Author: Jaffe.KHN@gmail.com

Clinton versus Trump on health care

lancet cover 2Volume 388, Number  10057 

5  November 2016 

WORLD REPORT   The presidential candidates have different ideas about improving US health care.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

The future of the Affordable Care Act, President Barack Obama’s signature health law, depends largely on the next occupant of the White House. Trump, the Republican candidate for president, wants to repeal and replace the law. Clinton, his Democratic opponent, wants to improve and expand it.  [Continued here] 

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Medicare Bars New ‘Seamless Conversion’ Efforts For Some Seniors

By Susan Jaffe  | Kaiser Health News | October 28, 2016 |  This KHN story also ran in 

The federal government is temporarily blocking more health insurance companies from automatically moving customers who become eligible for Medicare into Medicare Advantage plans while officials review the controversial practice.

They also will issue rules soon for plans that already have permission to make these switches, known as “seamless conversion,” according to a memo from Michael Crochunis, acting director of the Medicare Enrollment and Appeals Group at the Centers for Medicare & Medicaid Services.

Under current rules, an insurer can transfer customers who have purchased policies through an Affordable Care Act insurance exchange or other commercial plans when they become eligible for Medicare, typically at age 65. An insurer must give an individual 60 days’ advance written notice of the switch; if a person doesn’t opt out, that enrollment takes effect automatically.

… The decision to prohibit additional insurers from pursuing Medicare Advantage conversions comes after Kaiser Health News and The Washington Post identified problems with the practice in July. Some seniors did not know they had different coverage until receiving out-of-network providers’ bills for thousands of dollars. Others got the news when they received a Medicare Advantage membership card they hadn’t requested — with the name of a new primary care doctor they didn’t know. [Continued in Kaiser Health News and The Washington Post]…

US global health leadership hangs on election result

lancet cover 2Volume 388, Number  10055 

22  October 2016 

WORLD REPORT   On most issues, the US presidential candidates have polar opposite views; engagement in global health is no different.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

Americans will choose their next president in less than 3 weeks and yet some global health experts still wonder what would happen to the international health programmes that the USA has championed in recent decades if the Republican contender, Donald Trump, is elected. The uncertainty comes despite the Ebola virus and Zika virus threats that made global health front-page news.  [Continued here] …

Officials Warn Some Older Marketplace Customers To Switch To Medicare

By Susan Jaffe  | Kaiser Health News | October 14 2016 |  This KHN story also ran in 

Ever since the Affordable Care Act’s health insurance marketplaces opened for business in 2014, the Obama administration has worked hard to make sure Americans sign up. Yet officials now are telling some older people they might have too much insurance and they should cancehealthcare-gov-letterl their marketplace policies.

The federal Centers for Medicare & Medicaid Services is targeting two groups. First the agency is sending emails each month to about 15,000 people with subsidized marketplace coverage. The messages arrive a few weeks before their 6
5th birthday, which is also the age most people become eligible for Medicare. The email reminders will go to enrollees in the 38 states that use the federal marketplace.

“In most cases you won’t want to keep your Marketplace plan because once your Medicare coverage starts, you’ll no longer be eligible for any premium tax credits or other cost savings you may be getting for your Marketplace plan,” the notice says.  “To avoid an unwanted overlap in Marketplace and Medicare coverage … tell us you want to end your Marketplace plan.”

…Beneficiaries shoulder a lot of responsibility, even though there is no requirement they all be told what to do and when. Only the individual can terminate marketplace coverage when he or she becomes eligible for Medicare. Inaction means paying back any coverage subsidies received after they should have joined Medicare.  [Continued in  Kaiser Health News or The Washington Post]

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EpiPen’s price-gouging response “sickens” Congressional panel

Susan Jaffe | Washington Correspondent for The Lancet | 28th September 2016

The latest drug company chief to appear before Congress did not dodge questions by taking refuge in the Fifth Amendment’s protection against self-incrimination, as did Martin Shkreli, the former CEO of Turing Pharmaceuticalthe-lancet-usa-blog-logo1s.  But after a nearly four-hour congressional hearing last week investigating spikes in Mylan’s EpiPen prices, Maryland Democrat Elijah Cummings told Mylan CEO Heather Bresch, “You might as well have taken the Fifth, too, with the kind of information that we’ve gotten here today.” [Continued here]  
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Hillary Clinton proposes mental health care reforms

