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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Affordable Care Act. Show all posts
Showing posts with label Affordable Care Act. Show all posts

Friday, February 3, 2023

Contraceptive Coverage Expanded: No More ‘Moral’ Exemptions for Employers

Ari Blaff
Yahoo News
Originally posted 30 JAN 23

Here is an excerpt:

The proposed new rule released today by the Departments of Health and Human Services (HHS), Labor, and Treasury would remove the ability of employers to opt out for “moral” reasons, but it would retain the existing protections on “religious” grounds.

For employees covered by insurers with religious exemptions, the new policy will create an “independent pathway” that permits them to access contraceptives through a third-party provider free of charge.

“We had to really think through how to do this in the right way to satisfy both sides, but we think we found that way,” a senior HHS official told CNN.

Planned Parenthood applauded the announcement. “Employers and universities should not be able to dictate personal health-care decisions and impose their views on their employees or students,” the organization’s chief, Alexis McGill Johnson, told CNN. “The ACA mandates that health insurance plans cover all forms of birth control without out-of-pocket costs. Now, more than ever, we must protect this fundamental freedom.”

In 2018, the Trump administration sought to carve out an exception, based on “sincerely held religious beliefs,” to the ACA’s contraceptive mandate. The move triggered a Pennsylvania district court judge to issue a nationwide injunction in 2019, blocking the implementation of the change. However, in 2020, in Little Sisters of the Poor v. Pennsylvania, the Supreme Court, in a 7–2 ruling, defended the legality of the original Trump policy.

The Supreme Court’s overturning of Roe v. Wade in June 2022, in its Dobbs ruling, played a role in HHS’s decision to release the new proposal. Guaranteeing access to contraceptions at no cost to the individual “is a national public health imperative,” HHS said in the proposal. And the Dobbs ruling “has placed a heightened importance on access to contraceptive services nationwide.”

Wednesday, August 22, 2018

Has Genetic Privacy Been Strained By Trump's Recent ACA Moves?

Michelle Andrews
www.npr.org
Originally posted July 11, 2018

Here is an excerpt:

However, if you develop symptoms of a disease or are diagnosed with a medical condition, GINA no longer protects you. That's where the Affordable Care Act steps in. It prohibits health plans from turning people down or charging them more because they have a pre-existing condition.

"GINA did something good, and the ACA was the next important step," said Sonia Mateu Suter, a law professor at George Washington University who specializes in genetics and the law.

The Trump administration put those additional ACA protections in doubt last month when it said it won't defend that part of the law, which is being challenged in a lawsuit brought by the attorneys general of 20 states.

The administration said that since the penalty for not having health insurance has been eliminated starting in 2019, the provisions that guarantee coverage to people with pre-existing conditions and prohibit insurers from charging them higher premiums should be struck down as well.

The protections are a priority with many voters. In a June poll by the Kaiser Family Foundation, two-thirds of voters said that continuing protections for people with pre-existing conditions will be either the single most important factor or very important in determining their vote in this fall's elections.

The information is here.

Friday, June 8, 2018

The Ethics of Medicaid’s Work Requirements and Other Personal Responsibility Policies

Harald Schmidt and Allison K. Hoffman
JAMA. Published online May 7, 2018. doi:10.1001/jama.2018.3384

Here are two excerpts:

CMS emphasizes health improvement as the primary rationale, but the agency and interested states also favor work requirements for their potential to limit enrollment and spending and out of an ideological belief that everyone “do their part.” For example, an executive order by Kentucky’s Governor Matt Bevin announced that the state’s entire Medicaid expansion would be unaffordable if the waiver were not implemented, threatening to end expansion if courts strike down “one or more” program elements. Correspondingly, several nonexpansion states have signaled that the option of introducing work requirements might make them reconsider expansion—potentially covering more people but arguably in a way inconsistent with Medicaid’s broader objectives.

Work requirements have attracted the most attention but are just one of many policies CMS has encouraged as part of apparent attempts to promote personal responsibility in Medicaid. Other initiatives tie levels of benefits to confirming eligibility annually, paying premiums on time, meeting wellness program criteria such as completing health risk assessments, or not using the emergency department (ED) for nonemergency care.

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It is troubling that these policies could result in some portion of previously eligible individuals being denied necessary medical care because of unduly demanding requirements. Moreover, even if reduced enrollment were to decrease Medicaid costs, it might not reduce medical spending overall. Laws including the Emergency Medical Treatment and Labor Act still require stabilization of emergency medical conditions, entailing more expensive and less effective care.

The article is here.

Monday, May 22, 2017

Half of US physicians receive industry payments

Michael McCarthy
BMJ 2017; 357

Nearly half of US physicians receive payments from the drug, medical device, and related medical industries, and surgeons and male physicians are more likely to do so, a US study has found.

