infection, pain and urinary problems. Some patients have experienced a recurrence of the original condition that the surgery was supposed to resolve. Others have had to undergo repeat surgeries to remove the mesh. Some suffered significant loss of quality of life, including pain during sexual intercourse.

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October 22, 2008 | Permalink | Comments (0) | TrackBack (4)

Health Insurers Reinvent Themselves as Money Managers

The Los Angeles Times reports that many people rush to open banks as more Americans open health savings accounts, a tax-sheltered way to pay medical bills. Managing that money is more profitable than offering health insurance.  Michael A Hiltzik writes,

Health_insurers_reinvent_themselvesWellPoint Inc., the nation's largest health insurance company, ran into a snag last year while pursuing an important new business initiative.

Federal banking regulators insisted on classifying WellPoint as a healthcare company. And that was interfering with its efforts to open a bank.

The Federal Reserve Board eventually agreed that the company's core insurance business could be considered financial services. But what about its mail-order pharmacy and its program for managing chronic diseases, which was overseen by WellPoint doctors and nurses? Wasn't that healthcare?

WellPoint finally convinced the Fed that those activities were merely "complementary" to its main business -- financial services. It pledged to limit them to less than 5% of total revenue.

That a medical insurer would agree to keep a lid on healthcare expenditures so it could get approval to open a bank illustrates a fundamental change in the industry: Insurers are moving away from their traditional role of pooling health risks and are reinventing themselves as money managers -- providers of financial vehicles through which consumers pay for their own healthcare.

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October 22, 2008 | Permalink | Comments (2) | TrackBack (1)

Tuesday, October 21, 2008

An Eroding Model for Health Insurance

The Los Angeles Times reports that working Americans once could rely on employer-based benefits. But more people are now being forced into the individual market, where coverage is costly, bare-bones and precarious.  Lisa Girion and Michael A. Hiltzik write,

Health_careJennifer and Greg Danylyshyn of Pasadena are conscientious parents. They keep proper car seats in their used BMW, organic vegetables in the family diet and the pediatrician's number by the phone.
They don't have access to the group medical insurance offered by many employers. She's a stay-at-home mom. He's a self-employed music supervisor in the TV and film industry. So they buy individual policies for each family member.

As careful consumers, they shopped for the best deals, weighed premium costs against benefits and always assumed they could keep their family covered.

Then last spring Blue Shield of California stunned them with a rejection notice. Baby Ava, their happy, healthy 7-pounder, was born with a minor hip joint misalignment. Her pediatrician said it was nothing serious and probably temporary.
Still, Blue Shield declared the infant uninsurable. The company foresaw extra doctor visits, "the need for monitoring and an X-ray." Ava's slight imperfection "exceeds . . . eligibility criteria for acceptance," Blue Shield said.

"I was enraged, baffled; I just could not understand," recalled Jennifer, 36.

The family's experience is symptomatic of the nation's healthcare crisis. Ineligible for group insurance, millions of Americans are paying more for individual policies that offer less coverage and expose them to seemingly arbitrary exclusions and denials.

The health insurance system has become increasingly expensive and inaccessible. It leaves patients responsible for bills they understood would be covered, squeezes doctors and hospitals, and tries to avoid even minuscule risks, such as providing coverage to a newborn with no serious illness.

At the heart of the problem is the clash between the cost of medical care and insurers' need to turn a profit.

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October 21, 2008 | Permalink | Comments (1) | TrackBack (0)

Many Holes in Disclosure of Nominees’ Health

The New York Times reports that fifteen days before the election, serious gaps remain in the public’s knowledge about the health of the presidential and vice-presidential nominees. The limited information provided by the candidates is a striking departure from recent campaigns, in which many candidates and their doctors were more forthcoming.  Lawrence K. Altman writes,

Stethescope4In past elections, the decisions of some candidates for the nation’s top elected offices to withhold health information turned out to have a significant impact after the information came to light. This year, the health issue carries extraordinary significance because two of the four nominees have survived potentially fatal medical problems that could recur.