Susan Jaffe | Washington Correspondent for The Lancet | 7th September 2016

 Former Secretary of State and Democratic presidential candidate Hillary Clinton unveiled her “Comprehensive Agenda on Mental Health” last week, addressing the millions Americans with mental health problems.  “Too many Americans are the-lancet-usa-blog-logo1being left to face mental health problems on their own, and too many individuals are dying prematurely from associated health conditions,” according to her proposal. “The next generation must grow up knowing that mental health is a key component of overall health and there is no shame, stigma, or barriers to seeking out care.” [Continued here]
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Protecting California’s Seniors From Surprise Hospital, Nursing Home Bills

By Susan Jaffe  | Kaiser Health News & California Healthline | August 29, 2016CA Healthline logo-chl

Californians with Medicare coverage would no longer be surprised by huge medical bills stemming from “observation care” in hospitals under legislation that state lawmakers approved overwhelmingly last week and sent to Gov. Jerry Brown to sign into law.

The sticker-shock can happen when people go to the hospital but health care providers are not sure what’s wrong. If the patient is not sick enough to be formally admitted, but still not healthy enough to go home, they can stay in the hospital for “observation care,” which Medicare considers an outpatient service. That can mean higher out-of-pocket expenses for the patient….And because observation patients have not spent the required minimum of three straight days as an admitted patient, Medicare will not cover their follow-up nursing home expenses after discharge. Observation care doesn’t count….“I don’t think the average person knows the difference,” said Sen. Ed Hernandez (D-West Covina). Hernandez introduced the legislation requiring hospitals starting Jan. 1 to tell all patients if they are getting observation care.

…The legislation also would require the nation’s first minimum nurse-to-patient staffing ratios in observation care units for hospitals that have separate units for those patients. “We are still the only state that has these very specific mandated ratios for every unit of the hospital that have to be adhered to every minute of every day,” said Jan Emerson-Shea, a spokeswoman for the California Hospital Association, which represents 400 hospitals. Those staffing rules, however, excluded observation care units.

“We wanted to make sure hospitals didn’t use observation care as a loophole to avoid any of the minimum nursing staffing requirements,” said Sen. Hernandez. [Continued in California Healthline or San Jose Mercury News]…

US presidential candidates’ proposals to reduce drug prices

lancet cover 2
Volume 388,  Number 10047
27 August 2016
 WORLD REPORT   US presidential candidates’ proposals to reduce drug prices Clinton and Trump seem to agree on at least some ways to bring down the cost of prescription drugs, but Clinton offers more details.   Susan Jaffe, The Lancet’s Washington correspondent, reports. [Continued here] 
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Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans

By Susan Jaffe  | Kaiser Health News | July 27, 2016 |  This KHN story also ran in 

Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.

Neither the plan nor Medicare now would cover her medical costs. She owed $16,622.

“I was panicking,” said Hanttula, who lived in Carlsbad, N.M., at the time. After more than five hours making phone calls, she learned that because she’d had individual coverage through Blue Cross Blue Shield when she became eligible for Medicare, the company automatically signed her up for its own Medicare Advantage plan after notifying her in a letter. Hanttula said she ignored all mail from insurers because she had chosen traditional Medicare.

“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”

With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called “seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days. [Continued in The Washington Post and Kaiser Health News]…

Democrats back Clinton, progressive platform at DNC in Philadelphia

Susan Jaffe | Washington Correspondent for The Lancet | 29 July 2016

Vermont Sen. Bernie Sanders stressed the need for unity when he addressed the convention on its first day, citing the Democratic party platform as evidence of the gains his supporters have achieved. “It is no secret that Hillary Clinton and I disagree on a number of issues … that’s what democracy is about,” Sanders told the convention. “But I am happy to tell you that at the Democratic Platform Committee, there was a significant coming together between the two campaigns and we produced, by far, the most progressive platform in the history of the Democratic Party.” [continued here] [listen to podcast here]…

Republican Party lays out platform for Election 2016

Susan Jaffe | Washington Correspondent for The Lancet | 15 July 2016

Cleveland, OH – The Republican Party’s platform committee approved a blueprint this week that reflects the core principles of its most conservative wing, describing how a Republican presidential candidate would govern if elected.

gop_platform_committee_071116

                                                                                           Photo:SUSAN JAFFE

Several delegates said they don’t expect the presumptive Republican presidential nominee, Donald Trump, to agree with every point and that’s OK.

