State round-up: Penn. Medicare advantage; N.J. cuts immigrant care; Hospitals face hardships

Philadelphia Business Journal: "Independence Blue Cross has lost 30 percent of its Medicare managed-care members in the region this year in the wake of federal government rate cuts as its major competitors saw enrollment gains. The cuts came after the Philadelphia insurer eliminated some product offerings for senior adults and raised rates for others. Aetna's Medicare Advantage enrollment, meanwhile, has grown 10 percent since December to 57,503 enrollees, while Bravo Health's membership has climbed 27 percent to 56,824 so far this year" (George, 4/16). 

Bloomberg BusinessWeek: "About 12,000 resident immigrants would be kicked out of a low-cost health insurance program funded by New Jersey and 39,000 parents would be denied eligibility to sign up in the coming year due to state budget cuts. That's prompting concerns that Gov. Chris Christie's budget will increase emergency room visits and decrease preventative care for the working poor. Christie's $29.3 billion budget proposes saving $29 million by eliminating [legal] resident immigrants from Family Care, the state's low-cost health insurance program. It saves an additional $24.6 million by closing off the program to the tens of thousands of working poor parents who were projected to sign up" (Santi, 4/15).

The (New Jersey) Star-Ledger: "With millions of dollars in proposed cuts to health care, housing and public assistance programs ... Democratic members of the Senate Budget and Appropriations Committee pressed Human Services Commissioner Jennifer Velez to defend reductions in what they called key safety net programs. Those cuts include saving $15.3 million by taking the entire monthly disability check provided to developmentally disabled people [and] eliminating the $200 monthly check to spouses of permanently disabled partners to save $6.7 million" (Livio, 4/15).

The Philadelphia Inquirer/Associated Press: "A Pennsylvania court is ordering the state to transfer more than $800 million from its general fund into an account that helps physicians pay their malpractice premiums. Commonwealth Court panel on Thursday issued a 4-1 decision in favor of the state's hospitals and physicians, which had argued the state should not have been able to divert surplus money from a program known as MCare" (Scolforo, 4/15). 

Bloomberg BusinessWeek, on the same court ruling: "At issue was how the state handled malpractice abatements from 2003 to 2007. The MCare program is funded by an assessment on health care providers above and beyond their normal medical malpractice insurance. The fund is used to pay claims against medical providers for losses or damages that exceed their basic insurance coverage. In 2003, the state agreed to help doctors deal with skyrocketing malpractice premiums by giving them abatements on their MCare payments. In October, the state drained $808 million from two MCare accounts to help resolve a multibillion-dollar budget shortfall, one of the judges said" (Scolforo, 4/15).

Modern Healthcare also reports on the issue: "In the ruling, it was noted that ... the money belongs 'to the providers and not generally to the Commonwealth. ... The Commonwealth's concern that a decision in this case in Petitioners' favor may imperil the budget process is, therefore, without merit,' the majority concluded" (Robeznieks, 4/15).

The Los Angeles Times: "Days after state officials announced that Southwest Healthcare System in Murrieta had received California's first $100,000 fine for putting patients at risk of death or serious injury, federal regulators announced they plan to cut the hospital's Medicare funding June 1. State public health officials also said they had warned Southwest on Thursday that the hospital's 'license is in jeopardy due to ongoing systemic problems and a pattern of life-threatening lapses in care.' The federal action comes after a surprise inspection in January found deficiencies at the hospital in nine areas required for Medicare participation. ... Hospital officials said they were in talks with regulators to avoid losing their funding" (Hennessy-Fiske, 4/16).

San Jose Mercury News/The Associated Press: "Problems have been ongoing since regulators responded to a complaint at the hospital in June 2007, said Medicare regional director of hospital operations Rufus Arther. Among other problems, regulators said the hospital's staff removed and failed to replace an alarm designed to prevent newborn abductions and doctors failed to wear face masks or head coverings to prevent infections in the cardiac catheterization units" (4/15).

The Miami Herald: "A hitch has developed in Jackson [Health System's] well-crafted plans to cut expenses: County executives want bigger pay cuts than union members agreed to. At a Wednesday meeting of a Public Health Trust committee, Assistant County Manager Alena Tejada Hudak said the mayor and manager had mentioned this issue to Jackson executives 10 days ago and were surprised nothing had apparently been done. ... The discussion happened on a day when several hundred Jackson employees were notified that they had lost their jobs. That included 78 nurses and 15 attending physicians who are members of the Service Employees International Union" (Dorschner, 4/15).

---

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.