The study leader, Jona A Hattangadi-Gluth, of the University of California, San Diego, based in La Jolla, said that most payments were relatively small but that many specialists receive more than $10 000 (£7750; $9160) a year from industry, including 11% of orthopedic surgeons, 12% of neurologists, and 13% of neurosurgeons.

She said, “The data suggest that these payments are much more pervasive than we thought and [that] there is much more money going directly to physicians than maybe people recognized.”

The researchers analyzed data from 2015 collected from Open Payments, a program created by the 2010 Affordable Care Act that requires biomedical manufacturers and group purchasing organizations to report all general payments, ownership interests, and research payments paid to allopathic and osteopathic physicians in the US.

The article is here.

Saturday, March 4, 2017

JAMA Forum: Those Pesky Lines Around States

Larry Levitt
JAMA Forum Blog
Originally posted October 19, 2016

Here is an excerpt:

Allowing insurers to then sell plans across state lines would actually worsen access to coverage for people with preexisting conditions, since insurers would have a strong incentive to set up shop in states with minimal regulation, undermining the ability of other states to enact stricter rules.

Let’s say Delaware wanted to attract health insurance jobs to its state with industry-friendly regulations—for example, no required benefits (such as preventive services or maternity care) and no restrictions on medical underwriting (meaning people with preexisting conditions could be denied coverage). Insurers operating out of Delaware could offer cheaper health insurance by cherry-picking healthy enrollees from other states. If New York tried to require insurers to expand access to people with preexisting conditions or mandate specific benefits, its carriers would get stuck with disproportionately sick people.

Delaware is not a random example here. This is exactly what happened in the credit card industry after the Supreme Court ruled in 1978 that credit card companies could follow interest rate rules in the states where they operate, not the state where the cardholder lives. Two states—Delaware and South Dakota—moved quickly to deregulate interest rates, and banks followed suit by moving their credit card operations to those states. By 1997 Delaware had 43% of the nation’s credit card volume.

The blog post is here.

Tuesday, February 21, 2017

Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA

Gary Claxton, Cynthia Cox,  Anthony Damico, Larry Levitt, and Karen Pollitz
Kaiser Family Foundation
Originally posted December 16, 2016

Here is an excerpt:

Estimates of the Share of Adults with Pre-Existing Conditions

We estimate that 27% of adult Americans under the age of 65 have health conditions that would likely leave them uninsurable if they applied for individual market coverage under pre-ACA underwriting practices that existed in nearly all states. While a large share of this group has coverage through an employer or public coverage where they do not face medical underwriting, these estimates quantify how many people could be ineligible for individual market insurance under pre-ACA practices if they were to ever lose this coverage. This is a conservative estimate as these surveys do not include sufficient detail on several conditions that would have been declinable before the ACA (such as HIV/AIDS, or hepatitis C).  Additionally, millions more have other conditions that could be either declinable by some insurers based on their pre-ACA underwriting guidelines or grounds for higher premiums, exclusions, or limitations under pre-ACA underwriting practices. In a separate Kaiser Family Foundation poll, most people (53%) report that they or someone in their household has a pre-existing condition.

The article is here.

Tuesday, January 10, 2017

Why are doctors burned out? Our health care system is a complicated mess

By Steven Adelman and Harris A. Berman
STAT News
Originally posted December 15, 2016

Here is an excerpt:

Burnout and dissatisfaction with work-life balance are particularly acute for adult primary care physicians — the central figures in our unsystematic health care “system.” A system that was already teetering in 2011 has been stressed by the addition of 20 million covered lives by the Affordable Care Act. It’s little wonder that in Massachusetts, where near-universal coverage has filled up the offices of primary care physicians, malpractice claims against them are rising. Patients and physicians alike complain about the unsatisfying brevity of office visits, and many harbor intense feelings of antipathy towards cumbersome electronic health records and growing administrative burdens.

We believe that to alleviate the stress and burnout in the medical professions, we must pay attention to system factors that lead to what we call the “occupational health crisis in medicine.” We recently surveyed 425 practicing physicians and health care leaders and executives, seeking their opinions on the importance of eight approaches to transforming health care. We presented the results this fall at the International Conference on Physician Health.

The article is here.

Friday, September 9, 2016

Aetna Shows Why We Need a Single-Payer System

By Robert Reich
Robert Reich Blog
Originally posted August 16, 2016

The best argument for a single-payer health plan is the recent decision by giant health insurer Aetna to bail out next year from 11 of the 15 states where it sells Obamacare plans.

Aetna’s decision follows similar moves by UnitedHealth Group, the nation’s largest insurer, and Humana, one of the other giants.