“With Mr. Trump, on a lot of these issues, he’s with us,” said Melody Potter, a member of the Republican National Committee from Charleston, West Virginia. “We know for a fact that Hillary Clinton is not with us.”

…Reporters attending the platform committee meetings this week were not allowed to see copies of the roughly 50-page document delegates discussed. But some delegates were willing to mention some health care provisions.  [Continued]  …

HHS Proposes To Streamline Medicare Appeals Process

By Susan Jaffe  | Kaiser Health News | June 29, 2016 | This KHN story also ran on     nprlogo_138x46

The Department of Health and Human Services Tuesday proposed key changes in the Medicare appeals process to help reduce the backlog of more than 700,000 cases involving denied claims.

The measures “will help us get a leg up on this problem,” said Nancy Griswold, chief law judge of the Office of Medicare Hearing and Appeals.

If there weren’t a single additional appeal filed and no changes in the system, it would take 11 years to eliminate the backlog, Griswold said in an interview. [Continued on NPR or KHN]  …

Obama rejects Zika funding approved during Democrats’ sit-in

Susan Jaffe | Washington Correspondent for The Lancet | 27th June 2016

Four months after President Barack Obama requested $1.9 billion to respond to the Zikathe-lancet-usa-blog-logo1 virus, the U.S House of Representatives approved $1.1 billion last week. Just days later, the Senate rejected legislation on June 28 that would have provided the same amount. That’s not the only obstacle blocking funding. [Continued here]  …

Senate Panel Kills Medicare Program That Offers Help On Enrollment, Billing Issues

By Susan Jaffe  | Kaiser Health News | June 17, 2016 | This KHN story also ran on     nprlogo_138x46

A program that has helped seniors understand the many intricacies of Medicare as well as save them millions of dollars would be eliminated by a budget bill overwhelmingly approved last week by the powerful Senate Appropriations Committee.

The State Health Insurance Assistance Program, or “SHIP,” is among more than a dozen programs left out of the bill by the committee. Cutting these “unnecessary federal programs” helped provide needed funding for other efforts, Sen. Roy Blunt, R-Mo., chairman of the appropriations committee’s health and labor subcommittee, said in a statement last week.

Ending SHIP saves $52 million, which will help pay for a $2 billion increase for the National Institutes of Health, restore year-round Pell Grants, and increase resources to prevent and treat opioid abuse, among other things.

SHIP counselors are in every state, the District of Columbia and the U.S. territories offering free advice on how to choose from an array of drug and health insurance plans, challenge coverage denials, and receive financial subsidies for premiums, co-payments and deductibles. …Ohio’s SHIP program saved seniors $20.8 million in 2015 and was ranked first in the nation by the Department of Health and Human Services, the state’s lieutenant governor announced in February. [Continued on Kaiser Health News or NPR]

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US presidential candidates urged to support health research

lancet cover 2Volume 387, Number  10037 
18 June  2016 

WORLD REPORT   Advocates for medical research are eager to hear how the presidential candidates would advance the search for new treatments.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

As the most tumultuous presidential primary season in recent times comes to an end, biomedical researchers, physicians, and advocacy groups want the candidates campaigning for the White House to address some of the substantive matters they worry about: National Institutes of Health (NIH) funding, advancing Alzheimer’s disease research, speeding up drug development, and a host of research related issues.

… In New Hampshire last year, the campaigns provided a preview of the kind of discussion between candidates and voters that research and patients’ advocacy groups would like. It revealed a stark difference between Clinton and Trump on funding for Alzheimer’s research and support for those caring for the 5·4 million Americans stricken with the disease. [Continued here]

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Medicare Releases Draft Proposal For Patient Observation Notice

By Susan Jaffe | KAISER  HEALTH  NEWS | June 15, 2016 |This story also ran in usat 4sidebar

In just two months, a federal law kicks in requiring hospitals to tell their Medicare patients if they have not been formally admitted and why. But some physician, hospital and consumer representatives say a notice drafted by Medicare for hospitals to use may not do the job.

