Health Brief Archives - �鶹Ů�� Health News

Federal ACA Marketplace Enrollment Lagging

Julie Appleby, �鶹Ů�� Health News — Thu, 19 Dec 2024 14:23:55 +0000

It’s open enrollment season for the Affordable Care Act — and there are ongoing challenges.

First up, enrollment.

New and returning sign-ups through ��—��— are well below last year’s rate. New enrollments in early December, .

To give consumers in those states more time to enroll, the Centers for Medicare and Medicaid Services extended the deadline to Wednesday to sign up for coverage that starts Jan. 1. (Open enrollment itself ends in most states on Jan. 15, for coverage that would begin Feb. 1.)

Meanwhile, the Biden administration is seeking to put on hold an order by a federal judge in North Dakota who that challenged a rule allowing — for the first time��— enrollment in ACA coverage by “dreamers,” people brought to the United States as children without immigration paperwork.

The Dec. 9 ruling effectively barred those who qualified for the Deferred Action for Childhood Arrivals (DACA) program in the 19��states from enrolling in or getting subsidies for ACA plans. It does not appear to affect enrollment or coverage in other states, lawyers following the case have said.

On Monday, the U.S. Court of Appeals for the 8th Circuit granted a temporary stay of the order at the government’s request. A final decision, expected any day, could extend the stay while the court hears the appeal.

The Biden administration argues that North Dakota hasn’t proved it would be harmed by the rule — and that not granting a stay would be disruptive. The Dec. 9 order would cause the federal government to incur financial costs if it has to retool the marketplace to reflect the change and notify those who have already enrolled that their plans are canceled, the administration argued.

in August in U.S. District Court in North Dakota and is being heard by District Judge Daniel Traynor, who was nominated in 2019 by then-President .

Previously, the federal government uninsured people out of a half-million DACA recipients might sign up for 2025 coverage. In its new filing, the government says 2,700 have enrolled through the federal marketplace, and an unknown number in states involved in the litigation that run their own state-based marketplaces.

The Biden administration rule, finalized in May, clarified that those who qualify for DACA would be considered “lawfully present” for the purpose of enrolling in plans under the ACA.

All the states challenging the ACA rule say it will cause administrative and resource burdens as more people enroll, and that it will encourage additional people to remain in the United States when they don’t have permanent legal authorization.

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California’s ‘Care Courts’ Are Falling Short

Christine Mai-Duc — Fri, 13 Dec 2024 14:34:53 +0000

California’s controversial experiment to order mental illness and drug treatment for some of its sickest residents is rolling out statewide, but the latest data shows the new initiative is falling far short of early objectives.

The Community Assistance, Recovery and Empowerment Act — known as Care — recently expanded from 11 pilot counties to all 58, and is one of the many ways state and local governments across the nation are trying to grapple with a metastasizing crisis of severe mental illness and substance use.

“There are a lot of people who have had untreated illness for so long, and they’ve cycled out of incarceration and homelessness and hospital emergency departments,” Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, told me.

First-responders, families and local health officials can all file petitions requesting help for people who are ill.

California’s program empowers civil court judges to order adults into monitored plans that can include housing, social services and treatment for addiction or severe mental illness. Gov. Gavin Newsom, who signed the law in 2022, has called the program a “paradigm shift” that prioritizes Californians who are the most ill and in need. The Democratic governor initially said his administration would serve 2,000 people by the end of 2024.

From its launch at the beginning of October 2023 through the end of September this year, however, only 787 Care petitions were filed, according to the Judicial Council of California. Of those, 150 people were placed in court-approved treatment, with hundreds more pending.

As of the end of June, an additional 362 people had been “diverted” from the Care Court process and provided other services, according to the California Department of Health Care Services.

State officials have said between 7,000 and 12,000 people will ultimately be eligible for Care in a state of more than 39 million residents.

Corrin Buchanan, a deputy secretary for the California Health and Human Services Agency, said she is confident the state can still meet its treatment goal by the end of the year.

