Mental health parity law implementation evolves
Filed under: Government, Health care reform, Hot Health Headline
Writing for Kaiser Health News and The Washington Post, Sandra Boodman considers the effect that the American mental health parity law has had since it went into effect on Jan. 1.
The law applies to about 140 million Americans, Boodman writes, most of whom are insured by employers with more than 50 employees. For qualifying groups, “Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment.” It doesn’t apply to individual policies and doesn’t require employers to offer mental health coverage of any kind.
There are still questions about the implementation of the law, many of which are addressed in the Obama administration’s implementation plan (PDF), which should take effect on July 1.
Officials of key business and insurance industry groups said they were displeased that the regulations were “more expansive” than they believe lawmakers intended. Mental health advocates applauded the rules, which they said would help ensure that Americans battling schizophrenia, for example, receive the same level of care provided to those facing leukemia.
Federal officials estimate that complying with the law will increase premiums nationwide by four-tenths of 1 percent, or about $25.6 billion over 10 years. Employers are free to drop mental health and substance abuse coverage and are allowed to manage claims to determine if treatment is medically necessary, just as they do now for physical ailments, but the standards can no longer be more stringent. Plans are also allowed to exclude treatment for certain illnesses, such as eating disorders, as long as state law does not mandate coverage. There is also an escape hatch: Plans that can prove that their costs increased by more than 2 percent in the first year can file for an exemption.
Fortunately, it looks like that sort of cost increase will be rare, based on research that shows similar rules improved access without increasing cost.
For some background on the mental health parity law, check out MIWatch.org.
Health care summit streaming live
President Barack Obama is hosting a bipartisan meeting to discuss health care reform. The meeting, from 10 a.m. until 4 p.m. is being streamed live.
- Obama’s proposal
- Republican ideas included in Obama’s proposal
- Solutions to health care from the GOP
- Bipartisan meeting
Reporters chronicle the death of a sugary drink tax
With a classic tale of powerful established interests, millions and millions of dollars and savvy lobbying, Chicago Tribune reporters Tom Hamburger and Kim Geiger draw our attention to the news vacuum that has formed where debate over a sugary drink tax used to be. From its optimistic beginnings to its eventual slow strangulation, Hamburger and Geiger track the rise and fall of the push to tax sugary drinks in order to discourage poor dietary choices and help fund health care reform.
The reporters do a wonderful job of chronicling every lobbying pressure point pushed by the industry, from faux grassroots to industry alliances to muli-million-dollar advertising campaigns. Here’s a small sample of their overview:
The White House has dismissed the idea, however, even after President Barack Obama had expressed interest last summer. A key congressional committee, though initially seeming receptive, ended up refusing to consider it. Several minority advocacy groups, including some committed to fighting obesity, lined up against the tax after years of receiving financial support from the industry.
…..
Meanwhile, beverage lobbyists attacked several nutrition scientists, accusing them of bias and distorting available evidence. The beverage industry also financed research that reached conclusions favorable to its position.
(Hat tip to Audrea Huff of the Orlando Sentinel’s Fitness Center blog)
Academics: Media added to reform confusion
Filed under: Health care reform, Health data, Hot Health Headline, Member news
Health News Florida’s Carol Gentry talked to journalism professors at three major Florida universities about the effect of media coverage on public perception of health care reform. The trio suggested that the media muddied the issue by focusing coverage on the political horse-race aspects while neglecting to invest the time necessary to fully explain the proposed legislation’s finer details.
In a column for AHCJ, Trudy Lieberman, the organization’s immediate past president has discussed some of the same shortcomings of health reform coverage. The academics say this is nothing new – many of the same issues surfaced during Clinton’s health reform push in the early ’90s, but say today’s fragmented media environment and 24-hour news cycle have certainly exacerbated matters.
[Kim Walsh-Childers, University of Florida journalism professor] said many Americans get their information from talk radio or blogs, “which are far less likely to provide balanced, complete information than are traditional news outlets, especially newspapers.”
“Even those who read newspapers may be getting far more information about the political strategies (of) the various stakeholders … than they are about what those proposals actually would mean for the average family,” Walsh-Childers continued.
