Peggy Girshman, Author at �鶹Ů�� Health News

A Day Of Stark Differences For States On Health Insurance Exchanges

Peggy Girshman — Tue, 11 Dec 2012 13:25:42 +0000

On the same day HHS Secretary Kathleen Sebelius ��to Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington for their health insurance exchange plans, the Republican-dominated Florida Senate made��its��position on��the insurance marketplaces known. Friday is the deadline for states to decide if they want to build and operate their own exchanges or have the federal government do it. The online insurance marketplaces are supposed to start signing people up in October 2013 for policies that begin in January 2014.

Here are two dispatches from reporters in the field:

COLORADO

Exchange officials ��gave their first ��and floated potential revenue streams.

“We’re targeting a range of $22-26 million (annually) to run the exchange,” said , the CEO of the Colorado Health Benefit Exchange.

The exchange board expects about 250,000 Coloradans to get insurance through the exchange in its initial years. Exchanges are designed to help individuals and small businesses shop for coverage. The board is��contemplating charging��people a fee to pay for operations, either directly or via a per-enrollee fee on insurers selling in the exchange.

forbids the state from spending general fund revenue on the exchange.

The exchange board has the authority to impose enrollment fees on users with the approval of just one legislative committee. A vote by the full legislature would be required to get money from��a second potential��source:�� Those in the high risk pool will be transferred to the exchange in 2014, and there’s sure to be a scramble for the state funds now being spent on that program.

Fontneau says Colorado hopes to have its method for funding the ongoing operation of the health insurance exchange finalized “probably within the next six months.”

– Eric Whitney, Colorado Public Radio

FLORIDA

The Florida Senate on Monday launched a about the federal Affordable Care Act and reiterated that the state will not run a health insurance exchange in January 2014.

House and Senate leaders have already said the state cannot make a decision on an exchange until the 2013 legislative session. A question-and-answer section of the new webpage made clear the state wouldn’t be ready to run an exchange in 2014, even if it wanted to do so.

Federal officials initially set a November deadline for states to say whether or not they would run their own exchanges, but then the feds gave states another month. “Florida, and several other states, did not submit a letter to the Secretary of Health and Human Services by the November deadline to indicate an intention to operate a state based exchange for health care coverage in calendar year 2014,” the new Senate webpage says. “Another deadline is set for December 14, but Florida’s position is unlikely to change at that time.”

Florida and other states have until mid-February to say whether they will set up their exchanges in partnership with the federal government. In that model, states would keep control of some functions of the exchange , such as deciding which companies can sell there, while the federal government oversees other functions.

– Jim Saunders,

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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Not Your Typical Presidential Debate Forum For Obama, Romney

Peggy Girshman — Thu, 27 Sep 2012 15:01:36 +0000

There’s nothing unusual about the way The New England Journal of Medicine displays��: In dueling columns, under an original article on a “novel androgen-receptor blocker” for prostate cancer. But the authors of two of the perspectives are far from typical: and .

The introduction to both is basic:

The editors asked the Democratic and Republican presidential nominees, President Barack Obama and former Massachusetts Governor Mitt Romney, to describe their health care platforms and their visions for the future of American health care. Their statements follow.

And though the audience is far different from those at typical campaign stops, both candidates brought out familiar points.

Mitt Romney the health law and to replace it:

In the health care system that I envision, costs will be brought under control not because a board of bureaucrats decrees it but because everyone — providers, insurers, and patients — has incentives to do it. Families will have the option of keeping their employer-sponsored coverage, but they will also be empowered to enjoy the greater choice, portability, and security of purchasing their own insurance plans. As a result, they will be price-sensitive, quality-conscious, and able to seek out the features they want. Insurers will have to compete for their business. And providers will find themselves operating in a context where cost and price finally matter. Competition among providers and choice among consumers has always been the formula for better quality at lower cost, and it can succeed in health care as well.

Romney says he would make no changes to Medicare for today’s beneficiaries or those enrolled for the next 10 years and he advocates for Medicaid block grants to the states.

