The Health Shopper

As of today almost all employer-sponsored health plans will be required to cover contraceptives without deductibles, co-pays, etc. 28 states currently require health plans to cover contraceptives to some extent; the new ruling has made them completely cost-free.
The only exception is religious organizations, nonprofits, and places of worship that employ individuals of the same faith.

It’s that time of the year again, folks! The Surpreme Court’s 2011-2012 term began yesterday on Oct. 1, and a number of cases have reached the Court’s desk, two of the which have important implications for health care.
According to Andrew Cohen at The Atlantic, “in Caraco Pharmaceutical v. Novo Nordisk, the justices will broker a dispute between generic drug manufacturers and their brand-name counterparts. And in Mayo Collaborative Services v. Prometheus Laboratories, the justices will return again to the issue of whether a doctor’s diagnostic methods may be patented”.
The former, Caraco Pharmaceutical v. Novo Nordisk could massively impact prices of pharmaceuticals and the consumer’s access to generic drugs. The Mayo Collaborative Services v. Prometheus Laboratories case examines whether labs can patent certain diagnostic tests.
The star of the health care cases, however, is the Affordable Care Act. The constitutionality of reform has long been a subject of debate, and CNN predicts that we may have a verdict on the case by next June.
So keep your eyes peeled: there are big cases coming up in the high courts!

More and more, families are looking to public health insurance options for their children’s coverage thanks to greater access to public plans and job losses, according to a recent study by the University of New Hampshire. This seems to be particularly true for more rural as well as inner-city areas where overall coverage rates have generally been lower than suburban areas.

According to the researchers, unemployment is the key factor in the trend. With unemployment, employer-provided coverage is usually terminated and due to the drop in income families and individuals often become newly qualified for public plans. Eligibility for health insurance plans has also been expanded, which helps push families and individuals in making the choice to go to public insurance. The research also uncovered an unfortunate situation: nationwide, about 9 percent of children do not have any type of coverage; over half of them are eligible for coverage through Medicaid and/or SCHIP.

“Research demonstrates that most of these eligible children come from states with low participation rates and are disproportionately Hispanic. Because those who have health insurance are healthier overall and, more importantly, because healthy children are more likely to become healthy adults, focusing on covering eligible children should remain at the forefront of the nation’s agenda,” the researchers said.

Economists and legislators’ long-standing question has finally been addressed: Does health insurance for the poor really make a difference? As Medicare/Medicaid debts hit all-time highs, many states are cutting back their Medicaid programs. And while affordable health insurance remains a reach for the poor and uninsured, the first large-scale controlled study tackles the question of Medicaid’s influence on the uninsured.

Professor of health economics at the Harvard School of Public Health Katherine Baicker and professor of economics at M.I.T. Amy Finkelstein conducted a groundbreaking study, thanks to a peculiar situation in Oregon. Low on money, Oregon wanted to grow its Medicaid program but could only provide for 10,000 new enrollments. When almost 90,000 uninsured applied the state had to select applicants by a lottery, setting the stage for Dr. Baicker and Dr. Finkelstein’s study on the benefits of health insurance for the poor.

Using the uninsured applicants as a control group, the researchers asked those who had gotten Medicaid what difference the insurance made. The first phase of the study found vast differences between the two groups, and found that the insured had spent 25% more on medical costs. Under Medicaid, they were 35% more likely to see a doctor and 30% more likely to gain admission to a hospital, though there was no major change in ER use. Those who had insurance were also more likely to have a particular clinic and doctor they regularly checked in with.

Outside of the numbers, insurance also reported feeling much better. They were more likely to partake in preventive care with women being 60% more likely to get mammograms. And insurance made a difference for the subjects’ financial stability as well: those with Medicaid were 40% less likely to borrow money or fail to pay non-medical bills due to insurance costs.
Currently, the study is examining the health effects of health insurance. So far, 12,000 people have been interviewed and assessed for health via blood pressure, cholesterol, etc. Half of the interviewees are covered under Medicaid and half are not.

Dr. Baicker was surprised by the difference insurance made. “Being uninsured is incredibly stressful from a financial perspective, a psychological perspective, a physical perspective,” she said. “It is a huge relief to people not to have to worry about it day in and day out.”

Last week Health and Human Services Secretary Kathleen Sebelius announced that HHS would start to collect health data on the lesbian, gay, bisexual and transgender (LGBT) community, as well as introduce new standards for reporting and collecting data on ethnicity, sex, disability status, etc.

“Health disparities have persistent and costly affects for minority communities, and the whole country,” Sebelius said. “Today we are taking critical steps toward ensuring the collection of useful national data on minority groups, including for the first time, LGBT populations. The data we will eventually collect in these efforts will serve as powerful tools and help us in our fight to end health disparities.”

The Congressional Budget Office has some news on federal health care spending, and it’s not all good: one projection asserts that federal health care spending could nearly double in the next two decades, comprising around 11% of the nation’s GDP (currently 5.6%). A less optimistic projection of the health care budget presents the debt at 100% of GDP in the next decade, almost 200% by 2035.

