Affordable Care Act, NIH, The Lancet

High stakes for research in US 2018 budget negotiations

Volume 390, Number  10099
 9 September 2017

WORLD REPORT    As Congress considers how to fund the government next year, scientists hope spending for research will not be curtailed. Susan Jaffe, The Lancet’s Washington correspondent, reports.  

The dramatic defeat of the Republicans’ Affordable Care Act (ACA) repeal legislation still looms over the US Capitol as Congress reconvenes this month for more tough decisions, including many that will affect health and science research programmes.  …The prospects for science funding will depend on competing budget pressures and political fissures. “There are a lot of moving parts and a lot of uncertainty”, said Matt Hourihan, at the American Association for the Advancement of Science. “And while a spending deal [agreement] is certainly possible, it’s hard to see how they get there from here.” [Continued here]

Affordable Care Act, Medicaid

Counting On Medicaid To Avoid Life In A Nursing Home? That’s Now Up To Congress.

By Susan Jaffe | KAISER  HEALTH  NEWS | July 31, 2017 |This story also ran in 

Ten years ago, a driver ran a stop sign as Jim McIlroy rode into the intersection on his motorcycle. Serious injuries left McIlroy paralyzed from the chest down. But, after spending some time in a nursing home, he returned to his home near Bethel, Maine.

McIlroy does most of his own cooking since Maine’s Medicaid program paid for a stovetop that he can roll his wheelchair underneath to reach the food-prep area. His

Esther Ellis received a new mattress earlier this year from Partners in Care, a nonprofit that runs four of the dozens of sites in California’s Multipurpose Senior Services Program, a Medicaid-funded home services program. (Heidi de Marco/KHN)

new kitchen sink has the same feature. Wheelchair-friendly wood flooring has replaced McIlroy’s wall-to-wall carpeting.

The alterations plus a personal care aide — all paid for by Medicaid — enable McIlroy to stay in his house that he and his wife, who has since died, “worked really hard to own,” he said. The arrangement also saves Medicaid roughly two-thirds of what it would cost if he lived in a nursing home.

McIlroy depends on the federal-state program’s growing support of home-based care services — along with 2 million elderly or disabled Americans who rely on them to live at home for as long as possible.

However, that crucial help could face severe cuts if congressional Republicans eventually succeed in their push to sharply reduce federal Medicaid funds to states. [Continued at Kaiser Health News and USA Today] 

 

 

CDC, EPA, FDA, NIH, The Lancet

Science appointments in the USA

  Volume 389, Number  10088
    24 June 2017

WORLD REPORT    Slow appointments and vacant positions in federal agencies challenge the stability of research in the USA.   Susan Jaffe, The Lancet’s Washington correspondent, reports.  

     As President Donald Trump rolls out his domestic agenda, his proposed budget cuts and lingering vacancies in key federal agencies have rattled some people in the biomedical research and science community.
     “This has been the most anxious time in science that I have seen in this country”, said Rush Holt, chief operating officer at the American Association for the Advancement of Science (AAAS), which represents 250 scientific societies and academies serving 10 million members. Holt cited a litany of reasons: “fake news” that distorts science, “policy making based on wishful thinking rather than evidence, funding proposals that are nonsensical, and unfilled positions in government agencies”.  [Continued here]  

 

 

Affordable Care Act, Long term care, Medicare, Medicare costs, Social Security Administration

Feds To Waive Penalties For Some Who Signed Up Late For Medicare

By Susan Jaffe  | Kaiser Health News | June 6, 2017 | This KHN story also ran on     

[UPDATE: Since this article was published, Medicare officials extended the deadline for applying for an exemption to the Part B late enrollment penalty to Sept. 30, 2018. The announcement came in a fact sheet posted on Oct. 12, 2017.]

Each year, thousands of Americans miss their deadline to enroll in Medicare, and federal officials and consumer advocates worry that many of them mistakenly think they don’t need to sign up because they have purchased insurance on the health law’s marketplaces. That decision can leave them facing a lifetime of enrollment penalties.

Now Medicare has temporarily changed its rules to offer a reprieve from penalties for people who kept Affordable Care Act policies after becoming eligible for Medicare.

“Many of these individuals did not receive the information necessary [when they became eligible for Medicare or when they initially enrolled] in coverage through the marketplace to make an informed decision regarding” Medicare enrollment, said a Medicare spokesman, explaining the policy change.

