Texas is thinking of abandoning Medicaid, reports the New York Times, reprinting a story from the Texas Tribune, a colorful piece that omits one central fact about Medicaid expansion under the Affordable Care Act (ACA).

Apparently the state’s conservatives are unhappy that reform legislation will open Medicaid’s doors to millions of Texas. Today, in the Lone Star state, parents qualify for Medicaid only if their family income is below $5,720. The legislation would set a new national standard for Medicaid eligibility at about $28,000—or $33,000 for a family.

“Dropping out of Medicaid is worth considering,” State Senator Jane Nelson, who heads the state’s Senate Public Health Committee, told the Tribune. “Currently, the Texas program costs $40 billion for a period of two years, with the federal government paying 60 percent of the bill,” but “as a result of federal health care changes, millions of additional Texans will be eligible for Medicaid. I want to know whether our current Medicaid enrollees, and there certainly could be millions more by 2014, could be served more cost efficiently and see better outcomes in a state run program.” 

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On this eve of the mid-term elections, it’s becoming increasingly likely that Republicans will win a majority in the House and gain a sizable number of seats in the Senate. Some political pundits are predicting that Rep. Joe Barton, R-Texas could take over as chairman of the powerful House Energy and Commerce Committee next year and, according to Kaiser Health News, “the Texas Republican vows to make life miserable for Democratic defenders of the health care overhaul law.”

Between calls for complete repeal (highly unlikely to make it past President Obama’s veto) and rumors that Republicans will block funding for key initiatives, the media is rife with reports that health reform is in danger of death by a thousand cuts.

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This week The New Health Dialogue’s Meredith Hughes, Allison Levy and Sam Wainwright host a round-up of some of the best health care posts of the past two week.  Below, just a few highlights. (To read the entire review, click here )

On the Health Business Blog, David Williams asks New England Health Care Institute’s Valerie Fleishman to explain the definition of comparative effectiveness research, describe CER provisions contained in the ARRA and ACA and discuss the challenges in disseminating new information to be used at the point of care.  It’s an excellent interview which tells you everything you need to know about Comparative Effectiveness Research –and how the research will be used at point of care.

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                                      Rick Scott vs. Alex Sink
 

Source: FlaglerLive.com  

Summary: As regular HealthBeat readers know, Rick Scott, the former CEO of Columbia/HCA, a for-profit hospital chain that was raided by the FBI in 1997, is now in the running to become governor of Florida. (See links below to earlier HealthBeat posts.) As the election approaches, it appears that Scott might well win. Even the Florida Medical Association (FMA) is endorsing him.

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Are you wondering what kind of information will be gleaned about pharmaceutical company-physician relationships once the Physician’s Payment Sunshine Act takes effect in 2013? That’s the year when drug companies will have to start publicly reporting all payments and gifts they dole out to doctors who conduct “educational” speeches and seminars that promote proprietary pharmaceuticals.

In their recent “Dollars for Docs” project, reporters from the investigative news organization ProPublica offer a sneak preview of what kind of money we’re talking about. Reporters from the group probed the “labyrinthine websites” of seven Big Pharma companies that are already reporting this kind of data and discovered that between 2009 and 2010 these firms paid a whopping $257.8 million to about 17,700 providers for giving “educational” talks and seminars to colleagues about certain medications. Charles Ornstein, a reporter for ProPublica told NPR  “In our database we found that there were 384 doctors who, over the course of just the past 18 months, have received at least $100,000 from the drug companies that have reported so far.”

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Summary: Those who oppose health care reform continue to assert that the legislation is unaffordable. The only way to dispute this claim is first, to spell out the specific provisions in the Affordable Care Act (ACA) that trim spending and raise new revenues—without rationing care. These planks in the legislation provide substantial funding for the subsidies, employer tax credits, and Medicaid expansion needed to cover some 32 million Americans who are now uninsured—while simultaneously putting Medicare on the road to fiscal stability.

Here are the highlights. The Affordable Care Act finances reform by:

• collecting  over $100 billion in new fees from the insurers, drug-makers and device-makers who will see their revenues grow as millions of new customers buy their products

•  raising Medicare taxes for the 2% of the population at the very top of the income ladder

•   cutting $132 billion in over-payments to Medicare Advantage insurers

•   collecting penalties from individuals  who choose not to purchase “essential minimal coverage” for themselves or their families

•   collecting fees from employers with at least 50 full-time employees who do not offer insurance to their workers 

•   taxing “Cadillac” insurance plans (costing more than $10,200 for an individual, or $27,600 for a family)

•   reducing government subsidies to hospitals that treat a large number of uninsured patients. (Because there will be fewer uninsured, hospitals will no longer need such large subsidies.)

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The problem of elderly people taking too many medications is not new, but continues to pose a serious risk to health as well as contribute significantly to rising Medicare costs. The fact is that nearly 20% of adults aged 65 years and older who are not hospitalized take 10 or more medications daily. This number is not the result of shoddy care, but rather achieved when doctors simply follow practice guidelines for several common, co-existing conditions like diabetes, high blood pressure and depression, for example. If you look at all seniors (those both in and out of the hospital) the American Society of Consultant Pharmacists reports that the average 65-69 year old takes nearly 14 prescriptions per year; by ages 80-84 that number averages an astounding 18 prescription drugs per year.

What’s troubling is that instead of improving the health of seniors, evidence is growing that the more medications an elderly person takes, the more likely he is to experience falls, cognitive decline, loss of mobility, depression and even cardiac problems. These adverse drug effects may be mistaken for Alzheimer’s disease or other dementias too. The bottom line: Experts estimate that up to one-third of the elderly in our communities may be over-medicated and some 20% of their hospital admissions are due to adverse drug events. The costs related to over-medication in the elderly are thought to exceed $80 billion each year.

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Summary:  Yesterday, a federal District Court judge in Michigan rejected a constitutional challenge to the Affordable Care Act (ACA)  .This is the first time that a court has gotten to the merits of the case against the ACA.  Below, excepts from analysis by Timothy Jost of the Washington and Lee University School of Law, explaining the decision. Jost’s piece, titled“A Victory for Health Reform and Good Law” appeared on the HealthAffairs blog today.

I’ve added some comments in italics.

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Prevention is said to be the best medicine, even better than a cure; and as we’ve been told time and again, prevention pays. This is clearly the reasoning behind the health law’s new provision that aims to eliminate financial barriers to preventive services like mammograms and diabetes testing. Health and Human Services Secretary Kathleen Sebelius has said that Americans use preventive services at only about half the recommended rate; studies find that minorities and the poor are far more likely to be barred from these services by high out-of-pocket costs.

The new provision, which went into effect on September 23, requires that insurers provide 45 preventive services to beneficiaries without charging co-pays or deductibles. For now it applies only to new group and individual policies. Many health plans are “grandfathered” in; meaning that that they are exempt from the requirement until they make significant changes to their policies—something that most insurers will likely do before 2013. Medicare and Medicaid plans will have to remove deductibles and co-pays for the designated preventive services by 2011.

HSS estimates that in the coming year some 31 million people in new employer plans and 10 million people in new individual plans will benefit from the prevention provisions under the Affordable Care Act. By 2013, HHS expects some 88 million Americans will see their access to prevention coverage improve.

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