Health Law and Policy Update
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Headlines of the week
U.S. adults more likely to go without health care due to costs
Adults in the United States are more likely than those in other nations to report "negative insurance-related experiences," according to a survey by The Commonwealth Fund released this week.
The survey found: "One-third of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared with as few as 5 percent to 6 percent in the Netherlands and the U.K. One-fifth of U.S. adults had major problems paying medical bills...[and] uninsured and insured U.S. adults reported equally high rates of out-of-pocket costs, with one-third paying $1,000 or more out-of-pocket in the past year for medical bills, significantly higher than in all the other countries."
Post-election polls indicate health care not a top voter priority
In at least one poll conducted after the elections last week, health care trailed other issues and political affiliation as a top priority for voters. In a Kaiser Health Tracking Poll, when asked an open-ended question about factors that influenced their vote, 17 percent of respondents listed health care or health reform as a top factor, which places health care fourth after jobs and the economy, party preference and views on the candidates.
The poll continues to show the public fairly evenly divided on support for health reform with 42 percent holding a favorable view, 40 percent holding an unfavorable view and 18 percent declining to offer an opinion. In the same poll, when asked about repealing the health reform law, 24 percent of respondents favored repealing the entire law, a quarter favored repealing only parts, 19 percent wanted to leave it as is, and 21 percent wanted to expand it. A separate AP poll shows 39 percent of those polled favor repealing health reform.
CMS announces innovation center
The Centers for Medicare & Medicaid Services (CMS) announced this week the creation of the Center for Medicare and Medicaid Innovation (CMMI). The CMMI is charged with investigating new and better methods for health care delivery and payment to create better health outcomes for patients and make the overall health care experience less fragmented. The Center for Medicare and Medicaid Innovation has three areas of emphasis: improving care for patients to make it safer and more patient-centered, developing models to make it easier for providers to work together on behalf of patients, and integrating public health priorities like obesity prevention and smoking cessation. There are several initiatives CMMI will promote, including health homes and funding to states for demonstration projects that focus on coordinating care for people who are eligible for both Medicaid and Medicare in an effort to drive down costs and improve care.
Health plans paid millions to oppose reform
Health insurance companies gave the U.S. Chamber of Commerce $86.2 million last year to fight passage of the Affordable Care Act, the Bloomberg news service reported Wednesday.
"The expenditures reflect the insurers' attempts to influence the bill after Democrats in Congress and the White House put more focus on regulation of the insurance industry," according to the news agency.
What's new
Questions and answers on open enrollment
Health insurance open-enrollment season has started for many people. The Washington Post has compiled some helpful answers to questions from readers.
HHS releases heath reform guidance on exchanges
Secretary of Health and Human Services Kathleen Sebelius released guidance to the National Association of Insurance Commissioners along with a cover letter this week that details principles and priorities for states in the formation of health insurance exchanges under the Affordable Care Act.
Eagle County testing community paramedic program
A new program in Eagle County demonstrates how local innovation can help contain costs and improve health outcomes. Eagle County Public Health and the Western Eagle County Ambulance District have partnered to provide hospital discharge follow-up services, blood draws, medication consultation and wound care, the Vail Daily reports. Patients are referred to the community paramedic program by their primary physicians. The primary care physicians at Colorado Mountain Medical, Eagle Care, Eagle Valley Medical Center, Vail Valley Medical Center and Valley View Hospitals' have all agreed to refer patients to the program.
Patients will not be charged for the service during the five year pilot program. Funding includes $500,000 in grants with the Colorado Health Foundation providing $225,000. Eagle County is the pilot county in Colorado.
Many patients live far away from the hospital or doctor's offices making it very difficult for follow-up care. Two specially trained paramedics, coordinating with primary care physicians and the Public Health department, started the pilot program in August 2010.
The community paramedic program is based on similar partnerships in Nova Scotia, Alaska and rural Australia and has been piloted in Minnesota and Nebraska.
Advancing the debate
High demand for claims help shows need for accountability
While health insurance brokers claim to spend 76.8 million hours annually assisting clients with claims, a group of consumer representatives says that only demonstrates how broken the health insurance system is and why recently enacted reforms were necessary.
The consumer representatives, part of a group convened by the National Association of Insurance Commissioners (NAIC), argued that point in a Nov. 8 letter to the NAIC Exchange Subgroup. The consumer representatives were responding to a survey of health insurance brokers by an industry group that found brokers assist clients with an average of 223 claims per year.
"Getting a claim paid should be straightforward with clear rules that are readily understandable to consumers. Consumers, agents and insurance companies themselves should not have to spend hundreds of millions of hours each year on claims issues. Claim appeals should be straightforward, efficient, and effective. Premium dollars could be better spent paying for care or reducing premium costs," the group wrote. "The best way for agents and others to assist consumers is to support changes to the system that make insurers more accountable and advocacy less necessary."
The consumer representatives include Barbara Yondorf, a Colorado-based health policy consultant.
Job-based insurance continues to erode
Employer-sponsored health insurance continued to decline as a source of coverage for non-elderly adults nationwide in 2009, continuing a long-term trend, the Economic Policy Institute reported in a paper issued this week.
The share of people getting insurance through work fell from 61.9 percent in 2008 to 58.9 percent in 2009. The rising unemployment rate during that time explains a big part of the decline, the paper said.
"The current recession highlights how dependent Americans are on a health labor market for all facets of economic security, including access to health care," it said.
Meanwhile, overall insurance rates for children increased from 2008 to 2009, even while the share of children receiving insurance through an employer-sponsored plan declined. Expansions of public programs such as Child Health Plan Plus enabled more children to be covered even while more employer-sponsored plans were unavailable.
The same trend played out in Colorado, as the Colorado Fiscal Policy Institute, a project of Colorado Center on Law and Policy, reported in September.
The financial effect of medical errors
Medical errors added an estimated $19.5 billion to the cost of health care nationwide in 2008, according to new research from Milliman, a Seattle-based actuarial consulting firm.
A medical error is an injury resulting from inappropriate medical care, such as administering medication that is known to cause an allergic reaction. The Milliman study, published in August, identified five medical errors that together account for more than 55 percent of the total cost.
Separately, a government study released this week estimated 15,000 Medicare patients die each month in part because of care they received in the hospital, USA Today reports.
What's next
Health policy meeting set for Saturday in Colorado Springs
Gov.-elect John Hickenlooper is holding meetings across the state to gather ideas from residents as he prepares to assume the office, including a meeting to discuss health care set for Saturday in Colorado Springs.
The Saturday meeting will also concern human services, public health and military affairs. It's scheduled for 1 p.m. at Colorado Technical University, Room 250-252, 4435 N. Chestnut St.
Residents may also submit comments via the Hickenlooper transition website.
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Health Law and Policy Update is issued weekly by the health staff of the Colorado Center on Law and Policy. Subscribe by e-mail or read previous editions.
Health Care Director
Elisabeth Arenales
Health Care Attorney
Adela Flores-Brennan
Special Counsel
Ed Kahn
Communications Director
Perry Swanson
Released Nov. 19, 2010