Those who qualify include people 65 and older who have a marketplace plan or had one they lost or canceled, as well as people who have qualified for Medicare due to a disability but chose to use marketplace plans. They have until Sept. 30 to request a waiver of the usual penalty Medicare assesses when people delay signing up for Medicare’s Part B, which covers visits to the doctor and other outpatient care…

“This has been a problem from the beginning of the Affordable Care Act, because the government didn’t understand that people would not know when they needed to sign up for Medicare,” said Bonnie Burns, a consultant for California Health Advocates, a consumer group. “Once they had insurance, that relieved all the stress of not having coverage and then when they became eligible for Medicare, nobody told them to make that change.”[Continued at Kaiser Health News and NPR]

Drugs, FDA, The Lancet

Scott Gottlieb sworn in to head the FDA

lancet cover 2Volume 389, Number  10084 

27 May 2017 

WORLD REPORT    Scott Gottlieb becomes commissioner of the FDA, as the agency’s role is threatened by an administration adverse to regulation.  Susan Jaffe, The Lancet’s Washington correspondent, reports.

Only 6 months ago, Scott Gottlieb was still a resident fellow at the American Enterprise Institute, a conservative thinktank, when he presented testimony to a US Senate committee investigating prescription drug prices. Before he began, he volunteered that he was “a reformed government bureaucrat, having worked at FDA [US Food and Drug Administration] for a number of years”. He blamed astonishing price hikes—500% in the case of Mylan’s EpiPen—on “regulatory failures stemming from FDA policy, and I think that policy can be fixed”.

Gottlieb was sworn in as the 23rd commissioner of the FDA after being approved earlier this month by the US Senate, over the strong objections of most Democrats. Now Gottlieb will have a chance to fix a daunting array of policies. [Continued here] 

Long term care, Medicare

Volunteers Help Ombudsmen Give Nursing Home Residents ‘A Voice’ In Their Care

By Susan Jaffe  | Kaiser Health News | May 2, 2017 |  This KHN story also ran in 

Since retiring four years ago, Barbara Corprew has visited Paris, traveled to a North Carolina film festival and taken Pilates classes, focusing on — as she puts it — just “doing things for me.” Now the former Justice Department lawyer, who worked on white-collar crime cases, is devoting time to something completely different: She visits nursing homes every week.

Barbara Corprew, says her service as a volunteer ombudsman was sparked in part by her experience acting as an advocate for her parents when they became ill. (Courtesy of Barbara Corprew)

Corprew is a volunteer in the District of Columbia’s Long-Term Care Ombudsman’s Office, a government-funded advocacy agency for nursing home and assisted-living residents.

The ombudsmen’s offices, which operate under federal law in all 50 states and the District, investigated 200,000 complaints in 2015, according to the Administration on Aging, a part of the Department of Health and Human Services. Of those, almost 117,000 were reported to have been resolved in a way that satisfied the person who made the complaint, and about 30,000 were partially resolved. At the top of the list were problems concerning care, residents’ rights, physical environment, admissions and discharges, and abuse and neglect.

The volunteers have permission to enter any nursing home, assisted-living or other long-term-care facility anytime, unannounced, talk to any resident and go wherever they want. They respond to issues raised by residents and their families and can bring up problems they discover. All complaints are handled confidentially, even kept from family members, unless residents allow the ombudsman to reveal their identities.

… Medical or legal experience is not required. Volunteers come from all kinds of backgrounds and careers, but they seem to have one thing in common: an abundance of compassion.

Gwendolyn Devore, another District volunteer, remembers a forlorn woman sitting in a hallway at the nursing home where her aunt lived. When she asked a staff member about the woman, the only reply was an angry look that unmistakably said, “It’s none of your business,” Devore recalled as she explained her interest in becoming a volunteer. “Now no one will be able to say it’s none of my business.” [Continued at Kaiser Health News and in The Washington Post]

EPA, NIH, The Lancet

Marching for science as budget cuts threaten US research

lancet cover 2Volume 389, Number  10080 

29 April 2017 

WORLD REPORT   Americans push back against President Trump’s proposed budget cuts… Susan Jaffe, The Lancet’s Washington correspondent, reports. 

President Donald Trump is famous for his early morning Tweets and off-the-cuff remarks that can sometimes be puzzling. But what he thinks about biomedical research and basic science is quite clear in his first proposed budget for running the federal government.