Obama that have already proved popular, such as beginning to close the Medicare prescription drug doughnut hole and coverage for young adults on their parents’ insurance plans.��And he��promises:

If I am elected for a second term, I will follow through on all the work we have started together to implement the Affordable Care Act. I have also been clear that additional steps are needed. We need a permanent fix to Medicare’s flawed payment formula that threatens physicians’ reimbursement, rather than the temporary measures that Congress continues to send to my desk. I support medical malpractice reform to prevent needless lawsuits without placing arbitrary caps that do nothing to lower the cost of care.�� I also know we must continue to support life-sciences research and ensure that our regulatory system helps bring new treatments and tools to pharmacies, doctors’ offices, and hospitals across the country

Obama and Romney both provided the ,��a typical way scientific journals ensure that readers know about any funding source or conflicts of interest.

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Reinhardt On Medicaid, Medicare And The Default

Peggy Girshman — Fri, 29 Jul 2011 18:30:20 +0000

In our calls for on the effect of default on the health care industry, we spent some time talking with Princeton economist .

He doubts that health care would be affected, unless someone wanted to “make a dramatic statement.”

He believes��most doctors’ offices, labs and hospitals could survive a few weeks without Medicare payments with a normal cash cushion. And, he thinks even Medicaid could be safe, because of Obama administration support:

Democrats are a fierce champion of the poor.��The poor is the last group Democrats would pick on.

Then he speculated about what might be happening at the White House:

There probably already exists a list of priorities of whom you will not pay. My hunch is that list will be political. Though I think with President Obama, he wants to [turn] the other cheek, the Christian thing, rather than Reagan who had an amiable smile but knew how to mete out punishment. In a political list, the first things that wouldn’t get paid would be defense contractors in Republican��congressional districts [those that��don’t affect the wars]. They could certainly do some damage in Ft. Worth, Texas, before they would pick on health care providers. Obviously the party in power has some ability to use decision-making power as leverage. My hunch is that wouldn’t be the president’s instinct but the people around him.

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Get Yer Summer Health Care Fact-Checking Here

Peggy Girshman — Fri, 15 Jul 2011 21:26:37 +0000

The debt ceiling debate this month has sent claims and counter claims flying, keeping the nation’s fact checkers busy. Here’s a sampling of their mid-summer efforts:

was very curious about a number of claims by the conservative group , which is running a $7 million ad campaign aimed a number of Democrats, including the president (The “GPS” stands for Grassroots Policy Strategies, by the way).

One of the ads features a sleepless woman saying that the “instead of fixing healthcare, my mom’s Medicare will be cut.” FactCheck found that “the implication that the health care law takes away Medicare benefits is misleading. Extra benefits under Medicare Advantage plans are likely to be reduced, but the law actually expands traditional Medicare benefits, such as adding more prescription drug coverage.”

FactCheck goes on to say: “Even if viewers read nothing more into the claim than that, they should know that the law cuts the future growth of spending in Medicare over a decade, not the current budget. About 40 percent of those cuts come from reducing the future growth of payments to hospitals, and skilled nursing and home health organizations. “

wondered about a particular claim during a July 12 interview CBS’ Scott Pelley had with President Barack Obama:

Pelley: “Can you tell the folks at home that, no matter what happens, the Social Security checks are going to go out on August the 3rd? … Obama: “Well, this is not just a matter of Social Security checks. These are veterans’ checks, these are folks on disability and their checks. There are about 70 million checks that go out each month.”

Politifact checked with the and writes that, if the government could “prioritize,” it could “pay the monthly costs of Medicare and Medicaid ($50 billion), Social Security ($49.2 billion), Pentagon vendors ($31.7 billion), interest on the debt ($29 billion), and unemployment benefits ($12.8 billion). Those categories total $172.7 billion. But doing so would mean delaying other payments — for instance … salaries and benefits for federal employees ($14.2 billion), welfare and food programs ($9.3 billion), health and human services grants ($8.1 billion), housing assistance ($6.7 billion), and many other programs, including military active duty pay ($2.9 billion), veterans affairs program ($2.9 billion) … “

Politifact ended up rating the president’s statement “Half True.”

The

got an answer from the White House about a question raised in “: The Untold Story of Barack Obama’s Mother.” Author Janny Scott dug deep into a claim that the president about his mother:

For my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.

The Times notes that Scott questioned this account, quoting “from correspondence from the president’s mother to assert that the 1995 dispute concerned a Cigna disability insurance policy and that her actual health insurer had apparently reimbursed most of her medical expenses without argument.”

