Quote:

 

http://www.breitbart.com/InstaBlog/2014/08/15/CMS-Administrator-Told-Subordinates-to-Please-Delete-White-House-Email

CMS Administrator Told Subordinates to 'Please Delete' White House Email

CMS Administrator Marilyn Tavenner told two subordinates to "please delete" a forwarded email conversation between Tavenner and a group of White House advisers which took place days after the disastrous launch of healthcare.gov.

The House Energy and Commerce Committee published the October 5, 2013 email today. It contains a discussion Tavenner had with White House health care policy adviser Jeanne Lambrew and several other White House advisers including White House Chief Technology Officer Todd Park. Tavenner forwarded the email chain to the CMS spokersperson and another subordinate saying "Please delete this email-but please see if we can work on call script." Another short sentence that followed this has been redacted.

The email chain shows Lambrew was concerned about a call script being used by customer service representatives helping people enroll in insurance plans. "There may be a problem with the CSR training or script," she wrote. The phone system was seen as an important fallback in October when the government's new health exchange website proved unable to enroll more than a handful of people.

It's unclear why Tavenner wanted the email chain deleted. The House Energy and Commerce Committee sent Tavenner a letter asking why she told subordinates to delete the email and also whether she had directed that other emails be similarly deleted.

The letter also emphasizes the fact that the Committee has been requesting relevant documents, like this letter, from the administration since October 10, 2013. The email in question was part of a cache of documents CMS turned over the next day, 10 months after it was first requested.

Last week CMS also indicated that some documents may not be available at all, blaming the loss on the high volume of emails received. Committee Chairman Fred Upton said, "

Right on cue, when the going gets tough, the Obama administration proclaims it can't find the documents." "When HealthCare.gov was crashing, those in charge were hitting the delete button behind the scenes," Upton added.

Quote:

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/08/14/wal-mart-wants-to-be-your-doctor/

Wal-Mart wants to be your doctor

Welcome to Health Reform Watch, Jason Millman's regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Jason with questions, comments and suggestions here. Check back every Tuesday and Thursday afternoon for the latest edition, or sign up here to receive it straight from your inbox. Read previous columns here.

Wal-Mart's newest effort to make a play in the booming health clinic space comes after the big-box retailer has fallen far behind its rivals. And this time, Wal-Mart is shaking up its approach with a new model that's getting some attention in the health-care world.

Wal-Mart this year has opened six clinic locations across South Carolina and Texas in which the retailer is providing a broad range of primary care services, as described in a recent New York Times story. The company plans to have a dozen of these clinics open by the end of this fiscal year, executives said on a Thursday earnings call.

This new approach marks a major change from Wal-Mart's attempts to crack the retail clinic market in the past decade. For starters, retail clinics have generally been a place to get a vaccination or get your cold checked out — not a replacement for your primary care physician. And this time, Wal-Mart appears to be working with a single entity to run the clinics. That's different from its past lackluster efforts in which the retailer leased out space to hospital systems or venture capital-backed operators "who had virtually no experience in health care," said industry expert Tom Charland of Merchant Medicine.

Since Wal-Mart started in the clinic space, it's opened 260 locations but has closed 166 of those, according to Charland, whose company tracks retail clinics. Meanwhile, Walgreens, which has more than 400 clinics across 23 states, announced plans Wednesday to open an additional 27 location across the Dallas-Forth Worth and Houston areas. CVS, which has more than 850 Minute Clinics in 29 states and the District of Columbia, is also expanding.

[...]

As millions more low- and middle-income people gain insurance under the Affordable Care Act, retail clinics can appeal to especially cost-conscious consumers looking for basic health-care services. They also offer a convenience factor — about 44 percent of retail clinic visits occurred in the evening or on the weekend, when doctors' offices are typically closed, according to a 2012 Health Affairs study analyzing 2007-2009 usage patterns.

Some doctors groups have warned that these retail clinics can't effectively manage patients' more serious health-care conditions. "While retail clinics may provide a limited scope of health-care services for patients, this can ultimately lead to fragmentation of the patient’s health care unless it is coordinated with the patient’s primary care physician’s office," the American Academy of Family Physicians said in February 2014 policy statement.

The CVS and Walgreens clinics have been careful not to represent themselves as a primary care provider, in part to avoid angering doctors, Charland said. But the industry dynamics have been changing, starting with Walgreens announcement last year that it will diagnose and treat patients for chronic conditions, such as diabetes.

"You see that they're first looking at are there tests they can provide, but then you see that — more consistent with the Wal-Mart model — they're moving in that direction of providing care for diabetes and high blood pressure," said Ateev Mehrota, a Harvard Medical School health policy professor who authored the Health Affairs study of retail clinics.

Those clinics are also emphasizing partnerships with community providers. CVS' Minute Clinics, for example, tout their affiliations with about three dozen hospitals, clinics and provider groups.

A big question is how much patients are willing to accept the clinics as a stand-in for primary care. "It's not that easy to just open up a store, put out a sign, and say you're doing primary care," Charland said. "It remains to be seen whether [Wal-Mart] will be successful."

Quote:

 

http://www.kaiserhealthnews.org/Stories/2014/August/18/Hospitals-Reconsider-Charity-For-Patients-Who-Decline-Health-Coverage.aspx

Hospitals Reconsider Charity For Patients Who Decline Health Coverage

As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t.

The move is prompted by concerns that offering free or discounted care to low-income uninsured patients might dissuade them from getting government-subsidized coverage.