March for Science, Washington, D.C. / Susan Jaffe

Trump’s America First: A Budget Blueprint to Make America Great Again outlines a $1·1 trillion spending plan that would take effect when the new fiscal year begins in October. The president wants to move $54 billion from domestic agencies to fortify the US military. To help pay for the transfer, he is proposing funding cuts for the US Environmental Protection Agency (EPA; 31%) and the National Institutes of Health (NIH; 18%) [and other domestic agencies]….

To squeeze $5·8 billion out of the agency’s $30·3 billion budget, the Trump administration would reorganise NIH’s 27 institutes and centres and “rebalance federal contributions to research funding” according to the budget blueprint. …Health and Human Services Secretary Tom Price told a congressional committee last month that the NIH could operate on a tighter budget by cutting the roughly 30% of grant money that pays for indirect research costs. These expenses can include rent, utilities, administrative staff, and equipment. “That money goes for something other than the research that’s being done”, Price said.

Price’s suggestion was especially disturbing coming from the person who is responsible for overseeing the NIH, said Harold Varmus, who directed the NIH in the 1990s and headed the National Cancer Institute at NIH for 5 years until 2015. “You can’t do research in the dark”, he said. “You can’t do research—at least my kind of research—without a building and without electricity and water and administrative expenses”. [Continued  here]

 

EPA, The Lancet

US health and science advocates gear up for battle over EPA

lancet cover 2Volume 389, Number  10075 

25  March 2017 

WORLD REPORT    The Trump administration’s proposed budget makes large cuts to the US Environmental Protection Agency.  Susan Jaffe, The Lancet’s Washington correspondent, reports. 

As Oklahoma Attorney General, Scott Pruitt represented his state in more than a dozen lawsuits challenging the US Environmental Protection Agency’s (EPA) efforts to limit air and water pollution. Several cases sought to block President Barack Obama’s Clean Power Plan aimed at reducing the greenhouse gas emissions from coal plants linked to climate change.

…Less than a year later, Pruitt and his opponents have switched sides. President Donald Trump appointed Pruitt to lead the EPA and now those opponents accuse the Trump administration of federal overreach by seeking to undermine key environmental laws.

The administration has already taken steps to begin rolling back some environmental rules issued by the EPA under President Barack Obama (panel). And last week, Trump unveiled his proposed federal budget, which reduces federal non-defence spending by US$54 billion, including a 31% ($2·6 billion) cut in EPA funding—more than any other domestic agency.  [Continued here] 

Medicare costs, Observation care

By Law, Hospitals Now Must Tell Medicare Patients When Care Is ‘Observation’ Only

By Susan Jaffe | KAISER  HEALTH  NEWS | March 13, 2017 |This story also ran in usat 4sidebar

Under a new federal law, hospitals across the country must now alert Medicare patients when they are getting observation care and why they were not admitted — even if they stay in the hospital a few nights. For years, seniors often found out only when they got

Hospitals must complete this notice and give it to Medicare observation patients.

surprise bills for the services Medicare doesn’t cover for observation patients, including some drugs and expensive nursing home care.

The notice may cushion the shock but probably not settle the issue.

When patients are too sick to go home but not sick enough to be admitted, observation care gives doctors time to figure out what’s wrong. It is considered an outpatient service, like a doctor’s visit. Unless their care falls under a new Medicare bundled-payment category, observation patients pay a share of the cost of each test, treatment or other services.  And if they need nursing home care to recover their strength, Medicare won’t pay for it because that coverage requires a prior hospital admission of at least three consecutive days.

Observation time doesn’t count.

“Letting you know would help, that’s for sure,” said Suzanne Mitchell, of Walnut Creek, Calif. When her 94-year-old husband fell and was taken to a hospital last September, she was told he would be admitted. It was only after seven days of hospitalization that she learned he had been an observation patient. He was due to leave the next day and enter a nursing home, which Medicare would not cover. She still doesn’t know why.

“If I had known [he was in observation care], I would have been on it like a tiger because I knew the consequences

This KHN article also ran in The Philadelphia Inquirer.

by then, and I would have done everything I could to insist that they change that outpatient/inpatient,” said Mitchell, a retired respiratory therapist. “I have never, to this day, been able to have anybody give me the written policy the hospital goes by to decide.” Her husband was hospitalized two more times and died in December. His nursing home sent a bill for nearly $7,000 that she has not yet paid.  [Continued at Kaiser Health News and USA Today] 

Affordable Care Act, The Lancet

US health-care groups voice concerns about replacing ACA

lancet cover 2Volume 389, Number  10071 

25  February 2017 

WORLD REPORT    Few details have emerged regarding a replacement for the US health law.  Susan Jaffe, The Lancet’s Washington correspondent, speaks to stakeholders about the problems they foresee. 