According to the Times, a White House spokesman “chose not to dispute either Ms. Scott’s account or Mr. Obama’s memory … ‘We have not reviewed the letters or other material on which the author bases her account,’ said Nicholas Papas, the spokesman. ‘The president has told this story based on his recollection of events that took place more than 15 years ago.'”

FactCheck.org also presidential candidate Rep. Michele Bachmann’s claims on two Sunday talk shows that the “nonpartisan Congressional Budget Office said the federal health care law will ‘cost the economy 800,000 jobs.'” The service was blunt and to-the-point on this one: “The CBO didn’t say that. Instead, the CBO that the law would cause a reduction in the amount of labor workers choose to supply. Some Americans would decide to work fewer hours or retire earlier because their ability to get health insurance would be more secure. … Overall, the CBO said the impact on jobs would be ‘small.'”

The Washington Post’s asks: “Are Medicare patients ‘going to die’ under Obama’s health law?”

While the “death panels” thing has been around for quite some time, this time, Kessler is referring to a claim from Georgia Republican Rep. Phil Gingrey: “[U]nder this IPAB [Independent Payment Advisory Board] we described that the Democrats put in ‘Obamacare,’ where a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy, I guarantee you when you withdraw that the patient is going to die. It’s rationing.”

Kessler’s researched response? “ We can certainly understand that Gingrey may have philosophical concerns over the IPAB, but that does not excuse his leap of logic that it will lead to the deaths of seniors. Even with the potentially vague language on rationing in the law, the board members would need to be confirmed by the Senate, and Congress would have the opportunity to reject the recommendations.” and he then goes on to give Gingrey’s statement:

Three Pinocchios

Separately, Kessler found of misuse of a Medicaid statistic, including:

“Cash-strapped states are also feeling the burden of the Medicaid entitlement. The program consumes nearly 22 percent of states’ budgets today, and things are about to get a whole lot worse.”

— Sen. Orrin Hatch (R-Utah), June 23, 2011, at a

“Across the country, governors are concerned about the burgeoning cost of Medicaid, which in fiscal 2010 consumed nearly 22 percent of state budgets, according the National Association of State Budget Officers. That’s larger than what states spent on K-12 public schools.”

— , June 14, 2011

Kessler found fault with the “assertion that Medicaid is 22 percent of state spending, and thus now exceeds education spending.” While it comes from an annual survey of the National Association of State Budget Officers, he notes that “if you dig into the report — if you just go to page one — you will see that this number includes the federal contribution, in what is known as ‘total funds.’ … [The NASBO report says] ‘For estimated fiscal 2010, components of general fund spending are elementary and secondary education, 35.7 percent; Medicaid, 15.4 percent; higher education … ‘ In other words, without the federal dollars included, Medicaid falls to second place, far behind education. It turns out that on average, states spend 15.4 percent of their funds on Medicaid — not 22 percent.”

No Pinocchio ratings this time: Kessler rates this “True but False.”

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States Struggling To Pay For Aged, Disabled Community Programs – A KHN Interview

Peggy Girshman — Wed, 18 May 2011 07:08:00 +0000

Martha Roherty represents people who are facing a perfect storm.

Martha Roherty

As the executive director of the ,��Roherty knows what’s happening to��officials in charge of state programs that help older and disabled residents get access to basic services. For the past few years, they’ve been facing big state budget cuts, layoffs of key personnel and an increasing demand for services. And the situation has done nothing but get worse.

KHN’s Peggy Girshman talked with Roherty at the recent meeting of the American Society on Aging.

Here are edited excerpts of the interview:

What’s happened to these services in the past three or four years?��

In addition to��the fiscal downturn, [there have been] huge cuts in the non-Medicaid side of long-term services and supports. A lot of those are the softer, pre-Medicaid services you would get, like meals delivered, personal care services, homemaker respite. All of those have been slashed, slashed, slashed, slashed, slashed because they’re not mandatory. They’re not part of the Medicaid program [which funds nursing home stays] and as states have tried to balance their budgets, they’ve had to cut those things. So that’s been a big challenge for us.