The lawdraft obs notice 061517 was a response to complaints from Medicare patients who were surprised to learn that although they had spent a few days in the hospital, they were there for observation and were not admitted. Observation patients are considered too sick to go home yet not sick enough to be admitted. They may pay higher charges than admitted patients and do not qualify for Medicare’s nursing home coverage.

The NOTICE Act requires that starting Aug. 6, Medicare patients receive a form written in “plain language” after 24 hours of observation care but no later than 36 hours. Under the law, it must explain the reason they have not been admitted and how that decision will affect Medicare’s payment for services and patients’ share of the costs. The information must also be provided verbally, and a doctor or hospital staff member must be available to answer questions

And patients could have questions, said Brenda Cude, a National Association of Insurance Commissioners consumer representative and professor of consumer economics at the University of Georgia. She said the notice is written for a 12th-grade reading level, even though most consumer materials aim for no more than an eighth-grade level. It “assumes some health insurance knowledge that we are fairly certain most people don’t have.”    

…The form does not meet the expectations of Rep. Lloyd Doggett, D-Texas, who co-sponsored the law. “I am concerned that the proposed notice fulfills neither the spirit nor the letter of the law,” Doggett said in an interview. [Continuted at Kaiser Health News or USA Today]…

Medicare’s Efforts To Curb Backlog Of Appeals Not Sufficient, GAO Reports

By Susan Jaffe  | Kaiser Health News |  June 10, 2016

 Despite interventions by Medicare officials, the number of appeals from health care providers and patients Growing Wait Time1challenging denied claims continues to spiral, increasing the backlog of cases and delaying many decisions well beyond the timeframes set by law, according to a government study released Thursday.

The report from the Government Accountability Office, said the backlog “shows no signs of abating.” It called for the Department of Health and Human Services to improve its oversight of the process and to streamline appeals so that prior decisions are taken into account and repetitive claims are handled more efficiently.

HHS officials have acknowledged the problem. Although a judge is required to issue a decision within 90 days, the average time from hearing request to decision is slightly more than two years, Nancy Griswold, the chief administrative law judge of the Office of Medicare Hearings and Appeals, said in an interview.

Requests for hearings increased “so dramatically and so quickly over the past four or five years — during a period of time when our adjudication capacity was not able to keep up for funding reasons — we were drowning” in appeals, she said. “It is not quite as bad right now, but we are unable to keep up with [those] that are coming in the door.”  [Continued]…

Medicare returning to an old-fashioned idea: house calls

By Susan Jaffe, Kaiser Health News | May 21, 2016 | and also published in USA Today logo 2012
Looking for ways to save money and improve care, Medicare officials are returning to an old-fashioned idea: house calls.
But the experiment, called Independence at Home, is more than a nostalgic throwback to the way medicine was practiced decades ago when the doctor arrived at the patient’s door carrying a big black bag. Done right and paid right, house calls could prove to be a better way of treating very sick, elderly patients while they can still live at home. …By all accounts, saving any money on these patients is a surprise. Independence at Home targets patients with complicated chronic health problems and disabilities who are among the most expensive Medicare beneficiaries. [Continued in USA Today,  Kaiser Health News,  The Washington Post, or Next Avenue]

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Biden Pleads for Open Data for Cancer Moonshot

Susan Jaffe | Washington Correspondent for The Lancet | 10th May 2016

Three months after Vice President Joe Biden convened the first meeting of the Cancer Moonshot Task Force—aimed at accelerating the-lancet-usa-blog-logo1cancer prevention, treatment and cures—he pleaded for help from people who know how to marshal massive amounts of health data to create successful businesses, or apps that can guide consumers to the best hospitals. [continued here]…

US responds to increase in Zika cases

 lancet cover 2Volume 387, Number  10030
30 April  2016 
WORLD REPORT    Health officials pursue Zika research and prepare to combat a formidable foe—the mosquito— despite uncertain funding.   Susan Jaffe, The Lancet’s Washington correspondent, reports.

Anthony Fauci

As the number of confirmed cases of people who have contracted the Zika virus increases across the globe, the growing knowledge  about this once rare infection is not reassuring. “The more we learn, the more we get concerned”, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases…. 

Representative Tom Cole, the Oklahoma Republican who is chairman of the House appropriations health subcommittee, said its questions about [President Barack Obama’s $1.9 billion Zika emergency funding] request are not unreasonable….“Let us do our job to make sure we do this as prudently as possible and we will get there”, he said. “Nobody thinks this is not a serious challenge”….

