Category: HHS

CMS lost $84M in two years for ineligible nursing home stays

     IG investigators said such improper payments are accumulating year after year.

By Susan Jaffe  | Modern Healthcare | February 20, 2019

The CMS pays millions of dollars a year to nursing homes for taking care of older adults who don’t qualify for coverage, according to an investigation by HHS’ inspector general.

The IG’s report, released Wednesday, includes steps the CMS should take to fix the problem; but in a written response, CMS Administrator Seema Verma rejected some key recommendations. [Continued here.]…

USA sets goal to end the HIV epidemic in a decade

Volume 393, Number 10172   

16 February 2019       

 

WORLD REPORT   The unexpected announcement in the State of the Union address could set the start of a realistic agenda to end HIV/AIDS in the USA, provided funds are secured. Susan Jaffe reports.

Nearly an hour into his 90 min State of the Union address, President Donald Trump called for a government-run health-care programme “to eliminate the HIV epidemic in the United States within 10 years”.

Although the president has promised to get rid of the Affordable Care Act (ACA) along with its health insurance marketplaces and Medicaid expansion, these and other policies did not appear to dampen his enthusiasm. [Continued here.]…

House Drug Price Hearing Takes Aim at Industry

By Susan Jaffe  | Contributing Writer | MedPageToday  | January 30, 2019

WASHINGTON — Pharmaceutical companies were pummeled during Tuesday’s hearing of the House Committee on Oversight and Reform. The panel’s first hearing of the 116th Congress examined the reasons for rising drug prices and follows committee chairman Elijah Cummings’ (D-Md.) launch of an aggressive investigation into pharmaceutical pricing issues.

“For the past decade I’ve been trying to investigate the actions of drug companies for all sorts of drugs — old and new, generic and brand name,” Cummings said. “We have seen time after time drug companies make money hand over fist by raising the prices of their drugs often without justification…”  [Continued at MedPageToday]

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State exemptions to the Affordable Care Act expanded

Volume 392, Number 10164 

15 December 2018

 

WORLD REPORT   In its latest blow to the ACA, the Trump administration provides guidance on how states can circumvent the health law. Susan Jaffe, The Lancet‘s Washington correspondent, reports.

In its most far-reaching move yet, the Trump administration has reinterpreted a provision of the landmark Affordable Care Act so that states can apply for exemptions to some requirements of the health law for states. [Continued here.]
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Prospects for health after the US mid-terms

 Volume 392, Number 10161   

24 November 2018       

 

WORLD REPORT   After the mid-term elections, Susan Jaffe, The Lancet‘s Washington correspondent, looks at the consequences for health-care legislation in the USA.

     In the first national election since Donald Trump won the presidency promising, among other things, to repeal the Affordable Care Act (ACA), Americans went to the polls this month still concerned about health care. It was the most important issue for 75% of Democrats and 23% of Republicans who voted in the Nov 6 elections, according to exit polls. But, unlike in 2016, voters handed Democrats—the party responsible for the ACA—their largest victory since Republican Richard Nixon resigned as president after the Watergate scandal….
     “Health care was on the ballot and health care won”, said the House of Representatives’ Democratic minority leader Nancy Pelosi of California, who is expected to become speaker of the house when the new Congress convenes in January. [Continued here.]
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No More Secrets: Congress Bans Pharmacist  ‘Gag Orders’  On Drug Prices

Update:  After this article was posted Oct. 10th, the President signed the legislation into law later that day.

By Susan Jaffe  | Kaiser Health News | October 10, 2018  | This KHN story also ran on 

For years, most pharmacists couldn’t give customers even a clue about an easy way to save money on prescription drugs. But the restraints are coming off.

When the cash price for a prescription is less than what you would pay using your insurance plan, pharmacists will no longer have to keep that a secret.

…But there’s a catch: Under the new legislation, pharmacists will not be required to tell patients about the lower cost option. If they don’t, it’s up to the customer to ask.  [Continued at Kaiser Health News and at NBC News]

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Funding redirected to pay for immigrant detention centres

 Volume 392, Number 10157   

27 October 2018

 

WORLD REPORT   A plan to expand immigrant children detention centres requires money from medical research and
health programmes. Susan Jaffe, The Lancet‘s Washington correspondent, reports.