The numbers are startling, but there’s a catch: CBO is using pre-ObamaCare growth rates. Given the effects of the Affordable Care Act, from doctors’ payment cuts to decreased insurance subsidies, CBO has stated that the level of federal health care spending would not be easy to maintain long-term.

With the constitutionality of the Affordable Care Act currently up for debate in federal courts, what are your thoughts? Do you consider Medicare and Medicaid as a priority regardless of debt?

Last week the Department of Health and Human Services announced its plan to reduce premiums and make it easier to enroll in Pre-existing Condition Insurance Plans. Premiums will be cut by up to 40 percent in 18 states, and 23 states as well as the District of Columbia will find the eligibility requirements for PCIPs loosened.

“The Pre-Existing Condition Insurance Plan changes lives, and in many cases, literally saves lives,” said HHS Secretary Kathleen Sebelius. “These changes will decrease costs and help insure more Americans.”

From November of 2010 to March 2011, PCIP enrollment increased by 129 percent with over 18,000 enrolled. However, the 18,000 increase falls short of health advocates’ expected 375,000 covered. Created to bridge the insurance gap for patients with pre-existing conditions until their guaranteed coverage in 2014, the PCIP provides patients with chronic diseases such as cancer and asthma coverage under the Affordable Care Act.

Beginning in 2014, with the newly-instated Health Insurance Exchanges, providers will not be able to deny applicants based on pre-existing conditions. Tax credits will also help consumers with affordable health insurance. The lower premiums will kick in on July 1, along with loosened eligibility requirements. Here is a list of changes to PCIP as of July 1:

• Applicants will no longer need a letter from an insurer denying coverage; as of July 1, applicants will simply need a letter from a doctor, physician assistant or nurse from within the last year stating that they have a medical condition of disability.

• Applicants will not have to wait on a denial letter from insurers. (This option became available to minors in February, and will be open to all applicants as of July.)

It turns out Massachusetts’ mandated universal health care and subsidized plans didn’t ultimately cut down on emergency visits. Affordable health insurance may not have a causal connection with incidence of ER use. Despite a decrease in the number of uninsured by about 75 percent in Massachusetts, a recent study found that the total number of ER visits actually increased — this pattern has also been seen in action in other states.
Lead author of the study Dr. Peter Smulowitz felt that assuming greater access to basic insurance would directly impact ER visits “is a dangerous policy choice”.

Earlier this week we blogged about insurer-run retail clinics. A report from the Washington Post has pinpointed a new trend in insurer-run clinics: workplace health care. In the past, workplace clinics served a basic first-aid purpose for on-the-job injuries. Recently, employers have broadened the clinics to encompass more primary care oriented service. Of employers with 500 plus employees 15 percent already had on-site clinics with primary care services in 2010, according to consulting firm Mercer, and another 10 percent were considering the possibility.

What’s in it for the employer?

The employer’s motivation is twofold according to senior health researcher Ha Tu: providing immediate and consistent primary care could prevent potentially costly health issues in the long run; employees would also be given treatment that corresponds to their individual needs via evidence-based guidelines, leading to fewer outside tests and referrals.
According to physician Bruce Hochstadt at Mercer’s on-site clinic employers are also worried about adding a burden to the current strained health care system, especially in light of the addition of over 30 million health care recipients newly-qualified under the Affordable Care Act. Workplace health care may help alleviate some of the load. However, the future of on-site clinics after 2014 has been called into question – there is concern that health care and health care services may no longer be offered by employers in light of 2014’s health exchanges. But for now, on-site clinics are on the upswing.

What’s in it for insurers?

A large part of the draw for insurers is increased cost control and marketing opportunity. By providing care directly to the consumer insurers can get more hands-on with medical costs as well as begin marketing to the 30 million plus who will be required to purchase health care in 2014. According to CEO John Gorman of Gorman Health Group, insurers are currently more interested in controlling the spending of money as opposed to making money. “When you own the facility and you own the people who work there, it’s a lot easier to shape it in a way that conforms to the economic necessities of the local market,” Gorman said. The approach is akin to that of hospitals, which have recently begun to invest in clinics and primary care services alongside emergency care.

What’s in it for you?

For most working Americans, who spend 40 plus hours at the workplace per week according to the Bureau of Labor Statistics, on-site clinics are a practical option for basic health care services. Additionally, the clinics tend to have lower prices than community-based clinics. Provided services can range from basic annual physicals to long-term health management for chronic disease.

How would you feel about an on-site clinic at your workplace? Would you use one? Do you already have one? Let us know in the comments!

The Affordable Care Act saw its first rollback this week, which repealed a tax reporting requirement. The repeal was a bipartisan action, and the tax reporting requirement has been largely unpopular with businesses.
The requirement would have mandated tax forms each year for every vendor supplying a business with more than $600 in goods. While the requirement is unrelated to health care, it would have been used to help finance reform.