Governors in New York and Wisconsin have focused state resources on building community mental health care networks, Wesolowski said, while states such as Oregon and Washington have plowed resources into mental crisis emergency hotlines and mobile response teams.

Although treatment courts are common in other states, Wesolowksi said, California is the first to provide more comprehensive services — known as “wraparound” services, including housing and food support — rather than just prescriptions for medication. But the program is among the most restrictive, applying only to those diagnosed with untreated schizophrenia or a related psychotic disorder.

Such a narrow scope has led to disappointment among family members who have learned that few people qualify for the program, county representatives in California say.

Reaching those who do qualify can take time and treatment is largely voluntary.

Amber Irvine, program manager for San Diego County’s Care Court, said it takes workers there an average of 54 days of casual conversations, which the state doesn’t typically reimburse for, to persuade someone to accept help.

“We need to, as a whole, adjust our expectations of what can be accomplished in a year with such a complicated program and such a complex population,” Irvine said.

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As Rural America Grows More Diverse, Language Access Is Slow To Take Hold

Jazmin Orozco Rodriguez — Thu, 12 Dec 2024 14:37:54 +0000

The share of people who are Hispanic or Latino has grown to in Elko, Nevada, a small city in the remote northeastern corner of the state. That growth in diversity has also led to an increasing number of people who speak a language other than English at home, with Spanish spoken in in Elko County, which has a population of about 54,000.

That increasing diversity is part of a wider trend. While rural America remains largely White and predominantly English-speaking, its White population decreased by about 2 million from 2010 to 2020, by the Carsey School of Public Policy at the University of New Hampshire found. The percentage of people who are members of a racial or ethnic minority living in rural areas increased from 20 percent to 24 percent, with the largest share Hispanic.

Language access is protected federally, and 11 states plus D.C. have created broad policies for their residents. More states have laws targeting specific sectors, such as education or health care.

At the height of the pandemic, state and local governments lacking strong language-access systems struggled to communicate vital public health information to diverse communities. An posted on health department websites of the 10 most populous U.S. cities found it was not fully provided in Spanish.

Despite the growing need caused by limited English proficiency in rural areas, state lawmakers in Nevada left out smaller counties from a recently enacted statewide language-access law. More state and local governments have enacted similar measures in the past few years, but they’re concentrated in urban or suburban jurisdictions.

Implementing the laws is a challenge, researchers say, as standards can vary across state agencies and localities, making it difficult to ensure high-quality assistance for speakers of various languages. Not providing language access to people who need it is not only a violation of civil rights protected by Title VI of the Civil Rights Act, but it also can create public health and safety concerns, said Jake Hofstetter, a policy analyst for the Migration Policy Institute, a think tank focused on immigration policy and research.

Democratic state Sen. Edgar Flores, who represents part of Clark County, Nevada, and co-sponsored the state’s most recent language-access law, approved in 2023, said lawmakers faced pushback from state agencies. He said officials cited limited staffing and funding.

“I think, unfortunately, our rural jurisdictions are already incredibly limited with resources and, at the time of this request, there was a concern that they were not in a position to meet the requirements,” Flores said.

But as the number of state and local language-access policies increases, Hofstetter said he expects rural areas will be included. And as the Nevada Legislature convenes again in February, Flores said he’s certain there will be at least one language-access bill to consider.

“We have folks from all walks of life who have now made Nevada their home,” Flores said. “We have an obligation to them.”

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Florida’s Canada Drug Importation Plan Has Yet to Launch

Phil Galewitz, �鶹Ů�� Health News — Tue, 10 Dec 2024 14:24:14 +0000

Florida Gov. Ron DeSantis (R) spent years complaining that the Biden administration was slow-walking federal approval of his plan to import lower-cost prescription drugs from Canada — a concept endorsed by Donald Trump in 2020 just before his first presidential term ended.

But nearly a year since the Food and Drug Administration green-lit the state’s importation strategy, Florida has no planned date to begin bringing drugs over the border, according to a state official familiar with the program who asked not to be identified because they weren’t authorized to speak publicly.