Walsh-Childers praised NPR and The New York Times for their more thoughtful reform coverage, and said layoffs of experienced health reporters had likely weakened coverage at many outlets.
Gentry also cited surveys conducted by the Kaiser Family Foundation which found that peoples’ opinions of reform changed when they were better informed of the bills’ actual components.
Surveyors found that while a majority said they were opposed to the legislation, support grew markedly when survey participants found out the major parts of the plan.
Three-fourths became more favorable when they heard about tax credits for small businesses and two-thirds liked what they heard about health exchanges, constraints on health insurers and plugging the Medicare prescription-drug “doughnut hole.”
Related
More columns by Lieberman about coverage of health reform:
- Putting a human face on McCain, Obama health plans
- Look for opportunities to localize the debate on national health reform
- If candidates won’t focus on aging issues, journalists better
- Candidates’ health reform language needs closer scrutiny, definition
- Journalists must do better to inform, educate public
Open government directive bears fruit, databases
Filed under: Government, Health data, Hospitals, Hot Health Headline, Public records, Tools
In December, 2009 Peter Orszag, director of the White House’s Office of Management and Budget, issued an Open Government Directive (original PDF here) requiring a number of agencies to “identify and publish online in an open format at least three high-value data sets” on Data.gov within 45 days. That deadline came on Jan. 22, and the resulting data sets have all been posted online. The beefiest and most immediately useful are those from the Department of Veterans Affairs, but we’ve also included other sets which could prove useful for health care journalists. Descriptions are taken directly from Data.gov.
Department of Veterans Affairs
Veterans hospital report cards and safety reports
The VA has divided report cards (11 categories) and safety reports (4 categories) into topic-specific files, from Infrastructure to Nosocomial Infections. The best way to find what you’re looking for is to visit the Open Government Directive site and then scroll down to “Department of Veterans Affairs.”
FY08 Veterans Compensation and Pension by County
The Compensation and Pension by County dataset is a count of the number of veterans receiving disability compensation or pension payments from the Department of Veterans Affairs. The data is reported at the county level, by age group and by % disability rating.
Social Security disability claims
SSA Disability Claim Data
The dataset includes fiscal year data for initial claims for SSA disability benefits that were referred to a state agency for a disability determination. Specific data elements for each year and state include receipts, determinations, eligible population, and favorable determination rates.
SSA State Agency Workload Data
The dataset includes monthly data from October 2000 onwards concerning initial claims for SSA disability benefits that were referred to a state agency for a disability determination.
USDA nutrition data
MyPyramid Food Raw Data
MyPyramid Food Data provides information on the total calories; calories from solid fats, added sugars, and alcohol (extras); MyPyramid food group and subgroup amounts; and saturated fat content of over 1,000 commonly eaten foods with corresponding commonly used portion amounts.
USDA National Nutrient Database for Standard Reference
The USDA Nutrient Database for Standard Reference, Release 22 (SR22) is the major source of food composition data in the United States and provides the foundation for most public and private sector databases. SR22 contains nutrient data for over 7,500 food items for up to 143 food components, such as vitamins, minerals, amino acids, and fatty acids.
Medicare
CY 2009 MTM Contact List
CMS approved contact list of Part D Sponsors in Medication Therapy Management Program (MTMP) which is in their plans’ benefit structure.
Office of Medicare Hearings and Appeals Claims Listed by State
Total count of Claims received by Region, State and fiscal year. Appeals can be found here.
Part B National Summary Data File
The Medicare Part B National datasets are summarized by meaningful Health Care Common Procedure Coding/Current Procedural Terminology, (HCPC/CPT), code ranges. Each dataset displays the allowed services, allowed charges and payment amounts by HCPC/CPT codes and prominent modifiers.
Other
OSHA Data Initiative - Establishment Specific Injury and Illness Rates
Each year the Occupational Safety and Health Administration (OSHA) collects work-related injury and illness data from employers within specific industry and employment size specifications. This data collection is called the OSHA Data Initiative or ODI. The data provided is used by OSHA to calculate establishment specific injury and illness incidence rates.