It’s the things that allow people to keep their family members at home longer. Or, hopefully, indefinitely.��

Can you describe how people have used these services over time?��

A lot of people who call aging and disability centers for information, the first thing they’ll say is “Mom needs to go into a nursing home.” In fact, when they’ve done the benefits work and the options counseling, they end up needing things like meals delivered and maybe somebody to check on Mom and maybe some light housekeeping. And they never even need to go into the more expensive services.

And, not only that, most of the time the family will accept the cost of doing it. It’s not that they want the government to take care of it, they just don’t even know who to call or what to do. Sometimes it’s even as simple as a home modification. We can put ramps into places and people can stay at home longer.��

Is every state seeing cuts this way?��

Yes. Unequivocally. Yes. And three years in a row.

In state fiscal year ’09, the cuts were not as bad. They were like 5 percent or less, in most of the cases. The next year, they got a little steeper. But they were on top of the cuts they had sustained the year before. So they add up. And now we’re seeing states that are having to make up gaps of 25 percent. And the only thing you can do in that case is to eliminate whole programs. They’re working with significantly reduced staffs because they’ve cut state employees first.

They’re making decisions based solely on the numbers. And so if this program cost x billion or million, and you need to save x billion or million, you just eliminate it.��

What’s the role of the health law in all this, as we look down the road?

We picked up 16 million people in Medicaid in 2014 — that’s a lot of extras. We’re assuming that they will have significant health issues. It’s very difficult to stay at that level of poverty and not have health issues.

What we’ve seen in the Massachusetts model, which is a similar model to the national model, was that right at the beginning, those people when they come into the program, they deferred health concerns for a long time so they’re sicker when they first come in and they’re high-cost, sicker patients. That does level out a little bit, but in the beginning, there’s a spike. So that will put additional pressure on the already-pressured states. So I think there’s a nervousness around all of the additional population that’s coming in.

When you think of a year or two or three down the road, what is your biggest worry, or what wakes you up in the middle of the night in a cold sweat?��

I really do worry about the state staff. We have lost so many really qualified, excellent state staff to furloughs and to early retirements that the people that know how to trim programs without really trimming services, a lot of them have had to retire. And states don’t have the institutional knowledge to know if you do X, Y can occur. So they don’t see some of the unintended consequences of their actions. And I think that some of the short-sightedness of the state legislatures — that if they don’t get the savings in the first year, they’re not wanting to do programs — that’s very concerning.

I’m hoping that we’ll begin to see the end of the crisis that we’ve been in for the last three years, soon. Because I don’t know how much more sustainable it is.��

Can you talk a little bit about the turnover? How many people in these programs are new?

There were 37 governors up for election. We immediately lost about 20 of the state directors. We expect to have a total of 32 who will have transitioned out. It is a political job in most states. That’s a lot of new people. And because we switched parties in 16 states, they went down further and eliminated some of the other political appointments. So some of the institutional knowledge also left during that period. There’s an awful lot of new aging and disability directors trying to learn all of the Affordable Care Act (the federal health care law) at the same time as they deal with the economic crisis.��

And is this a field these people know and understand? Are they getting jobs because they’re the best qualified, among the political jobs? Are they coming in with some background?��

It is a political position and so the Number 1 criterion is their relationship with the governor. It doesn’t matter if they’re an expert in aging if they can get to the governor and get things done and they’re a good manager. But it does make it a little tough when they don’t know any of the programs.

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‘Big Cleanout’ No Cure For Hoarding

Peggy Girshman — Mon, 02 May 2011 12:52:35 +0000

If basic cable is we have a fascination with hoarding. “We all love a good train wreck” says Mark Odom, clinical consultant to the . He says many people including psychiatrists think hoarders are obsessive/compulsive. It’s even in the “bible” of psychiatric disorders, the DSM IV.

But that’s not necessarily true, according to several studies presented at the annual conference of the American Society on Aging, which wrapped up this weekend in San Francisco. Hoarders are than to have OCD.

Shadwwulf via en.wikipedia

And the problem . University of California, San Francisco researcher Monika Eckfield studied 22 older adults and found that changes in their social environment created boredom and isolation. So, for some, shopping became a socially-appropriate way to interact with the world. And then, they don’t get rid of anything once they bring purchases home.

All 16 women and 6 men described “blockages,” with no motivation to discard many things, though no one kept everything. One woman said her house was “constipated,” Eckfield reports.

