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Tuesday, Jan 26 2016

Full Issue

Viewpoints: Hospitals And Preventable Harm; How Medicaid Expansion Is Playing In Iowa, New Hampshire

A selection of opinions on health care from around the country.

Each year, in the United States, millions of patients are harmed while receiving care in hospitals. They get infections, experience adverse reactions to drugs, develop dangerous bed sores, or come down with pneumonia from the very ventilators meant to help them breathe. The estimates of the number of people who die each year as a result of hospital errors have ranged from as many as 98,000 in a landmark Institute of Medicine report from 1999 to as many as 440,000 in a 2013 study. It鈥檚 believed that most of these deaths could be prevented if health care providers always adhered to evidence-informed practices. (David Bornstein, 1/25)

Separation of powers in government is one of the most basic concepts in our democracy. Iowans frustrated with Gov. Terry Branstad鈥檚 plan to privatize administration of Medicaid understandably turn to the Iowa Legislature for help. Lawmakers, however, seem to be at a loss for what to do. Short of holding the state budget hostage, they don鈥檛 have many options. The Obama administration is the only hope for stopping the governor by denying his application for a waiver needed to move forward. (1/25)

The Legislature now has to decide whether to continue the Medicaid expansion. The program sunsets on Dec. 31. Without reauthorization, it dies and all those who became medically insured would become uninsured again. The state would also lose an enormous amount of federal money: hundreds of millions of dollars per year moving forward. So far, New Hampshire has taken quite an independent path in crafting a Medicaid expansion that fits our state. ... Simply put, the Medicaid expansion is a win-win. Providers get paid and consumers get coverage. Considering the mental health and opioid crisis in our state, this coverage could not be more timely. (Jonathan P. Baird, 1/24)

Once again, the Affordable Care Act is helping bail out the Kansas budget. Gov. Sam Brownback has proposed using a $25.5 million increase in federal funding for the Children鈥檚 Health Insurance Program, per ACA, to free up state money to go toward covering the budget shortfall next fiscal year, the Kansas Health Institute News Service reported. Brownback wants to do the same thing with $17.7 million in federal CHIP funds this current fiscal year. In December 2014, Brownback used $55 million from a Medicaid drug rebate program that was made possible by the ACA to help plug the state budget (Phillip Brownlee, 1/25)

Former Secretary of State Hillary Clinton and Sen. Bernie Sanders continue to spar over health care and Mr. Sanders鈥檚 single-payer plan. Have you noticed that Republican presidential candidates have spent far less time debating differences between their proposals? One reason: Republicans care less about detailed policy plans than do Democrats. (Drew Altman, 1/26)

Clinton made clear her vision of her presidency: She鈥檇 try to push through incremental improvements in job creation (through a program of infrastructure projects), health care (through tweaking Obamacare so more people could benefit) and education (through making community college more accessible). In one of her few mentions of Sanders, she said the two of them had a common goal -- universal health care. But, she said: "He wants to start over, and I want to build on our achievements. It's a shorter distance to 100 percent from 90 percent than from zero." ... [Bernie Sanders] was talking about the same things as Clinton -- paying for universal health care and free college education by closing tax loopholes used by the wealthy and corporations. Yet his message seemed to have more impact, his credibility enhanced by his pride in collecting 2.5 million campaign contributions averaging $27 apiece and by the evangelical zeal behind his belief that the most ambitious goals were achievable through collective action, not backroom dealing. (Leonid Bershidsky, 1/25)

When the Affordable Care Act was drafted, the Congressional Budget Office expected people to sign up quickly for new health insurance. Now, two years into the law, it鈥檚 clear that progress is going to be slower. The Obama administration acknowledged as much in late 2014, and again in October, when it presented its own modest predictions. Monday, the budget office also agreed, slashing its 2016 estimate by close to 40 percent. (Margot Sanger-Katz, 1/25)

Sen. Bernie Sanders (I-Vt.) jumped at a chance to talk about mental health care during a presidential town hall event in Iowa hosted by CNN on Monday. 鈥淢ental health should be treated as part of health care, and should be available to all people,鈥 he said. That may not sound like a controversial position and, within the Democratic Party, it isn鈥檛. Democrats, including Hillary Clinton, have long championed treating mental health on the same footing as physical health. But historically, health insurers have not treated mental and physical health the same way. Insurers routinely capped psychiatric benefits -- by limiting inpatient hospital days or therapy sessions, or putting dollar caps on mental health benefits. (Jonathan Cohn, 1/25)

This month鈥檚 edition of Health Affairs features an article focusing on patients with high mental health costs 鈥 and how they incur 30 percent more costs than other high-cost patients. This research helps to make the increasingly compelling case for earlier identification and intervention to address mental illnesses 鈥 if we鈥檙e concerned about saving money. (Paul Gionfriddo, Theresa Nguyen, and Nathaniel Counts, 1/25)

Thirteen years ago, I started a pharmaceutical sales career for Wyeth Pharmaceuticals, peddling samples out of my bag near the lush beautiful beaches of Newport and Laguna beaches in California. I threw ornate dinners for local psychiatrists to boost the sales of Effexor XR for depression and anxiety, even though it was clear that the physicians I sold to 鈥 the "pain docs"鈥 prescribed Effexor off-label for pain. Almost a decade later, I parked my sporty Infiniti company car in Beverly Hills and traded my $200,000-plus salary, which I was then receiving from a boutique firm called Medicis, for a used epidemiology textbook at the Johns Hopkins Bloomberg School of Public Health in Baltimore, where I started a master of public health program in 2011. What I did not realize at the time was that my own actions in closing a drug sale, without any bioethical considerations of what I was doing, helped contribute to the over prescription of powerful psychotropic drugs much like that of OxyContin, a powerful pain killer. (Nate Hughes, 1/25)

I am a disabled woman, a mother, an attorney and a business owner. I am a parent to four children with disabilities, two of whom are dependent on medical technology to live. I represent two organizations that exist to protect the rights and lives of disabled persons: Not Dead Yet and Disabled Parents' Rights. I am also strongly opposed to legalizing assisted suicide and the bills introduced in the Colorado legislature that would do so. (Lucas, 1/25)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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