If elected, Senator John McCain of Arizona, 72, the Republican nominee, would be the oldest man to be sworn in to a first term as president and the first cancer survivor to win the office. The scars on his puffy left cheek are cosmetic reminders of the extensive surgery he underwent in 2000 to remove a malignant melanoma.

Last May, his campaign and his doctors released nearly 1,200 pages of medical information, far more than the three other nominees. But the documents were released in a restricted way that leaves questions, even confusion, about his cancer.

A critical question concerns inconsistencies in medical opinions about the severity of his melanoma; if the classification of his melanoma is more severe, it would increase the statistical likelihood of death from a recurrence of the cancer.

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October 21, 2008 | Permalink | Comments (1) | TrackBack (0)

Monday, October 20, 2008

Gaps Seen in Maryland Drug Treatment

The Washington Post reports on a recent report commissioned by the Maryland General Assembly has concluded that state services for drug addicts and alcoholics falls far short of the need, a problem it says is most profound in Prince George's County.  Rosalind S. Helderman writes,

Files3The report comes as new figures show that several counties, including Prince George's, regularly return hundreds of thousands of dollars in unspent substance abuse treatment funds to the state.

According to the report, which was compiled by University of Maryland researchers working in conjunction with a Harvard Medical School professor, the state would have to admit 14,423 more people into public or private drug treatment programs each year to meet the need. In Prince George's alone, 4,606 more people each year need treatment than receive it. A gap exists in other area counties too -- Montgomery needs 2,950 more treatment admissions annually, and Anne Arundel needs 755.

Researchers examined indicators of drug use, including drug arrests, mortality rates and hospital discharges, to produce an estimate of need in each county. They then compared those rates with the number of treatment admissions each year.

The gap in Prince George's occurred not because researchers found more drug use there -- the county ranked third from the bottom in the researcher's analysis of total need. Instead, they found that Prince George's admits the fewest people for substance abuse treatment per 100,000 residents of any Maryland county, treating far fewer people than they estimated need help.

Their analysis showed that 1,078 substance abuse admissions were needed each year per 100,000 residents in the county; instead, Prince George's had 524.

"We don't have enough trained drug counselors," said Del. Justin D. Ross (D-Prince George's), one sponsor of legislation that produced the report. "We don't have enough treatment beds. When people finally hit their knees and want to go get help, you can't tell them there's a waiting list."

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October 20, 2008 | Permalink | Comments (5) | TrackBack (1)

Parents Press States for Autism Insurance Laws

The Washington Post reports that parents and an advocacy group, Autism speaks, are encouraging the passing of laws requiring health insurers to cover intensive and costly behavior therapy for autism.  Carla K. Johnson writes,

Gavel4In Washington state, Reza and Arzu Forough pay more than $1,000 a week for behavior therapy for their 12-year-old autistic son.

In Indiana, Sean and Michele Trivedi get the same type of therapy for their 11-year-old daughter. But they pay $3,000 a year and their health insurance covers the rest.

Two families. Two states. Big difference in out-of-pocket costs.

If autism advocates get their way, more states will follow Indiana's lead by requiring health insurers to cover intensive and costly behavior therapy for autism.

In the past two years, six states, Texas, Pennsylvania, Arizona, Florida, South Carolina, Louisiana,  passed laws requiring such coverage, costing in some cases up to $50,000 a year per child.

The powerful advocacy group Autism Speaks has endorsed bills in New Jersey, Virginia and Michigan and is targeting at least 10 more states in 2009, including New York, California and Ohio.

Other states, including Illinois, have similar bills in the works but aren't working directly with Autism Speaks.

"This is the hottest trend in mandates we've seen in a long time," said J.P. Wieske, a lobbyist for an insurance coalition that argues that these state requirements drive up insurance costs for everyone. "It is hard to fight them."

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October 20, 2008 | Permalink | Comments (3) | TrackBack (0)