Florida is the first and only state that has been approved to import drugs from Canada — a strategy for which politicians ranging from conservatives such as DeSantis to progressives such as Sen. Bernie Sanders (I-Vermont) have long pushed.

Drug companies say importation would increase the risk of counterfeit drugs appearing on U.S. pharmacy shelves, while Ottawa has warned it won’t allow medicines to be exported if Canadians could experience shortages as a result.

The Trump administration gave states the option to apply to bring medicines over the border in 2020, a move Trump touted in . He vowed to continue his “efforts to protect Americans from unaffordable drug prices” in a second term.

Colorado has an importation plan pending with the FDA.

Floridians would not directly benefit, as the program is geared toward lowering costs for the state Medicaid program and for the corrections and health departments.

LifeScience Logistics — a Dallas-based company whose board includes Alex Azar, secretary of the Department of Health and Human Services for most of the first Trump administration — $50 million from Florida to set up its program, including warehousing its medicines.

Azar said he wasn’t authorized to speak about the program, and DeSantis administration officials refused for months to answer questions about it.

After �鶹Ů�� Health News reported in November that Florida had not set a date to start its program, Alecia Collins, deputy chief of staff for the Florida Agency for Health Care Administration, said the state is “awaiting feedback from the FDA on the last of the [pharmaceutical] labels so we can move forward with the next steps for launching the program.”

After Florida applied to create an importation program in November 2020, DeSantis filed suit against the FDA in 2022 for what he called a “.”

Camm Epstein, a health policy analyst in Saratoga Springs, New York, said drug importation is a seemingly simple concept that resonates. “It riles up the crowd,” he said. “Who doesn’t want to pay lower drug costs?”

But it is complicated because of the FDA’s many requirements, including finding companies to work with — a Canadian exporter and a U.S. importer — and following a process that ensures the drugs are authentic, Epstein said.

“This was, at best, a boondoggle,” he said.

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Are States Keeping Their Promises on Opioid Settlement Transparency?

Aneri Pattani — Mon, 09 Dec 2024 14:19:14 +0000

It’s been about two years since most states began receiving millions of dollars in opioid settlement payments from companies that made or distributed prescription painkillers. But whether you can track how that windfall has been spent depends largely on where you live.

That’s because there is no federal standard dictating the information that must be made public. That determination falls to states.

Christine Minhee, founder of , found last year that 12 states promised to publicly report expenditures of 100 percent of their funds in a way any person could find and understand.

But when Minhee and I checked up on those states this year, we found a significant gap between meeting the letter of the law and actually communicating to the public in a clear and informative manner.

Take Idaho. The hosts more than 90 standardized spending reports from state and local entities. Sounds great. But in reality, it reads like this: In fiscal 2023, the city of Chubbuck on Section G, Subsection 9.

Cracking that code requires a . And even that provides only broad outlines.

G-9 refers to “school-based or youth-focused programs or strategies that have demonstrated effectiveness in preventing drug misuse.”

“What does that mean? How exactly are you doing that?” asked Corey Davis, a project director at the Network for Public Health Law, when he first saw the Idaho reports.

Does a school-based program involve hiring mental health counselors or holding a one-time assembly? Without details on the organizations receiving the money and the projects being pursued, it’s impossible to know where the funds are going. It’s like saying 20 percent of your monthly salary goes to food. But does that mean grocery bills, eating out at restaurants or hiring a cook?

The Idaho attorney general’s office, which oversees the state’s opioid settlement reports, did not respond to requests for comment.

In New Hampshire, the state government controls 85 percent of the state’s settlement funds and posts reports from grant recipients on its . The reports explain the projects and populations served but lack a key detail: how much money each organization received.

To find dollar figures, you have to search through the opioid abatement advisory commission’s meeting minutes, which date back several years, or search the governor and executive council’s for the proposed contracts. Typing in the search term “opioid settlement” brings up no results. Searching “opioid” instead surfaces results about opioid settlements as well as federal opioid grants. To tell which results are relevant requires opening each link.

People in recovery, parents who lost their children to overdose and others interested in the money “shouldn’t have to go click through the meeting notes and then control-F and look for opioids,” Davis said.

