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March 23, 2015

Washington Health Policy Week in Review Archive baba7deb-d7b1-400e-9b4b-8f9f6853a565

Newsletter Article


Racial, Ethnic Health Coverage Disparities on the Decline, HHS Says

By Rebecca Adams, CQ Roll Call

March 16, 2015 -- Minorities have gained health insurance at higher rates than white Americans since the marketplaces created by the health care law opened in October 2013, Health and Human Services (HHS) officials said last week when releasing a report that found 16.4 million people gained insurance since 2010.

African-American and Latino adults still remain less likely to have health coverage than white people. However, the disparities are declining.  

HHS Secretary Sylvia Mathews Burwell called the increases in insurance rates "the largest reduction in the uninsured in four decades."

Before the marketplaces opened, about 14.3 percent of white adults did not have coverage, compared to 22.4 percent of African-Americans and 41.8 percent of Hispanics, according to the HHS report. As of March 4, about 9 percent of white adults were uninsured, compared to 13.2 percent of African-Americans and 29.5 percent of Latinos.

The improvement is "not probably exactly where you want to be because the numbers are still high," Burwell recently told reporters.

"We did a lot of things to highly target those communities," said Burwell. "I believe we can do more."

She noted that she held a large number of events focused on urging minorities to sign up for coverage, including Google hangouts, visits to African-American churches, and an increased percentage of ad buys on Spanish-language media. HHS officials are now analyzing which efforts worked.

Hispanic adults stand out because they are less likely to have employer-sponsored insurance and because people who are in the country illegally are not eligible to buy insurance through marketplace plans created by the health law. Those who live in states that have not expanded Medicaid to more people also have fewer opportunities for coverage.  Nationwide, about 1.5 million Latinos would gain coverage if all states expanded, said Steven Lopez, a health policy expert at the National Council of La Raza, an advocacy group. About 1 million of them live in just two states: Florida and Texas.

"We're encouraged by what we see as an upward trajectory," said Lopez. "But we know it's going to take time to bring those numbers down."

Lopez and other advocates are encouraging HHS officials to tweak their outreach efforts and make it easier for people without a long credit history to verify their identities so that they can get coverage.

The HHS numbers indicate the percentage of adults over the age of 18 who have coverage. HHS officials are expected to release more comprehensive data including children later this year.

For young adults between the ages of 19 to 25, the uninsured rate dropped from 34.1 percent to 26.7 percent since 2010. The law allows young adults to stay on their parents' coverage until age 26, in addition to providing new coverage options for some young adults through marketplace insurance or Medicaid.

The HHS analysis was based in part on previously reported survey data from 27,800 adults through the Gallup-Healthways Well-Being Index survey, which was released on March 4. That information showed that 12.3 percent of the U.S. population is uninsured. The organization will release new numbers in early April.  The agency also used previously reported data from the National Health Interview Survey conducted by the U.S. Census Bureau.

About 40 million adults were uninsured before insurers started selling insurance through the marketplaces in 2013, and about 26 million adults are currently uninsured, based on data extrapolated from the uninsured rates.

The report and remarks by Burwell come as part of the administration's publicity around the upcoming anniversary of the health care law, which President Barack Obama signed almost five years ago.

The news comes as federal and state officials are waiting for a ruling, expected to probably come in June, on whether federal tax subsidies should be available in states that did not create their own state-run enrollment marketplaces.

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Senate Democrats Resist Emerging 'Doc Fix' Deal

By Melissa Attias, CQ Roll Call

March 19, 2015 -- Senate Democrats are resisting the emerging House-negotiated deal to permanently replace Medicare's physician payment formula less than two weeks before a patch averting cuts to doctors is set to expire.

Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee, was not among the cosponsors of a bill unveiled last week detailing the policy parameters to replace the sustainable growth rate formula, or SGR. The measure (HR 1470) does not contain other policies and offsets expected to be included in the deal to move the package through Congress.

Asked about his unwillingness to sign on, Wyden said that there are "major health policy issues involved here, and we're just not there yet."

Senate Minority Leader Harry Reid thinks the SGR agreement "stinks," a source familiar with the Nevada Democrat's view of the measure told CQ Roll Call. Reid is of the belief that House Democrats have significant leverage against Speaker John A. Boehner of Ohio and other Republicans when it comes to resolving the "doc fix."