What else is there?
The “Tools” section of the site includes widgets and data-mining and extraction tools, applications, and other services to “provide the public with simple, application-driven access to Federal data with hyperlinks.” The “Geodata” section includes federal geospatial data with metadata and links to more detailed Federal Geographic Data Committee (FGDC) metadata information.
The site is soliciting comments about what datasets should be made available, so you can suggest more datasets here. The site also offers a tutorial.
Health reform and the Supreme Court
Filed under: Government, Health care reform, Health data
Sarasota Health News‘ David Gulliver and Health News Florida’s Mary Jo Melone considered exactly how last Thursday’s Supreme Court ruling on campaign contributions by corporations would impact the health care lobby and the health reform debate. Their most interesting angle? That health care companies have already spent such gigantic sums of money on lobbying (more than $2.2 billion in 2008 and 2009) that the ruling won’t have the same impact on health as it will on other industries. In other words, the medical industry has already had the volume on the lobbying amp cranked to 10 for some time now, and it’s just not possible to ratchet it up any higher.
Gulliver and Melone on exactly what has changed in theory:
Until now, companies could not spend their own money directly on political advertising. They had to create political action committees, or a shadowy type of nonprofit known as a 527 organization. Then those groups could raise money from donors to pay for advertisements. For PACs, those donations are limited under federal law to $5000 per person per year.
In practice, the impact is less clear. Even under the previous system, those with money found ways to use it with impunity. It’ll be a more straightforward process now but, especially in health care, may not lead to huge changes in the money being spent. According to one school of thought, the biggest change will be in the use of explicit anti-candidate advertising threats as a metaphorical club during negotiations.
NOTE: It’s important to remember that, in a companion decision, the court upheld the transparency requirements that accompany these political donations. If you’re interested in tracking the changes in donations post-decision, head over to OpenSecrets.org, where they have a post explaining exactly how to use their tools to do so.
As for immediate impact, the reporters quote several experts who seem to think that unrestrained spending won’t transform the health care reform debate, partly because it’s already been so thoroughly transformed by other factors.
(Brad Ashwell of Florida Public Interest Research Group) said the legislative health-reform package pending in Congress is already “pretty moderate,” and it’s not likely to get more consumer-friendly now that business interests “can go straight to their treasuries.”
Even before the Supreme Court ruling, chances of helping Florida’s 3.8 million uninsured were looking increasingly sketchy, with a special-election loss that cost Democrats a crucial seat in the U.S. Senate this week. The only quick route to passage was for the House to accept the version of the legislative package that barely passed in the Senate on Christmas Eve, and House Speaker Nancy Pelosi announced Thursday she doesn’t have the votes to pull it off.
How health reform lost popular support
Filed under: Government, Health care reform, Health policy
Kaiser Health News staff writers, including Jordan Rau, Mary Agnes Carey, Julie Appleby and Phil Galewitz, teamed up to figure out why Americans are so disenchanted with health care reform. After talking to an analyst who admitted that politicians “can do everything right and still fail in health reform,” the reporters set out to figure out what, if anything, went wrong.
The reporters divided the administration’s missteps (and, to a lesser degree, those of lawmakers) into four categories: helping individuals understand how reform tangibly benefited them, threatening Medicare, proposing a number of confusing tax increases, and the lengthy and frustrated deal-making process that preceded the reform bills now under consideration.
Myth surrounds reform’s ‘Safeway Amendment’
Filed under: Government, Health care reform, Health policy
Throughout the health care reform process, politicians have held up Safeway’s health incentive program as a model for future government health plans. The supermarket chain’s program requires employees who fail basic health screenings for blood pressure, weight, and cholesterol to pay higher health insurance premiums. 
Safeway maintains that this policy encourages its employees to make healthy lifestyle changes to in turn lower their health care costs. The Washington Post’s David Hilzenrath looked into the grocer’s impact on proposed health reform plans. Hilzenrath reports on how misconceptions about Safeway’s wellness program could impact public health policy in the U.S. Senate’s proposed Safeway Amendment.