Trump administration officials told congressional leaders last month it will transfer as much as US$466 million from cancer research, meals for older adults, preschool for toddlers, HIV/AIDS prevention, and other initiatives that are central to the agency’s mission to protect Americans’ health. “These transfers are only a temporary solution to the sad consequence of a broken immigration system”, said HHS Deputy Secretary Eric Hargan. [Continued here.]
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Prospects for US single-payer national health care

 Volume 392, Number 10149   

1 September 2018

 

WORLD REPORT   The single-payer national health-care bill, so-called Medicare for All, is gaining momentum with the public but is stalling in Congress. Susan Jaffe, The Lancet‘s Washington correspondent, reports.

Instead of fading away into legislative oblivion, some Democrats campaigning for congressional seats and candidates for state offices are supporting the Medicare for All bill—or some variation thereof—as the November election approaches. They are not alone: a Morning Consult/Politico national poll in June found that 63% of Americans support “a Medicare for All healthcare system, where all Americans would get their health insurance from the government”. [Continued here.]

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Trump’s second Supreme Court nominee, Brett Kavanaugh

Volume 392, Number 10144   

 28 July 2018

 

WORLD REPORT   If confirmed, Kavanaugh could tilt the court toward the president’s views on US public health policy. Susan Jaffe, The Lancet‘s Washington correspondent, reports.

Before Republicans chose Donald Trump as their party’s candidate for president in 
2016, some doubted whether the New York real-estate developer seeking political office for the first time was truly conservative. To shore up his conservative credentials, Trump produced a list of judges with help from the conservative Heritage Foundation and Federalist Society that he promised to choose from to fill a vacancy on the Supreme Court should an opening occur during his presidency.... 
Health-care issues are expected to dominate the debate over [Judge Brett] Kavanaugh’s nomination in the US Senate, which will decide if he should join the court. Several cases involving the Affordable Care Act (ACA) and reproductive rights are working their way through the legal system. …If Kavanaugh, aged 53 years, is approved, his lifetime position on the court means his vote could be a deciding factor in cases for several decades. [Continued here.]

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Trump Administration’s Medicaid work rules hit a snag

Susan Jaffe | Washington Correspondent for The Lancet | 10th July 2018

 After winning a federal court decision to stop Kentucky from requiring some Medicaid patients find paid or volunteer work to keep their coverage, beneficiary advocates are considering legal challenges to stop similar efforts in other states.

The victory may expose a major flaw in the Trump Administration’s effort to reshape the Medicaid program, advocates say.  But others claim the flaw is in the court decision. [Continued here.]…

Gun violence research in the USA: the CDC’s impasse

Volume 391, Number 10139   

 23 June 2018

 

WORLD REPORT   Months after the Trump Administration said that there is no ban on gun violence studies, the CDC still lacks the funding to proceed. Susan Jaffe, The Lancet‘s Washington correspondent, reports.

…Appeals for immediate federal action to make schools and communities safer have so far largely gone unanswered. And legislative efforts languish in Congress, as the chairman of a key congressional committee that oversees federal health programmes has so far resisted requests by its Democratic members to hold hearings on preventing gun violence [continued here].…

Trump unveils plan to cut drug prices

 Volume 391, Number 10136   

 2 June 2018

 

WORLD REPORT   The president’s wide-ranging plan to reduce prescription drug prices won’t be easy to achieve, experts say. Susan Jaffe, The Lancet’s Washington correspondent, reports.

“We will have tougher negotiation, more competition, and much lower prices at the pharmacy counter. And it will start to take effect very soon“, said President Donald Trump.  

How soon will depend on what steps the administration takes on its own, through regulations and other mandates, and what changes can only be achieved through new laws enacted by Congress, which will increasingly be preoccupied by November’s election. [Continued here.]…

Trump Administration’s new direction for Medicaid

Volume 391, Number 10126   
24 March 2018

 

WORLD REPORT   Medicaid work requirements would make the health insurance programme a pathway out of poverty, say top US health officials. Susan Jaffe, The Lancet’s Washington correspondent, reports.