Less than 8 hours after Donald Trump took the oath of office as the 45th President of the USA, he signed an executive order reiterating a popular campaign promise: “It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act [ACA].”

Californians march against the repeal and replacement of the ACA, Feb 4, 2017 / Getty Images

Yet 5 weeks later, the Trump Administration and the Republican controlled Congress cannot agree on whether to repeal and replace it simultaneously—as the president desires—and what the replacement will be. Tom Price, Trump’s new Health and Human Services Secretary, assured senators during his nomination hearing last month that “nobody’s interested in pulling the rug out from under anybody. We believe that it’s absolutely imperative that individuals that have health coverage be able to keep health coverage…”

…The ACA’s uncertain future has rattled health insurers—initial 2018 policies are due as soon as April—and rippled through the health-care system to worried providers and patients. “Like everyone else, we are waiting for more information to be released by the Administration and Congress”, said Jan Emerson-Shea, a spokeswoman for the California Hospital Association, a state with more than 1·5 million patients enrolled in ACA insurance plans.  [Continued here] 

Long term care, Medicare costs

Judge Accepts Medicare’s Plan To Remedy Misunderstanding On Therapy Coverage

By Susan Jaffe  | Kaiser Health News | February 3, 2017 | This KHN story also ran on     

A federal judge has accepted Medicare’s plans to try once more to correct a commonly held misconception that beneficiaries’ are eligible for coverage for physical and occupational therapy and other skilled care only if their health is improving.

“Confusion over the Improvement Standard persists,” wrote U.S. District Court Chief Judge Christina Reiss in Vermont in a decision released by the court Thursday. Advocates for seniors say coverage is often mistakenly denied simply because the beneficiary reaches “a plateau” and is no longer making progress.[Continued at Kaiser Health News and NPR]

Long term care, Medicare costs

Medicare’s Coverage Of Therapy Services Again Is In Center Of Court Dispute

By Susan Jaffe  | Kaiser Health News | January 30, 2017 | This KHN story also ran on     

Four years after Medicare officials agreed in a landmark court settlement that seniors cannot be denied coverage for physical the
rapy and other skilled care simply because their condition is not improving, patients are still being turned away.

So federal officials and Medicare advocates have renewed their court battle, acknowledging that they cannot agree on a way to fix the problem. Earlier this month, each submitted ideas to the judge, who will decide — possibly within the next few months — what measures should be taken.

Several organizations report that the government’s initial education campaign following the settlement has failed. Many seniors have only been able to get coverage once their condition worsened. But once it improved, treatment would stop — until they got worse and were eligible again for coverage.

Every year thousands of Medicare patients receive physical therapy and other treatment to recover from a fall or medical procedure, as well as to help cope with disabilities or chronic conditions including multiple sclerosis, Alzheimer’s or Parkinson’s diseases, stroke, and spinal cord or brain injuries. [Continued at Kaiser Health News and NPR]

FDA, NIH, The Lancet

Experts confident of congressional funding for US Cures Act

lancet cover 2
Volume 389,  Number 10065
14  January 2017

How future funding for the landmark 21st Century Cures Act and repeal of the Affordable Care Act may affect its success.  [Interviews with lead sponsors Representatives Fred Upton, Diana DeGette, NIH Director Francis Collins, and patient advocates.  Full article here] 

Long term care, Medicare costs

New Nursing Home Rules Offer Residents More Control Of Their Care

By Susan Jaffe  | Kaiser Health News | January 4, 2017 |  This KHN story also ran in 

About 1.4 million people living in nursing homes across the country can now be more involved in their care under the most wide-ranging revision of federal rules for such facilities in 25 years.

The changes reflect a shift toward more “person-centered care,” including requirements for speedy development of care plans, more flexibility and variety in meals and snacks, greater review of a resident’s drug regimen, better security, improved grievance procedures, and scrutiny of involuntary discharges.

“With proper implementation and enforcement, this could really transform a resident’s experience of a nursing home,” said Robyn Grant, director of public policy and advocacy for the Consumer Voice, a national group that advocates for residents’ rights. The federal Medicare and Medicaid programs pay for most of the nation’s nursing home care — roughly $75 billion in 2014 — and in return, facilities must comply with government rules. [Continued in  Kaiser Health News and The Washington Post]