If a patient is eligible to purchase subsidized coverage through the law’s online marketplaces but doesn’t sign up, should hospitals “provide charity care on the same level of generosity as they were previously?” asks Peter Cunningham, a health policy expert at Virginia Commonwealth University.

Most hospitals are still wrestling with that question, but a few have gone ahead and changed their programs, Cunningham says.

The online charity care policy at Southern New Hampshire Medical Center in Nashua, for example, now states that “applicants who refuse to purchase federally-mandated health insurance when they are eligible to do so will not be awarded charitable care.”

The same rule disqualifies aid to those who refuse to apply for expanded Medicaid, which New Hampshire lawmakers voted to extend, beginning Aug. 15.

Some Hospitals Require A Nominal Contribution

At BJC HealthCare, which has 12 hospitals in Illinois and Missouri, including Barnes Jewish Hospital in St. Louis, anyone receiving financial assistance must make some contribution to their care, for instance, $100 for emergency care. BJC does not bar financial aid to those who have refused to buy insurance through the health care law.

While all uninsured patients get a 25 percent discount off list charges, BJC gives additional discounts to those earning up to three times the federal poverty level, or about $35,000 for an individual. Formerly, those additional discounts were available for those earning up to four times the poverty level, or about $46,600.

“Patients will continue to receive needed medical care regardless of their ability to make payment at the time of service,” says spokeswoman Kim Kitson, adding the changes are likely to affect fewer than 3 percent of patients.

To be sure, hospitals have a strong financial interest in having more patients covered by insurance. That’s particularly true for hospitals that see many uninsured patients because the health law also reduces their government payments for uncompensated care. The assumption was that most uninsured people would gain coverage and no longer run up large hospital bills that could not be paid. But since the Supreme Court ruled that states could opt out of the health law’s Medicaid expansion, 24 states decided not to participate. Hospitals that treat large numbers of low-income people in those states face real financial pressures.

In addition, the health law requires nonprofit hospitals to make their written charity policies widely available, although it does not specify what criteria hospitals use to determine who is eligible. The assistance programs aren’t just for the uninsured: Most hospitals also help insured patients struggling to pay deductibles or other costs associated with their care.

“Even those with health insurance are ‘uninsured’ for an increasing percentage of the medical care they need” because many have high annual deductibles, said Steven Lipstein, president and CEO of BJC HealthCare, in an opinion piece published in The St. Louis Post-Dispatch.

Still, as the health law changes the insurance marketplace, “we are seeing charity care reductions,” says Michael Miller, director of strategic policy at Community Catalyst, an advocacy group in Massachusetts.

While Miller says the health law will result in more people with insurance, the need for financial assistance programs remains. He disagrees that charity programs would dissuade uninsured consumers from enrolling in coverage since most will need other health services besides hospital care.

“It’s really premature for hospitals to start presuming that level of calculation on the part of someone who shows up uninsured,” Miller says

[...]

Quote:

 

http://dailycaller.com/2014/08/18/ny-fed-obamacare-is-boosting-businesses-health-costs/?advD=1248,153371

NY Fed: Obamacare Is Boosting Businesses’ Health Costs

Obamacare is increasing the cost of providing health insurance to workers, according to a report released Monday by the Federal Reserve Bank of New York.

A majority of businesses surveyed by the New York Fed expect the health-care law to increase the cost of their coverage, and the median respondent estimates a boost by 10 percent in 2015. The report is based on two separate surveys of service and manufacturing companies.

Last year, the New York Fed saw a similar increase in health care costs; this year, though, an even larger majority of companies this year cited Obamacare as the driving force behind the increases.

That means for New York state, much of northern New Jersey, part of Connecticut, Puerto Rico and the Virgin Islands, businesses, workers and customers are all going to be hit by increased costs due to the health-care law.

The “vast majority” of companies surveyed said they’re being charged a higher monthly premium for each of their employees, and many of them said they’re passing some or all of that increase onto their employees. Businesses are also dealing with higher costs by charging higher deductibles, co-pays and out-of-pocket maximums. Just over a third of companies said they weren’t making changes to their health plans as a result of Obamacare.

Changes are happening everywhere: 20 percent of businesses said they were either cutting employees or increasing their share of part-timers because of Obamacare. About the same amount said they were paying their employees less due to the health-care law, or outsourcing instead of hiring more workers.

The problems aren’t just going to hit employees either: 36 percent of manufacturers and 25 percent of service companies reported upping their prices because of Obamacare as well. About half of all companies said they weren’t making such changes, however.

Employers have long been expecting the Affordable Care Act to increase the cost of providing health coverage to workers. One analysis found that the many taxes included in Obamacare will add an average of $196 a person to premiums for employer sponsored plans this year alone.

Baldo

Aug 21 2014, 07:47 AM

Employers Hiring More Part-Time Workers Due to Obamacare

A New York Federal Reserve survey shows that employers are hiring more part-time workers due to rising health care costs caused by Obamacare.

snip

Quote:

 

http://www.kaiserhealthnews.org/Stories/2014/August/22/Michelle-Andrews-on-contraceptive-coverage.aspx

Some Insurers Refuse To Cover Contraceptives, Despite Health Law Requirement

How much leeway do employers and insurers have in deciding whether they’ll cover contraceptives without charge and in determining which methods make the cut?

Not much, as it turns out, but that hasn’t stopped some from trying.

Kaiser Health News readers still write in regularly describing battles they’re waging to get the birth control coverage they’re entitled to....