Under a regulation advanced during George W. Bush’s administration, incentives conditioned on meeting wellness targets are limited to 20 percent of the premium – including employer and employee contributions to the premium. The Safeway Amendment would allow employers to increase the stakes to 30 percent, and it would give federal officials license to raise the limit to 50 percent. It would also allow insurers to use the same approach – initially in 10 states and potentially in others.
Employers and insurers would be required to make exceptions for people with extenuating medical circumstances.
Supporters of the amendment maintain that it will encourage private-sector employees to monitor and improve their health. Dissenting organizations, including the American Heart Association and the American Cancer Society, suggest that the legislation will unhinge a central tenet of health reform: That an individual’s health status will no longer impact premiums.
Safeway credits its internal health plan for keeping the company’s health care costs nearly steady between 2005 and 2009. An external survey of 1,700 employers revealed that companies’ health care costs increased by 30 percent in the same time period, on average.
Hilzenrath reports that “a review of Safeway documents and interviews with company officials show that the company did not keep health-care costs flat for four years. Those costs did drop in 2006 – by 12.5 percent. That was when the company overhauled its benefits, according to Safeway Senior Vice President Ken Shachmut.”
Groups give Obama “A” for openness despite barriers between journalists, federal experts
Filed under: Government, Health journalism, Hot Health Headline, Public records
A coalition of reform groups, including Common Cause, Democracy 21, the League of Women Voters and U.S. PIRG, recently issued “A Report Card from Reform Groups on the Obama Administration’s Executive Branch Lobbying, Ethics and Transparency Reforms in 2009.” The administration gets high marks in a number of categories, including an “A” for open government. The report card, however, seems to overlook an issue of particular interest to health care journalists.
The groups praise the administration’s “unprecedented steps to implement Executive Branch transparency,” steps they said include the disclosure of official visits to the White House, the publication of stimulus and other government contracts online and the administration’s “presumption of disclosure” approach to FOIA requests. They also note a few shortcomings, including the administration’s reliance on Internet-only avenues of disclosure and time lags in the availability of some information.
According to AHCJ’s Right to Know Committee, there’s another shortcoming those reformers missed in their report card: Restricted access to federal employees. AHCJ has already requested that the administration reverse inherited policies that allow federal public information officers to restrict the access the public has to federal experts, and while committee representatives praised the administration’s move toward a more open government, they don’t think this particular obstructionist policy should be ignored.
By way of explanation, here’s an excerpt from a letter sent by Right to Known Committee Chair Felice Freyer and AHCJ President Charles Ornstein to the groups responsible for the report card.
… we wanted to make you aware of another issue the administration has yet to address: the continuing difficulty that journalists face in speaking with federal employees. Under policies that have intensified over the past 15 years, public information officers often block or delay our access to the people who have the facts needed to inform the public.
This is not just a matter of reporters looking to make their jobs easier. It’s a question of our ability to tell the public what federal employees are doing with taxpayers’ money and to report on important research and public health issues. Many times staff members are eager to talk with us, but they require permission from public information officers. The PIOs sometimes simply say “no.” Or they never call back. Or they tell the reporter to wait for the official news release. Many insist on listening in on interviews, ensuring that staff will stick to the “official story.”
Reform bills would benefit Indian Health Service
Filed under: Government, Health care reform, Health policy
Mark Trahant, writing for InvestigateWest, points out that, because it’s in both the House and Senate versions of the bill and thus safe in conference committee, the reauthorization and extension of the Indian Health Care Improvement Act will pass as long as the larger reform package does.
The Parker Indian Health Services Hospital in Parker, Ariz. Photo by churl via Flickr.Originally enacted in 1976, the IHCIA has, in various iterations, been the primary vehicle for the delivery of health care to the country’s American Indians and Alaska Natives.
The latest version of the bill would adjust the Indian Health Service budget to account for medical inflation and population growth, increase efforts to recruit and retain health care professionals, introduce coverage for long-term care, improve youth suicide prevention programs and encourage innovation that will help provide easier access to health facilities.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- 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
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