James Boffetti, New Hampshire’s deputy attorney general, who helps oversee the opioid settlement funds, defended the state’s reporting. “It’s all publicly out there,” he said. “We’ve certainly been more than transparent.”

Check out the whole series for more information on the opioid settlements and how the money is being used across the country.

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Georgia Said It Would Fix Care for the Disabled Years Ago. It’s Still Not Done.

Sam Whitehead — Fri, 06 Dec 2024 17:39:37 +0000

In recent decades, the Justice Department has sued for unnecessarily confining people with disabilities in places such as state psychiatric hospitals, nursing homes and segregated workspaces.

Such treatment violates a key part of the Americans With Disabilities Act — as affirmed in the 1999 decision from the Supreme Court: that people with disabilities have a legal right to receive care at home or in other community settings.

Some states — and — addressed the problems after settling with the DOJ. Others have struggled.

was among the first DOJ targets for an enforcement lawsuit (and coincidentally the home of the two plaintiffs in the Olmstead case, Lois Curtis and Elaine Wilson). In 2010, the state by agreeing to an overhaul of its system to support people with developmental disabilities and mental illness.

The state agreed to finish that work in five years. Nearly 15 years later, it’s not done. And that’s putting some of Georgia’s most marginalized people in jeopardy.

People like Lloyd Mills, a 32-year-old with cerebral palsy and autism. He was confined to a small hospital room for more than eight months because the state agency in charge of his care couldn’t find him a suitable community placement. The stay didn’t help him mentally, physically or emotionally, he said.

“The longer it continues, the more you sort of say, ‘Are we serious about solving this problem?’” said Geron Gadd, a senior attorney with the National Health Law Program.

Disability rights advocates note that it took more than a decade to increase some of the rates the state pays disability and mental health service providers, which led companies that offer direct care services and run group homes to shut their doors. When that happens, providers sometimes dump patients at local hospitals.

But even critics say Georgia has come a long way.

State lawmakers have invested nearly $521 million in community services since the start of the settlement — in quick-response teams to help people with mental illness in crisis and Medicaid programs to help people get care at home.

And a federal judge recently from several portions of the 2010 settlement for having attained compliance.

There is still work to do. The state agrees it needs to remove more people with developmental disabilities from psychiatric hospitals, deliver better case management to people with mental illness, and provide more housing with mental health supports.

That final goal is the “bedrock” of Georgia’s mental health and disability system, said Susan Walker Goico, with Atlanta Legal Aid. “You have to have a place to live in order to get your services and to stay out of institutions.”

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Your Next Hospital Stay Could Involve Fewer IV Fluid Bags. Here’s Why.

Jackie Fortiér — Wed, 27 Nov 2024 17:53:40 +0000

When Hurricane Helene struck in late September, it flooded the largest IV fluid factory in the United States. The Baxter International facility in western North Carolina had been producing 1.5 million IV bags a day, of the nation’s supply. The company immediately began rationing its products, and the shortage sent ripples through the health-care industry.

IV saline and fluids with carbohydrates are used regularly in hospitals and other clinical settings, both for hydration and to deliver medications. The shortage has left facilities scrambling to figure out the best use of the IV fluid bags they have.

But some hospital administrators see an opportunity in the IV fluid shortage to question standard practices. “There has been increasing literature over the last 10 to 20 years that indicates maybe you don’t need to use as much,” said Sam Elgawly, chief of resource stewardship at Inova, a health system in the D.C. area. “And this accelerated our sort of innovation and testing of that idea.”

Elgawly said he’s keeping one question front of mind: “How often are we actually giving it more than we need to, where we just keep it going because a patient’s in the hospital?”

He told �鶹Ů�� Health News that across the system IV fluid usage has dropped 55 percent since early October.

Hospitals such as those in the Inova system are using different ways to conserve, including giving some medications intravenously but without a dedicated IV fluid bag, known as “pushing” the medication.

“You don’t even need a bag at all. You just give the medication without the bag,” he said.

