July 31, 2012
2:39 pm
The International AIDS Conference that took place last week in Washington, D.C. was a significant event in terms of nations and organizations renewing their commitment to combat the spread of the HIV virus, which has infected 1.2 million people in this nation alone. After the speeches are long completed, though, what really matters are the actions to connect those who have HIV/AIDS with the healthcare they need in order to live active, productive lives.
In that light, the Merck Company Foundation deserves thanks for the launch of its new HIV Care Collaborative for Underserved Populations in the United States. Starting in three cities, the new initiative shows great promise in reaching the one of every three Americans who have HIV and are not receiving essential medical care.
What’s sensible about the Merck approach is that it is building upon programs that are already active and working. The Atlanta/Fulton County Department of Health and Wellness, the Houston Department of Health and Human Services, and the Philadelphia Department of Public Health will each receive up to $1 million from the Merck Foundation over three years to support initiatives that are identifying local citizens living with HIV and helping them navigate their community healthcare systems.
As Merck Foundation president Geralyn S. Ritter put it, “Too many people living with HIV/AIDS are not getting the healthcare they need to stay healthy and contribute to healthy communities.” In fact, as Merck pointed out in announcing the initiative, 20 to 40 percent of patients are failing to establish care immediately after receiving an HIV-positive diagnosis. That’s why it’s so essential to fund the local outreach taking place in communities across the country.
Let’s hope that future AIDS conferences, thanks to this initiative and others like it, will feature reports on the improved healthcare being received by HIV/AIDS patients.
July 10, 2012
9:26 am
Governor Rick Perry’s announcement that Texas will not participate in the coming expansion of the Medicaid program – a decision made possible by last month’s Supreme Court decision forbidding the federal government to penalize states that opt out of Medicaid expansion – is extremely significant, but it’s probably not the most important Medicaid-related headline to come out of the Lone Star state this week.
Yesterday, the Texas Medical Association released new statistics showing a precipitous decline in the number of physicians accepting new Medicaid patients. In 2000, two out of every three doctors were seeing new patients on Medicaid. This year, that number has dropped to 31 percent.
That wasn’t the only worrisome aspect of the survey. The report also found that 58 percent of Texas physicians said they are seeing new Medicare patients. That number was 78 percent in 2000.
What these Texas figures show is that we have trend lines moving in opposite directions. The intent of the Patient Protection and Affordable Care Act (PPACA) is to put millions more Americas on the Medicaid program. And, at the same time, the retirement of the baby boom generation is moving over 7,000 citizens per day onto the Medicare rolls. While the Medicare-Medicaid population is increasing rapidly, more physicians are refusing to see patients reliant on government health programs.
This problem was predictable. As the head of the Texas Medical Association put it, “Every business has a breaking point, and physicians’ practices are no different.” With Medicare and Medicaid payment rates significantly lower than private insurance reimbursements, it’s naïve to expect physicians to accept an altered patient mix with a significantly higher proportion of patients receiving government health coverage.
This is a question the next Congress (understanding that this issue won’t be resolved in the current election climate) will need to address. With numerous governors not yet committing to Medicaid expansion and more physicians joining their Texas counterparts in not expecting new Medicaid patients, is there a better way to provide health coverage to low-income Americans?
June 28, 2012
9:18 am
The Supreme Court has upheld the Patient Protection and Affordable Care Act (PPACA). We applaud the fact that mechanisms remain in place to bring millions of uninsured Americans into the health coverage system. We shouldn’t lose sight of the fact, though, that the need to continue improving the quality and affordability of our healthcare system remains strong.
Expanding access to health insurance, while maintaining system stability and affordability for patients and consumers, requires broad public participation. While the individual mandate has been deemed constitutional under Congress’s taxation powers, we continue to be concerned it may not be fully effective in encouraging sufficiently large numbers of healthy, uninsured Americans to purchase health coverage. We urge Congress to consider supplementing the mandate with additional enrollment incentives. Also, HLC will work to educate Americans about their coverage options and assist them in the enrollment process.
