I have been out of the country these last two weeks and am trying to catch up. Perhaps the biggest news item while I was away happened just as I left town – the election of Matt Bevin as our next Governor. I had only just learned of this fact when I was contacted by an out-of-state reporter who asked whether people in Kentucky who gained coverage through Medicaid expansion or through our KYNECT state insurance exchange should be concerned. If so, why would people who only so recently obtained healthcare coverage vote for Mr. Bevin – as they obviously must have in winning fashion?
Of course they should be concerned!
I responded that based on Mr. Bevin’s campaign promises and comments alone, as reported by our local press, current KYNECT and Medicaid expansion recipients have every reason to worry about their future coverage and access to healthcare. I would certainly worry if I were in their shoes and not the satisfied Medicare beneficiary that I am. In the heat of the campaign, and to appeal to virulent anti-Obama haters, Tea-Partiers, and other conservative voters; Mr. Bevin unequivocally promised to undo as much as possible of the Affordable Care Act (ACA) implemented in Kentucky by Governor Steve Beshear. At least that is what I heard.
Real promises or campaign maybes?
Campaign promises included unwinding Kentucky’s successful KYNECT insurance plan, or switching it from a state-run plan to a federal plan. It also seemed clear to me that Mr. Bevin promised to end or roll back the Medicaid expansions that have numerically provided the most coverage to previously uninsured Kentuckians. (Mr. Bevin later apparently hedged his promise to something short of a full roll-back.) Much was made during the campaign of Mr. Bevin’s possible confusion of Medicare and Medicaid, and statements about whether beneficiaries of publicly-financed healthcare should be required to submit urine tests for illegal drugs. I took some of this to be red-meat stuff thrown Trump-style by both parties to their admiring crowds. I would rather see Governor-elect Bevin improve what we have rather than walk away from it solely to satisfy his political base. Continue reading “Big-Change or No-Change in Post-Election Kentucky Healthcare?”
My cup runneth over with potential issues to explore.
June has been a busy month both locally and nationally insofar as things I like to write about. The shame-on-me is that I have not carved out enough time to do so! In part I am still picking up the pieces after my early spring travels. Exploring how to unpack and deal with the new Medicare prescription drug data base also took a lot of time. The truth is that I am a slow writer handicapped by a default and probably over-wordy professorial style. I haven’t even been able to update the Institute’s Facebook and Twitter pages! What follows is a list of things that occured during the month that I wanted to write about and hope to do so in more detail later. These are not necessarily in chronological order or of importance.
The Supremes Rock & Rule!
We were presented with two back-to-back major decisions by the U.S. Supreme Court. The first, King v. Burwell, allows federal subsidies of health insurance premiums for low income individuals and their families to continue even if their insurance was purchased in states that chose to allow the federal government to operate their health insurance exchanges. The lawsuit brought by Obama/Obamacare-haters to limit premium support to insured individuals in states like Kentucky that chose to operate their own exchanges would have essentially gutted the Affordable Care Act (ACA) and tossed millions back into the uninsured category. For the time being, Obamacare stands intact for at least the next year and a half, despite promises by opponents to throw up additional challenges. All our legislators should be working together to deal with a major remaining deficiency of the ACA. The Act has been very successful in decreasing the number of uninsured people, but it makes little headway against the exploding costs of unnecessary, marginally effective, or for that matter even necessary medical care. Continuing to forbid the federal government to negotiate over the prices of drugs is a case in point. Subsidies were deemed necessary for a reason! Continue reading “Potpourri of Health Policy Issues in June.”
The Federal Government has been releasing an avalanche of health care utilization data over the past very few years while the rest of use are still trying to figure out how to use the information. While there exists the potential to use the data to evaluate healthcare quality and safety, to ferret out best medical practices, to more efficiently use increasingly limited healthcare dollars, or to otherwise guide good public policy; the most apparent utility so far is to identify medical fraud. It is easier to justify looking for fraud than to confront entrenched interests dug in deep in this profitable segment of the economy.
Medicare prescription drug cost and utilization data.
One month ago, the Centers for Medicare and Medicaid Services (CMS) published another data-dump. It was the first compilation of all drugs and selected supplies prescribed by physicians and other healthcare professionals to the majority of Medicare patients in 2013. Included beneficiaries number 35.7 million and include those enrolled in freestanding Medicare Part-D drug plans, or those covered by drug plans that are part of Medicare Part-C (managed care) Advantage plans. These make up about 68% of all Medicare beneficiaries. Medicare fee-for-service patients are not included. Recall also that a proportion of all Medicare beneficiaries are enrolled because they are disabled, not because they are over 65 years old. Each provider has a line item for every discrete drug prescribed more than ten times by them (to protect patient privacy) including the number of unique beneficiaries receiving the drug, the number of times times prescribed or renewed, the number of days worth of of drug prescribed, and the total amount paid for the drug by the patient, Medicare, and any third party payers. In the full data file there are 23,650,520 line items for more than 1 million individual providers prescribing 3449 different drugs or supplies. Continue reading “Narcotized Elderly America: Diseased, Stoned, or Dealing?”
Hackers breached whatever firewalls and security measures were present at Premera Blue Cross based in Washington state. The personal, financial, and now even medical information of some 11 million past- and present customers were accessed. The breach may have occurred last May, was detected on January 29, but not disclosed to either the public or regulators until a few days ago. Nice job on the accountability front.
I recently wrote about an even larger breach of security at Anthem where the personal information of almost 80 million people was penetrated. It was not thought that medical information was compromised then, but how can one know for sure? I predicted we would be seeing more attacks on medical record and insurance databases but it is disappointing to see them coming on so rapidly. There are at least two driving forces or enablers. The first follows from Willie Sutton’s law explaining his reason for robbing banks—because that is where the money is. Some 18% of our gross national product fuels the healthcare industry— that is where the real money is. Medical fraud is part of that big business. Continue reading “Another Major Data Breach for a Health Insurer.”