Simpler conservation measures could become common after the shortage abates, said Vince Green, chief medical officer for Pipeline Health, a small hospital system in the Los Angeles area that serves mainly people on Medicare and Medicaid. Green said medical staffers are encouraging patients to drink Gatorade or water instead of defaulting to IVs for hydration.

And medical staff make sure to use up the entire bag before starting another.

“If they come in with IV fluids that the paramedics have started, let’s continue it. If it saves half a bag of fluids, so be it, but it adds up over time,” Green said.

The North Carolina factory has reopened and is IV fluid products, but it’s not up to prehurricane production levels. Some hospital administrators are anticipating dealing with the shortage through the end of the year.

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Efforts To Curb ACA Enrollment Fraud Face Real-World Test

Julie Appleby, �鶹Ů�� Health News — Tue, 26 Nov 2024 14:43:49 +0000

The current Affordable Care Act open enrollment season is the first big test of new federal guardrails against fraud.

The rules aim to head off unauthorized ACA plan enrollments or switches by rogue agents and entities looking to make money via enrollment commissions. Such sign-ups triggered more than 274,000 consumer complaints through August this year.

But some health insurance experts fear the new rules could slow consumer sign-ups and reduce the number who sign up for 2025 coverage. In most states, ACA open enrollment started Nov. 1 and extends through Jan. 15.

Regulators “really have this tightrope to walk,” said Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University.

The Centers for Medicare and Medicaid Services, for example, now requires that certain policy adjustments — those in which the agent is not “affiliated” with the existing plan — have more restrictions, such as mandating a three-way call between the agent or broker, the consumer and .

In August, CMS also barred two of about a dozen private sector online enrollment platforms from connecting with healthcare.gov. And it suspended 850 agents suspected of possibly being involved in these activities, although some were reinstated.

Federal regulators said in mid-October that casework associated with consumer complaints had fallen by almost.

Still, CMS’s actions inadvertently could slow the enrollment process.

Given that phone lines for already get busy — especially in mid-December — Ronnell Nolan, president and CEO of Health Agents for America, a professional organization for brokers, said consumers should “hit the ground running.”

Meanwhile, reports are emerging that fraudsters are already figuring out workarounds for CMS’s antifraud protections, Nolan said.

For its part, CMS said it has “ramped up support operations” at its healthcare.gov marketplace call centers, which are open 24/7, in anticipation of increased demand for three-way calls, said Jeff Wu, deputy director for policy of the CMS Center for Consumer Information and Insurance Oversight. CMS officials expect “minimal wait times,” Wu added.

The problem of unauthorized switches is not new but took off during last year’s open enrollment.

Brokers generally blamed much of the problem on the ease with which agents could access ACA information in the federal marketplace. Though federal regulators have worked to tighten that access, they stopped short of instituting what Nolan and some other agents say is needed: two-factor authentication.

For consumers, unauthorized switches can cause a host of problems, from higher deductibles to new networks that do not include their physicians or hospitals, or even tax bills if those unauthorized policies came with premium credits for which they did not qualify.

But they also posed a political liability for the Biden administration, a blemish amid two years of record ACA enrollment. of rogue agents, while Republicans say fraud was fueled by Biden administration moves that allowed for more generous premium subsidies and special enrollment periods. The fate of those enhanced subsidies, which are set to expire at the end of 2025, will be decided by Congress next year.

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Federal Watchdog Urges Crackdown on Medicare Advantage Home Visits

Fred Schulte, �鶹Ů�� Health News — Fri, 22 Nov 2024 16:51:44 +0000

Medicare officials are pushing back against a federal watchdog’s call to crack down on home visits by Medicare Advantage health plans — a practice the watchdog says may waste billions of tax dollars every year.

��, a Health and Human Services inspector general audit found that the insurers pocketed $7.5 billion in 2023 from diagnosing health conditions that prompted no medical services — about $4.2 billion of it through the health assessments done in patients’ homes.

Assistant Inspector General Erin Bliss told me the plans are raking in billions of dollars without providing any treatment for medical conditions the plans flagged during the visits, including serious diseases such as diabetes and major depression.

