Viewpoints: Concerns about ACOs; problems in Va. gov.'s strategy; Medicaid 'black hole'

Jun 24 2014

The New York Times: Bigger Health Companies: Good For Medicare, Maybe Not For Others
Although Obamacare's health insurance expansion has directly provided coverage to only about 4 percent of Americans, changes embedded in the Affordable Care Act could affect many more people, and not always in good ways. One such change is a provision that allows organizations that join forces to manage care for a large population to receive bonuses from Medicare for controlling costs and hitting quality targets (or face penalties if they do not). Medicare's Accountable Care Organization model, as it's called, favors larger health provider organizations that can manage the costs and quality of all types of care Medicare pays for, from primary care to high-intensity hospitalization and everything in between (Austin Frakt, 6/23).

The Washington Post: Virginia's Governor Claims He Can Expand Medicaid On His Own Say-So
[Gov. Terry] McAuliffe on Friday announced that he would go it alone, bypassing the General Assembly and unilaterally expanding access to affordable health care in the state. In a public address, the governor insisted that he had many legal avenues, and he assigned his secretary of health and human services to bring him a plan by Sept. 1. There's no way to pass judgment on the governor's plan until one exists. Perhaps there is a sensible and legal way for him to push through a coverage expansion in line with what the Affordable Care Act envisioned for Virginia, respectful of the prerogatives of the General Assembly. But much as we support the goal of wider coverage, we're skeptical about the prospect of unilateral action (6/20).

Los Angeles Times: Can We Finally Agree That Obamacare Is Working?
At the end of a war, some people will remain holed up in the trees, thinking they can still turn the tide of a lost cause. Increasingly, that's the best description of the anti-Obamacare dead-enders, including Congressional Republicans, who continue to depict the Affordable Care Act as a failure despite facts (Michael Hiltzik, 6/20).

Charlotte Observer: Expand Medicaid – It Has Value In N.C.
N.C. lawmakers don't seem inclined to reconsider their unwise decision not to expand Medicaid. But that doesn't mean we should stop shouting loudly why they should. A new Robert Wood Johnson Foundation report last week underscores the value for the Tar Heel state. The report looked at the Affordable Care Act's impact in 14 large U.S. cities. ... The report points out that had North Carolina expanded the state's Medicaid program for low-income and disabled residents, the decrease in uninsured in Charlotte would be even greater – an estimated 57 percent. That would be an additional 36,000, bringing the number of Charlotte residents gaining insurance to 99,000 by 2016 (6/22). 

Bloomberg/BusinessWeek: The Medicaid Black Hole That Costs Taxpayers Billions
Here's some cheerful news: States and the federal government are doing little to stop a costly form of Medicaid fraud, according to a government report released last week. Medicaid, the federal-state health insurance program for poor Americans, now covers more than half its members through what's known as Medicaid managed care. States pay private companies a fixed rate to insure Medicaid patients. ... Despite the growth of managed care in recent decades, officials responsible for policing Medicaid "did not closely examine Medicaid managed-care payments, but instead primarily focused their program integrity efforts on [fee-for-service] claims," according to the Government Accountability Office (John Tozzi, 6/23).

USA Today: Washington Won't Let Me Help My Patients
Every year, lawmakers wrap health care providers like me in ever-tighter reams of red tape. Their ceaseless pen-pushing raises prices, limits availability and reduces face-to-face time between doctors and patients. This problem preceded the Affordable Care Act by decades. Whether it's Medicare, Medicaid or something else, every federal health care reforms only empower bureaucracies to write the tune to which health care providers must dance. Yet Obamacare worsened the bureaucratic burden like nothing I've ever seen (Kathryn Chenault, 6/22).

Politico: How Congress Brought The Measles Back
In 2000, the Centers for Disease Control and Prevention made a stunning declaration: Measles -; a disease that once infected 3 million to 4 million Americans each year, and killed 500 of them -; had been eliminated in the United States. It was a victory decades in the making, the product of a highly effective vaccine and a strong public health system. But today, measles is back. Just this month, the CDC reported more cases in the country in the first six months of 2014 -; 477 -; than during that same period in any year since 1994. Public health has taken a giant, 20-year step back, and we have Congress to thank (Sarah Despres, 6/22).

The New York Times: The Heavy Burden of Post-Traumatic Stress Disorder
Post-traumatic stress disorder has reached staggering levels in the American military. ... The Departments of Defense and of Veterans Affairs have poured billions of dollars into treating the debilitating condition. Yet neither department really knows whether the treatments offered and applied are effective, according to a report issued Friday by the Institute of Medicine, a unit of the National Academy of Sciences, which had been asked by Congress to evaluate the programs (6/20).

The Washington Post: A Mississippi Infant's Case Opens A New Door On Studying A Cure For HIV
The possibility of achieving an HIV cure for thousands of infants is too important not to pursue vigorously. The National Institutes of Health will soon launch a carefully monitored clinical trial in 12 countries, including the United States. The study aims to replicate the results of the Mississippi baby case in other infants exposed to HIV in the womb. It is hoped that this study will prove that immediate treatment for HIV-infected newborns can protect them from a lifetime of anti-HIV therapy, while furthering our understanding of how we might pursue a cure for HIV infection in adults (Anthony S. Fauci, 6/20).

The Washington Post: A Father's Day Goodbye
Father's Day found me with a man who often doesn't remember who I am, although we have spent much of his 93 years together. My father has dementia. ... I was angry at first. I couldn't save him. Diapers. Confusion. Indignity. He was a proud man. Respected. I didn't like deciding whether he needed medication that I knew would knock him out. The resentment is gone now, replaced by abiding sadness (Pete Earley, 6/20).

Bloomberg: Big Leagues Should Kick the Habit
It's hard to be shocked by anything involving the tobacco companies, but what's really bewildering is the MLB Players' Association's continued role in enabling them. Minor league baseball banned smokeless tobacco in 1993 and levies hefty fines for those caught chewing; but those players are not unionized and thus presented little roadblock. The MLBPA, meanwhile, uses its position as the most powerful union in all of sports -- and, arguably, the country -- to fight a losing battle to retain their players' right to chew (Kavitha A. Davidson, 6/20).

The Washington Post: Best State In America: Vermont, For Its Healthy Kids
A lifetime of good health starts in childhood. Health insurance, access to health care and regular exercise make for fit kids with long life expectancies. And nowhere in America are kids healthier than in Vermont. Across a range of metrics, the Green Mountain State excels, according to the latest data collected by the Centers for Disease Control and Prevention (Reid Wilson, 6/20).

WBUR: Best Kept Secret For Postpartum Depression? Help At Home
In 2010, while pregnant with my only child, I lined up a postpartum doula before I even chose the hospital where I would give birth. I had worked with new families throughout the Boston area for fifteen years, mainly as a professional birthing coach (another type of doula), and occasionally as the postpartum type myself. So I knew getting help for myself after childbirth was the first thing I had to have in place. I'd seen up close how much help vulnerable new mothers need and how rarely they get it. And I was well aware of the more-common-than-you think risk of postpartum depression (Ananda Lowe, 6/20).