How reform will affect America, group by group
Filed under: Health care reform, Health policy, Hot Health Headline, Studies
In Health Affairs (AHCJ members get free access), economist Joseph Newhouse considers how health care reform will affect four major groups. They’re summarized below.
- Uninsured or on Medicaid or CHIP (30 percent)
- Insured individually or through a small business (10 percent)
- Insured through a mid-size or large business (45 percent)
- Recipient of Medicare (15 percent)
Medicaid expansion and broader subsidies are “major gains.”
This group will undergo the most change, with the individual mandate expanding their ranks to as much as 50 million people (16 percent of Americans). Health reform should “repair” this now-broken sector of the market.
A wash, as an insurance tax is balanced out by a reduced need to cover uncompensated care for the uninsured.
Complicated. The doughnut hole will close, but future financing sources are murky. Newhouse goes pretty deep into just how murky.
His conclusion is relatively upbeat. Newhouse writes that while reform “addressed many issues in health care financing, it left many others unresolved.” The system will need to be revised and updated throughout the foreseeable future, Newhouse writes, and effective implementation will “require persistence for many years to come.”
Reform may worsen ER crowding
Filed under: Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Member news, Studies
Associated Press medical reporter Carla K. Johnson has found that, contrary to common assumptions, emergency rooms could become even more crowded with the passage and implementation of health care reform. Popular wisdom has it that, with more access to insurance thus to primary care, folks will be less likely to go to the emergency room for minor complaints or to allow illness to progress to the point where an emergency visit is necessary. Johnson, an AHCJ board member, gives three big reasons why it’s not that simple:
- There are not (will not) be enough primary care physicians in America to deliver that preventative care.
- At present, the uninsured are no more likely to use the ER than patients with insurance coverage.
- “The biggest users of emergency rooms by far are Medicaid recipients,” Johnson writes. “And the new health insurance law will increase their ranks by about 16 million.”
ERs are crowded, Johnson writes, not only because of a lack of insurance but also because of obstacles inherent in their structure and mission, such as an aging population, more people with chronic illnesses, the closures of many ERs in the 1990s and the demand for beds for both emergency patients and patients scheduled for elective surgeries that bring more money.
AHCJ Immediate Past President Trudy Lieberman praised Johnson’s story and linked it to reporting by The Boston Globe on the impact of that state’s reform law upon emergency room use. So far, events in Massachusetts reinforce Johnson’s predictions.
The Boston Globe revisited Massachusetts’s ER conundrum last week, and reported pretty much what it did last year—that despite the state’s reform law, which mandated everyone have coverage beginning in July 2007, emergency room use is rising. Last year, the state’s Division of Health Care Finance and Policy cautioned that it was too early to draw any conclusions from the seven percent rise in ER visits between 2005 and 2007. Now the agency is saying that expanded coverage may be one reason for the 9 percent rise from 2004 to 2008. According to commissioner David Morales, many studies have shown that expanding coverage does not reduce emergency room visits. That’s because the uninsured “are not really responsible for significant ER use,” he told the Globe.
We have public options now. Are they any good?
Filed under: Government, Health care reform, Hot Health Headline
ProPublica’s Sabrina Shankman reviews America’s existing “public options” for health care, finding mixed results and limited utility. In addition to Medicare and Medicaid, Shankman reviews a few less prominent institutions:
- The armed forces Tricare plan: Covers all active members of the military, retirees and their families, regardless of preexisting conditions. If you stick to military treatment facilities, it’s cheap.
- Veterans Health Administration: Veterans who meet its standards are guaranteed high quality care, but funding is tight at the VA right now.
- Indian Health Service: Allows American Indians and Alaska Natives free access to reservation clinics… until the service’s funding runs out, as it does about halfway through each year.
- Healthcare Group of Arizona: It was founded to provide afforable insurance to certain small businesses, but a lack of funds and climbing deductibles mean that many employers will be better off looking to the private market anyway.
Reuters has a handy summary of the key provisions of the latest bill likely to be considered by the House of Representatives.
Key CMS database unresponsive, inadequate
Filed under: Health data, Hot Health Headline, Public records, Studies
The Department of Health and Human Services’ Office of Inspector General released a memo (27-page PDF) detailing an investigation that found that the effectiveness of a key database used for detecting Medicaid fraud has been compromised by slow response times and inefficient data tracking.
The Centers for Medicare and Medicaid Services’ Medicaid Statistical Information System is “the only nationwide Medicaid eligibility and claims information source.” It aggregates Medicaid from states, and its data are relied upon by a number of other federal databases and agencies. MSIS is used as a source on everything from data releases to congressional inquiries.
And, as is most relevant to the OIG’s investigation, MSIS is used by Medicaid Integrity Program to detect fraud, waste and abuse in the system. In the course of the investigation, OIG agents evaluated MSIS for immediacy, accuracy and utility. Investigators found that, between 2004 and 2006, eligibility and claims files both took almost 600 days to complete their file submission and validation process, and that “states submitted nearly two-thirds of the initial MSIS file submissions after the CMS due dates.” Furthermore, 32 states didn’t even get their submissions in within six months of the deadline.
Investigators also faulted CMS for not reporting adjustments that would affect statistical error in the data and for not tracking categories that would be useful in detecting fraud.
(Hat tip to Peter Newbatt Smith of The Center for Public Integrity)
Health a factor in report card on homeless kids
The National Center on Family Homelessness has released a report card on child homelessness, with an estimate that more than 1.5 million children in the United States are homeless.
The report points out that:
“Children without homes are twice as likely to experience hunger as other children. Two-thirds worry they won’t have enough to eat. More than one-third of homeless children report being forced to skip meals. Homelessness makes children sick. Children who experience homelessness
are more than twice as likely as middle class children to have moderate to severe acute and chronic health problems.”
Health is one measure taken into account for the report’s child well-being score and the report has sections that deal with the health of children as well as policy initiatives, such as Medicaid and SCHIP.
The report has a state-by-state breakdown that shows the percentage of uninsured children, Medicaid expenditures and eligibility and other measures. It also includes rankings and an evaluation of each state’s policy and planning for homelessness.
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