And the hoarding was not because they had lived in the same place for decades; even people who moved in the last 5 to 10 years didn’t purge when they moved. They hired helpers, who packed, moved and then stacked boxes. Eckfield said their homes “looked like storage lockers.” In fact, because they seemed to lack the capability or help to unpack, and then they couldn’t find things like kitchen supplies, they went out and bought more.

In the March issue of the International Journal of Geriatric Psychiatry, R. Scott Mackin, also from UCSF, and a team of researchers found that about had “severe compulsive hoarding behaviors,” while just 2 percent��to 5 percent of non-depressed older adults are hoarders.

He notes that both depression and hoarding are “frontally mediated” that is, both seem to affect the frontal lobes of the brain, which are associated with planning, motivating and organizing.

The hoarders had much more trouble categorizing objects such as sorting cards based on color or shapes ��and solving problems.

These “cognitive deficits” need to be taken into account before intervening to clean out the hoarder’s home, the team concluded.

Christiana Bratiotis, of the , says cognitive behavioral therapy can help. Prior to a recent study the school did with the Elder Services of Merrimack Valley (Mass,), the agency used only large scale clean-outs to clear the clutter. She said 100 percent of the time, the elders began hoarding again immediately. And they were angry, distressed and distrustful of anyone (family members, social workers) who tried to intervene again.

For their study, social workers visited 26 people, ages 60-90, weekly for up to a year. They found that the older adults described themselves as “packrats” or “collectors,” not hoarders. The social workers worked with them slowly, to reduce the mistrust and to build organizing skills.
They put the hoarders in control of all the decision-making, except eliminating imminent risk (such as papers on the stove) and found that by the end of the year, most could tolerate incremental changes and none had been evicted.

That jives with the Orange County task force’s experience. Mark Odom notes that an effective strategy for them is to emphasize “harm reduction.” He said by invoking regulation-enforcers, such as landlords or fire departments, hoarders had “exterior motivation” to clear at least some of the clutter.

“It’s about house ‘safe and functional,'” he said, “not ‘house beautiful.'”

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Midnight Munchies Keep Elderly Safer In NY Nursing Home

Peggy Girshman — Tue, 16 Mar 2010 15:49:00 +0000

This story also appeared on NPR’s health blog,

Midnight snacks aren’t just for college students anymore.

Like many nursing homes, the Parker Jewish Institute in New Hyde Park, N.Y., was having problems with some of its patients with dementia wandering at night. The staff worried about falls, but they didn’t want to hand out more psychotropic medicines that would make the patients sleepy, because that increased the risk of falling. Of the 42 residents, 8 to 10 were constantly moving.

But one night in 2007, a certified nursing assistant accidentally stumbled on a solution.

Her boss, Aura Gordon, an RN manager, told the story this week��at the Aging in America conference in Chicago.

A patient, “a lovely man,” got out of bed around 2 a.m., as was his custom, picked up his newspaper and headed down the hall. He was preparing to “go to the market,” which had been his pattern when he was working. The nurse saw him and figured if he thought he was going to work, he should eat a little something. She gave him a slice of cake and a cup of coffee. He ate the cake, drank the coffee, and then went back to bed.

Thus began the midnight snack program at 8 South, a unit at Parker. By 2008, Gordon has persuaded the home to provide snacks for the nighttime wanderers: cake, sandwiches, cookies, pudding, Jell-O, juices, coffee. They added bananas when they discovered that one very agitated woman — who didn’t want to eat the nursing home food because she thought it was poisoned — immediately calmed down when she had a banana. They don’t know why, but now they always have bananas on hand. And they make sure some of the snacks are sugar-free, for their diabetic patients.

Gordon says patients with dementia often don’t know what time it is, which causes some to get up at all hours, ready to go. They get confused, and sometimes even violent, when they’re urged back into their rooms and to bed.

She reported that, since the snack program began, they saw falls and related injuries decrease by 50 percent. And, they also saw a decrease in pressure sores (also known as bed sores, or nosocomial ulcers). Now, she says, there are no sores in all of 8 South.

It’s not rigorous scientific research, but 8 South is much calmer now, 24 hours a day.

This is one of KHN’s “Short Takes” – brief items in the news. For the latest news from KHN, check out our News Section.

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