While clinical research and the funding debate continues, protection from the Zika virus will depend largely on avoiding the mosquitoes that carry it….

After years of cuts in federal and local funding for mosquito control, Zika is “a pretty major wake up call to rebuild those capacities”, said Lyle Petersen, director of CDC’s division of vector-borne infectious diseases. The virus is the latest “major pathogen that has come into the Americas” in recent years—after chikungunya, dengue fever, and West Nile virus—“and it won’t be the last.” [continued here]  [listen to podcast here] …

Paris Climate Change agreement to be signed in New York

Susan Jaffe | Washington Correspondent for The Lancet | 19th April  2016

Secretary of State John Kerry will join world leaders at the United Nations headquarters in New York on April 22 to sign the landmark Paris Climate Change agreement, aimed at controlling greenhouse gasThe Lancet USA blog logoes and preventing what many scientists believe would be the harmful effects of global warming.

Representatives of some 155 countries  are expected at the signing ceremony, including President François Hollande of France, Canadian Prime Minister Justin Trudeau and other heads of state. …UN Secretary-General Ban Ki-moon has urged all countries to ratify the agreement as soon as possible.  “It is in their national interest to implement the agreement and reap the benefits of sustainable global climate action,” he said in an email to The Lancet.

…When 55 countries responsible for at least 55 percent of global emissions do so, the agreement takes effect.  That could happen this year said UN spokeswoman Devi Palanivelu, noting that several countries are coming to New York with ratification documents they will submit after signing the agreement.  But things are not moving as swiftly in the U.S.  [Continued here]  …

US election: what are the candidates’ health-care pledges?

 lancet cover 2Volume 387, Number  10026 
2  April  2016 
WORLD REPORT    Democrats vying for their party’s presidential nomination have more detailed health-care plans than their Republican counterparts.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

Billionaire real estate developer Donald Trump’s unorthodox campaign to become the Republican presidential nominee has dominated the 2016 political race, nearly overshadowing some unconventional contenders on the Democratic side.  The result is a political season that has defied the odds makers.

Former US Secretary of State and Senator from New York, Democrat Hillary Clinton may be well on her way to becoming the first woman in US history to win her party’s nomination for president. Vermont Senator Bernie Sanders, a self-proclaimed socialist, is trailing Clinton in the number of delegates needed to win the nomination. Yet his popular call for “a political revolution” continues to slowly raise his delegate count. [MORE]

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When Medicare Advantage Drops Doctors, Some Members Can Switch Plans

By Susan Jaffe  | Kaiser Health News | March 29, 2016 | This KHN story also ran on  nprlogo_112x37

Eliza Catchings has been seeing doctors at the Christie Clinic in central Illinois since 1957. But just after receiving this year’s WellCare Medicare Advantage member card, the insurer told her the clinic was leaving WellCare’s provider network and she would have to choose new doctors.

“I was terrified,” said Catchings, 79, who gets care for diabetes and heart problems. But she was helped by a little-noticed change in federal policy.

Medicare Advantage plans sold by private insurers are an alternative to traditional Medicare, but they cover services only from doctors, hospitals and other providers that are in the insurer’s network. Although providers are allowed to drop out of the plans any time, members can usually change only during the annual sign-up period in the fall. There are exceptions, but until recently losing a provider was not among them.

After insurers dropped hundreds of providers in 2013, the Centers for Medicare and Medicaid Services issued rules giving people a “special enrollment period” to change plans or join regular Medicare if there was a “significant” change in their provider network. The policy took effect in 2015 and applies only to Medicare Advantage members, not to the plans CMS oversees in the health law’s marketplaces. …Yet officials didn’t explain what they considered significant or what would trigger the option.

In the past eight months, Medicare officials have quietly granted the special enrollment periods to more than 15,000 Medicare Advantage members in seven states, the District of Columbia and Puerto Rico based on provider cuts. These decisions offer important details about how members can get permission to follow their doctors who leave their plans. … Medicare doesn’t publicize the option, and few beneficiaries may know about it. Representatives who answered calls earlier in March to Medicare’s toll-free number said nothing could be done.  [Continued on Kaiser Health News or NPR] 

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