One major point of contention is that the deal is only expected to include two years of funding for the Children's Health Insurance Program (CHIP), which covers children from low-income families that aren't poor enough to qualify for Medicaid. Democrats want four more years of funding for CHIP, which is set to expire Sept. 30.

"We're staying together. We insist on the four. It's important to us and the House knows we are insisting on it. They need 60 votes to get all of this," said Ohio Democrat Sherrod Brown, the sponsor of a Senate bill to extend the program for four years.

He noted that he wants to see a deal on SGR but asked, "How do you give doctors a fix permanently and then only do two years for kids?"

Pennsylvania Democrat Bob Casey took a softer line, saying, "I want to take a look at it and see what the details are but my very strong preference is four years."

"We should take advantage of an opportunity to get four years in place," he added.

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Federal Officials Release Health IT Rules

By Rebecca Adams, CQ Roll Call

March 20, 2015 -- The Centers for Medicare and Medicaid Services (CMS) outlined in a recently proposed rule the criteria that doctors, hospitals, and other medical providers need to meet in order to win Medicaid incentive payments and avoid Medicare cuts.

The proposal fleshes out the agency's expectations for providers during the third and final stage of the so-called meaningful use rules for electronic medical records. Providers that participate would typically need to comply by 2018.

Providers would have a choice of starting the third phase of the initiative, known as Stage 3, in either 2017 or 2018, which gives providers an extra year to start than under current regulation. The proposed rule would realign the reporting period into a single one for all providers starting in 2017. Hospitals will participate in the calendar year instead of the fiscal year.

The proposal removes some measures that are redundant or that most providers have already adopted. It would cut the overall number of objectives for providers to eight goals that focus on the advanced use of medical records.

"It helps simplify the meaningful use program, advances the use of health IT toward our vision for improving health delivery, and further aligns the program with other quality and value programs," said Patrick Conway, CMS acting principal deputy administrator and chief medical officer. "And, in an effort to make reporting easier for health care providers, we will be proposing a new meaningful use reporting deadline soon."

HHS' Office of the National Coordinator for Health Information Technology also released separate regulations that would update the certification program for healthcare information technology, which helps providers be sure that the software they purchase meets the standards needed for them to comply with CMS rules.

The public has until May 29 to comment on both regulations.

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Health Centers Portrayed as Cost Savers as Cuts Loom

By Melanie Zanona, CQ Roll Call

March 17, 2015 -- Advocates for community health centers facing a drop-off in federal payments later this year are highlighting the estimated $24 billion in medical spending the centers save annually.

A report released last week  by the National Association of Community Health Centers (NACHC) also estimates the centers create jobs and $26.5 billion in "needed economic activity to economically distressed communities." The facilities provide preventive and primary care services to underserved communities.

Mandatory funding authorized by the 2010 health care law—which makes up almost 70 percent of the centers' overall funding—will run out on Sept. 30 unless Congress intervenes. The law set aside $11 billion over five years for a health center fund.

Supporters acknowledged that federal funding cuts could spell doom for the centers, which have existed since the 1960s and have long enjoyed bipartisan support.

"Losses in federal funding would dramatically unravel not only recent progress, but 50 years of achievement, resulting in a loss of care for millions of patients and layoffs of clinicians and other key personnel at a time when demand for primary care is increasing," said Dan Hawkins, senior vice president of public policy and research at the NACHC, speaking at a recent press conference. "There is too much at stake to turn back now."

Hawkins estimates that 7.4 million people would no longer be able to access care at a local health center within the first year, while nearly 57,000 clinicians and staff would be laid off, if federal funding dries up.

Community health centers are projected to serve 28 million patients this year in areas that typically lack access to large hospitals or doctors' offices, according to the report. The facilities are often credited with generating health care savings by improving patient outcomes and enhancing poor and uninsured individuals' access to care.

President Barack Obama requested $4.2 billion, including $2.7 billion in new mandatory resources, for health centers in his fiscal 2016 budget request, while lawmakers from both parties have expressed support for extending funding for the centers. The question is how to come up with the money.

The outcome could hinge on whether lawmakers choose to address the other health funding that expires at the same time—a predicament some are calling the "primary care cliff." The National Health Service Corps, which offers scholarships and school loan assistance, and Teaching Health Centers, which provides training for health professionals, are funded entirely through mandatory spending that would expire Sept. 30.