Beneficiaries can lose their health care if they fail to pay a premium, submit documentation that they qualify for an exemption, or to report a change in eligibility. “All roads lead to people being terminated from the programme or locked out of coverage,” said Leonardo Cuello, an attorney and director of health policy at the National Health Law Program in Washington, DC.  

“This is not about punishing anyone”, said Arkansas Governor Asa Hutchinson. “It’s about giving people an opportunity to work and give them the training they need and help them move out of poverty and up the economic ladder.”  [Full article here.]   …

After a weekend of negotiations and demonstrations, shutdown disrupts health agencies

Susan Jaffe | Washington Correspondent for The Lancet | 22nd January 2018

On the first anniversary of Donald Trump’s inauguration as the 45th president of the United States on January 20, 2018, the federal government ground to a shutdown and hundreds of thousands of women and their supporters rallied against the new president in dozens of cities across the country. [Continued here.]  

 

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Alex Azar’s controversial qualifications

Susan Jaffe | Washington Correspondent for The Lancet | 27th December 2017

When President Donald Trump nominated Alex Azar last month to lead the Department of Health and Human Services (HHS), supporters said his experience working in government and the pharmaceutical industry more than qualified him for the job. … the-lancet-usa-blog-logo1But critics say Azar has the wrong kind of experience. When he appeared before Senate Committee on Health, Education, Labor and Pensions (HELP) last month, the committee’s senior Democrat Patty Murray of Washington said if Azar runs HHS then “the fox is guarding the hen house.” [Continued here]

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As HHS Moves To End Overload Of Medicare Claims Appeals, Beneficiaries Will Get Top Priority

By Susan Jaffe  Jan. 21, 2014  KAISER HEALTH NEWS  in collaboration with 

Medicare beneficiaries who have been waiting months and even years for a hearing on their appeals for coverage may soon get a break as their cases take top priority in an effort to remedy a massive backlog.

Nancy Griswold, the chief judge of the Office of Medicare Hearings and Appeals (OMHA), announced in a memo sent last month to more than 900 appellants and health care associations that her office has a backlog of nearly 357,000 claims. In response, she said the agency has suspended acting on new requests for hearings filed by hospitals, doctors, nursing homes and other health care providers, which make up nearly 90 percent of the cases. But beneficiaries’ appeals will continue to be processed.

“We have elderly or disabled Medicare clients waiting as long as two years for a hearing and nine months for a decision,” said Judith Stein, executive director of the Center for Medicare Advocacy. [More from KHN] [More from Washington Post]…

Fighting ‘Observation’ Status

By Susan Jaffe   |   January 10, 2014, 2:41 pm  

Every year, thousands of Medicare patients who spend time in the hospital for observation but are not officially admitted find they are not eligible for nursing home coverage after discharge. 

…Medicare officials have urged hospital patients to find out if they’ve been admitted. But suppose the answer is no. Then what do you do?

Medicare doesn’t require hospitals to tell patients if they are merely being observed, which is supposed to last no more than 48 hours to help the doctor decide if someone is sick enough to be admitted. (Starting on Jan. 19, however, New York State will require hospitals to provide oral and written notification to patients within 24 hours of putting them on observation status. Penalties range as much as $5,000 per violation.)  [Continued in The New York Times.]…

Doctors skittish about health technology despite promise of big federal bucks

By Susan Jaffe  | Center for Public Integrity  |  July 7, 2011

The goal is to bring the last outposts of the nation’s health care system into the computer age, linking medical providers so that they can coordinate and improve patient care and — in the process—reduce unnecessary health care spending. But convincing everyone to use electronic health records has not been easy. …Neither  reward nor punishment has 

persuaded some small practice doctors — a troubling omen for the Obama administration, which believes that conversion of paper records to electronic form is a crucial step toward health care reform. [Continued]

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