Zika virus continues to spread, CDC issues Florida travel advisory
Susan Jaffe | Washington Correspondent for The Lancet | 9th August 2016
As the number of people in the United States and Puerto Rico with the Zika virus approaches 7,400, public health officials are learning the mosquitoes that can transmit the virus are deceptively formidable foes.[Continued here]
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 becaus
e 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]
US presidential candidates far apart on environmental health
Volume 388, Number 10043
30 July 2016
WORLD REPORT The Republican and Democratic campaigns have polar opposite policies on environmental issues
important to health. Susan Jaffe, The Lancet’s Washington correspondent, reports. [Continued here]
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.
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 
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 Zika
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 
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]
US presidential candidates urged to support health research
Volume 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]
Medicare Releases Draft Proposal For Patient Observation Notice
By Susan Jaffe | KAISER HEALTH NEWS | June 15, 2016 |This story also ran in 
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 law
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 
challenging 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 
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]
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 
cancer 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
Volume 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]