The Court’s decision notwithstanding, Congress must still address aspects of the health reform law that could undermine healthcare affordability, access, quality and innovation. There is a bipartisan understanding, for example, that the Independent Payment Advisory Board exists only to cut payments to providers without regard to value, making it more difficult for seniors to receive medical care. Medical device excise taxes will place obstacles in the way of new lifesaving innovations getting to patients while also removing jobs from our economy.
The goal of health reform is to ensure that every American has access to high-quality, innovative, affordable healthcare. All health sectors are dynamically moving forward to deliver that care to patients and consumers. Now policymakers must do their part to advance and remove impediments to this essential progress.
June 26, 2012
12:03 pm
I don’t want to minimize the importance of Thursday’s forthcoming U.S. Supreme Court ruling on health reform. There is a great deal at stake. Particularly if the Court declares the individual health insurance mandate unconstitutional but leaves insurance reforms in place, Congress is faced with the responsibility of finding mechanisms to bring more healthy Americans into the health coverage system.
But, even though Washington, D.C. and every cable news network is consumed with what might happen on Thursday, it’s worth nothing that there are substantial healthcare challenges that will continue to exist regardless of what the Court decides. And there are healthcare delivery reforms that are and will continue to be ongoing well after the Justices have their say.
These points were made clear over the past few days by two leading health industry CEOs, both members of the Healthcare Leadership Council.
In a conversation with Sarah Kliff of the Washington Post’s well-read WonkBlog, Aetna CEO Mark Bertolini said that the future of the healthcare system hinges far more on the industry’s ability to contain costs than it does on the Supreme Court decision. His company is among those working on health delivery and payment structures that align reimbursement with quality and patient outcomes instead of quantity of services.
And in an interview with Bloomberg Television, Cleveland Clinic CEO Toby Cosgrove left no doubt that health providers are already implementing cost-effective, quality-driven reforms. He also raised an issue that will continue to be an important one well after the Supreme Court announcement Thursday. Dr. Cosgrove correctly pointed out that, in order to get costs under control, the nation needs to place a stronger emphasis on wellness and disease prevention.
To truly understand where American healthcare is going in the next few years, you’ll gain more from reading and watching these interviews than you will from following Thursday’s wall-to-wall cable TV court analyses.
March 30, 2012
2:16 pm
While the U.S. Supreme Court was hearing oral arguments this week on the constitutionality of the individual mandate provisions of the Affordable Care Act, another serious concern about the mandate didn’t involve constitutional issues and stayed relatively unnoticed.
Is the individual mandate sufficient to achieve its intended goal, to bring healthy Americans into the health insurance pool? In answering this question, the stakes are high. If millions of currently uninsured Americans choose to remain without coverage, and simply pay the noncompliance penalty instead, serious questions are raised as to whether other insurance reforms can take effect – most importantly, eliminating pre-existing conditions as a barrier to coverage – without destabilizing the marketplace.
This is a legitimate worry. In 2014, a person who chooses to remain uninsured would be penalized $95 or one percent of adjusted taxable income, whichever is greater. And even when the penalty is fully implemented in 2016, the penalty will be the greater amount of $695 or 2.5 percent of adjusted taxable income. These penalties will still be less than the cost of purchasing health coverage.
As University of Illinois law professor Richard L. Kaplan put it, accurately, “(A) person might choose not to buy health insurance, opting to wait until something medically unfortunate happens. Insurance companies will not be able to refuse her at that point, a situation that might imperil the private insurance market.”
Even if the Court upholds the constitutionality of the individual mandate, lawmakers can’t complacently assume that it will be strong enough to move uninsured citizens into the insurance marketplace. It would be worth studying the efficacy of other incentive programs, such as those used by the Medicare Part D prescription drug program. Part D has utilized both limited enrollment windows as well as higher costs for those who delay enrollment.
The goal of incentivizing Americans to acquire health insurance is a good and necessary one. It’s necessary, though, to keep in mind that the constitutionality of the individual mandate may be the most visible issue, but it’s far from the only one.
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