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CMS Weighs Expanding Payment for End-of-Life Planning

By Kerry Young, CQ Roll Call

March 20, 2015 -- Medicare officials may this year propose creating a new payment for time that doctors spend helping their patients plan for how they would confront terminal illness and rapid declines in health.

Patrick H. Conway, the chief medical officer for the Centers for Medicare and Medicaid Services (CMS), gave an update on this work last week at an Institute of Medicine (IOM) conference on end-of-life planning. CMS last year rejected a request from the American Medical Association to create a new billing code, but clearly signaled an interest in looking further at this proposal as part of a future rule on payments for doctors.

"In this year's rulemaking, we will be considering whether to propose that code and whether there will be a payment for that code," Conway said, adding that he couldn't comment further.

Many doctors and lawmakers are pressing to incorporate end-of-life counseling into routine medical practice in the United States, moving beyond the limited discussion now covered as part of the wide-ranging "Welcome to Medicare" visit. The approach came under fire during the debate leading to enactment of the 2010 health law (PL 111-148, PL 111-152), with critics portraying it as a government effort to establish "death panels."

Advocates for end-of-life planning say a lack of planning can lead people to suffer through needless treatments and long hospital stays when they might prefer to spend more time at home. Noted surgeon and author Atul Gawande pointed out at the meeting that the week in which people in the United States are most likely to undergo surgery is the last week of their life. Without advanced consideration, the wishes of the dying person can be overlooked in a hurried chain of discussions about their care, with family members often flying in from all over the country to attend a loved one, he said.

"There's been no plan and no discussion," he said.

While CMS' rulemaking may provide the most direct path for expanding end-of-life planning among elderly Americans, lawmakers also are weighing action. Sen. Susan Collins, R-Maine, and Mark Warner, D-Va., addressed the IOM meeting early in the day. Collins had helped get the advanced directive discussion included in the Welcome to Medicare visit.

"Many people nearing the end of life may not be physically or cognitively capable of making their own decisions about care," Collins said in remarks prepared for the IOM meeting. "Moreover, some of these patients will, at some point, receive acute hospital care from physicians who do not know them or their families."

Warner is likely to reintroduce a measure that he offered in the last session of Congress, a bill developed with Sen. Johnny Isakson, R-Ga., that would create a Medicare and Medicaid benefit for end-of-life planning. Speaking at the Institute of Medicine (IOM) meeting last week, Warner recalled how that even families with access to good medical information now struggle when confronting with terminal illnesses, as happened in his own mother's fight with Alzheimer's disease. After her initial diagnosis, his family didn't discuss living wills and advanced care directives or what his mother wanted in her final years.

"I was an informed citizen at the time - the governor of Virginia - and yet my family and I didn't have a full understanding of everything that was before us," Warner said. "With more information and support, we could have been able to hold important family discussions with my mother, worked with her doctors and pastor to craft a care plan that truly reflected her wishes."

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Ruling Against Health Law Subsidies Would Hurt Country, Poll Finds

By Rebecca Adams, CQ Roll Call

About 62 percent of people surveyed by the nonpartisan Kaiser Family Foundation said that if the Supreme Court strikes down tax credit subsidies in the federal health law marketplace, it would have a negative effective on the country, according to the recent poll.

The subsidies are at the heart of a case, King v. Burwell, that justices are expected to decide later this year.

Some 69 percent of respondents said that if the court eliminates subsidies in states that didn't set up their own insurance marketplace, those states should create their own exchanges. Another 23 percent said states should not act while 8 percent said they did not know.

The high bipartisan support for subsidies contrasts with the public's overall opinion of the health law. About 43 percent of the people polled from March 6 through March 12 opposed the law while 41 percent viewed it favorably.

The difference is the slimmest in two years. The opposition is lower than last July, when 53 percent of the people surveyed did not support the law and 37 percent did.

About 81 percent of participants knew that the health law requires most Americans to get coverage or face a fine. But only 53 percent knew that the tax filing season that ends next month is the first time that people have to report whether they have insurance.

The foundation asked questions of 1,503 adults. Questions that were asked of everyone had a margin of error of plus or minus 3 percentage points.

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