But the power to curb billing tied to home visits rests with regulators at the Centers for Medicare and Medicaid Services, who appear unmoved by the OIG’s criticism.

In a statement to �鶹Ů�� Health News by spokesperson Alexx Pons, CMS said it “appreciates the OIG’s review in this area” and will keep studying the issue.

In a formal response published in the audit report, CMS said it disagreed with the watchdog’s call to restrict use of home health assessments in computing how much to pay health plans. People on Medicare “should have access to care that is appropriately provided in the home setting,” CMS wrote.

That’s just fine with the insurance industry. The OIG drew “inaccurate conclusions,” said Heather Soule, a spokesperson for UnitedHealthcare. The insurer is the largest Medicare Advantage contractor and accounted for about two-thirds of the payments tied to home visits and related data mining of patient files cited in the audit.

The home visits are “among the most comprehensive and thorough assessments of a patient’s health and physical environment available in the health-care system, helping to identify and drive needed follow-on care for the vast majority of the patients with whom we engage,” Soule said in the statement.

Medicare Advantage plans serve more than 33 million Americans, more than half of the people eligible for Medicare.

Government spending on the program, which is dominated by a handful of private health insurance companies, is expected to hit this year. The industry most Medicare Advantage enrollees are satisfied with the care they receive and typically pay less out-of-pocket than those enrolled in original Medicare.

But critics of the program point to years and years of , whistleblower lawsuits and other investigations revealing that many health plans exaggerate how sick patients are to boost their payments.

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Nearly All Vermonters Have Health Insurance, but Care Is Tough To Find

Wed, 20 Nov 2024 14:39:29 +0000

Almost all people have health insurance in Vermont, a state famed for its maple syrup and Ben & Jerry’s ice cream, yet residents pay the nation’s highest insurance premiums for individual coverage and endure months-long waits for care — and most hospitals here are losing money, according to state reports and interviews with residents and industry officials.

For more than 15 years, federal and state policymakers have focused on increasing the number of people insured, which they expected would shore up hospital finances and make care more available and affordable.

“Vermont’s struggles are a wake-up call that insurance is only one piece of the puzzle to ensuring access to care,” said Keith Mueller, a rural health expert at the University of Iowa.

Regulators and consultants say the state’s small, aging population of about 650,000 makes spreading insurance risk difficult. That demographic challenge is compounded by geography, as many Vermonters live in rural areas, where it’s difficult to attract more health workers to address shortages.

Unlike most states, Vermont regulates hospital and insurance prices through an independent agency, the Green Mountain Care Board. Until recently, the board typically approved whatever price changes companies wanted, said Julie Wasserman, a health consultant in Vermont.

In September, Bruce Hamory, a consultant hired by the board, recommended changes including potentially converting four rural hospitals into outpatient facilities and consolidating specialty services at others.

He cautioned that any fix would require sacrifices from everyone, including patients. “There is no simple single policy solution.”

Lynne Drevik, who runs an inn and spa in northern Vermont, said her doctor told her in April that she needed knee replacement surgeries — but the earliest appointment would be in January for one knee and next April for the other.

Drevik said it hurts to climb the stairs in her 19th century farmhouse. “My life is on hold here, and it’s hard to make any plans.”

Andy Kehler often worries about the cost of providing health insurance to the 85 workers at Jasper Hill Farm, the cheesemaking business he co-owns in northern Vermont. The company pays half the cost of workers’ health insurance premiums because that’s all it can afford, he said.

“It’s an issue every year for us, and it looks like there is no end in sight,” he said.

Recent data shows the University of Vermont Health Network controls about two-thirds of the state’s hospital market, and its main facility, the University of Vermont Medical Center in Burlington, has some of the highest prices nationwide.

Hospital officials contend their prices are average for the industry.

But for 2025, the Green Mountain Care Board required the Burlington hospital to cut the prices it bills private insurers by 1 percent.

The nonprofit system says it is navigating its own challenges, including a lack of housing to recruit workers and a shortage of mental health providers, nursing homes and long-term care services, which often creates delays in discharging patients, adding to costs.

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