All claim they’re not making enough money because too many people with serious health problems are using the Obamacare exchanges, and not enough healthy people are signing up.

The problem isn’t Obamacare per se. It’s in the structure of private markets for health insurance – which creates powerful incentives to avoid sick people and attract healthy ones. Obamacare is just making the structural problem more obvious.

The entire blog post is here.

Tuesday, August 23, 2016

Administration Paints Rosy Future For Obamacare Marketplaces

By Phil Galewitz
Kaiser Health News
Originally published August 11, 2016

Despite dire warnings from Republicans and some large insurers about the stability of the Affordable Care Act exchanges, an Obama administration report released Thursday indicated the individual health insurance market has steadily added healthier and lower-risk consumers.

Medical costs per enrollee in the exchanges in 2015 were unchanged compared with 2014, according to the Centers for Medicare & Medicaid Services. In contrast, per-member health costs rose between 3 percent and 6 percent in the broader U.S. insurance market, which includes 154 million people who get coverage through their employer and the 55 million people on Medicare, the report said.

Aviva Aron-Dine, senior counselor to U.S. Health and Human Services Secretary Sylvia Burwell, said the data was encouraging when many insurers have announced double-digit rate increases for 2017 and others have pulled back in some states to curtail financial losses.

The article is here.

Tuesday, December 22, 2015

Common Violations

Parity Track
A website dedicated to inform about mental health parity.

Here are some of the most common ways your parity rights could be violated. Please keep in mind that not every possible parity violation is on this page.

1. I have a separate deductible for behavioral health services that is not part of my overall deductible.

2. My co-pay for behavioral health services is higher than it is for other health services.

3. I have limits on how many time I can see a behavioral health provider.

The website is here.

Friday, April 17, 2015

Instilling empathy among doctors pays off for patient care

By Sandra G. Boodman via Kaiser Health News
CNN website
Originally posted March 26, 2015

Here is an excerpt:

Clinical empathy was once dismissively known as "good bedside manner" and traditionally regarded as far less important than technical acumen. But a spate of studies in the past decade has found that it is no mere frill. Increasingly, empathy is considered essential to establishing trust, the foundation of a good doctor-patient relationship.

Studies have linked empathy to greater patient satisfaction, better outcomes, decreased physician burnout and a lower risk of malpractice suits and errors. Beginning this year, the Medical College Admission Test will contain questions involving human behavior and psychology, a recognition that being a good doctor "requires an understanding of people," not just science, according to the American Association of Medical Colleges. Patient satisfaction scores are now being used to calculate Medicare reimbursement under the Affordable Care Act. And more than 70 percent of hospitals and health networks are using patient satisfaction scores in physician compensation decisions.

The entire article is here.

Friday, April 10, 2015

Ethics of Money in Medicine

By Danielle Ofri
Physician, Writer, Editor


Here is an excerpt:

But this is just one example of unethical allocation of money in medicine. Much ado was rightly made last year when Medicare data showed a few doctors with unsavory and maybe illegal billing practices.  But for all the complaints about doctors’ salaries driving up healthcare costs, hardly anyone made a peep when that same data revealed that it is the salaries of the administrators and executives that are tipping the scales.

Nor did anyone so much as hiccup when it was reported that $455 million dollars was spent on TV ads since the Affordable Care Act was enacted, more than 90% of which was devoted to trying to destroy the ACA. We are so jaded about CEO salaries and the money swamp of politics that we hardly are hardly bothered when we see these statistics.

When I read about the $400 million was spent on TV ads to prevent uninsured Americans from getting health insurance, I was frankly disgusted. If people with deep pockets are really interested in improving our healthcare system there are far better ways to use that money. That handsome sum could have put several thousand nurses in clinics or schools. It could have sponsored medical school for 2000 students from underserved communities.  Heck, it could have purchase 6 million albuterol inhalers and handed them out. But no, the money was squandered on TV advertisements.

The entire article is here.

Tuesday, March 31, 2015

Mental health coverage unequal in many Obamacare plans

By Laura Ungar and Jayne O'Donnell
USA Today
Originally posted March 9, 2015

Insurance coverage for mental and physical illness remains unequal despite promises that Obamacare would help level the playing field, mental health advocates and researchers say.

A new study by the Johns Hopkins Bloomberg School of Public Health found that consumer information on a quarter of the Obamacare plans that researchers examined appeared to go against a federal "parity" law designed to stop discrimination in coverage for people with mental health or addiction problems.

This makes it nearly impossible for consumers to find the best plan to cover their mental health needs, the research suggests.

The entire article is here.

Friday, March 6, 2015

Medicaid, Morality and Mormonism

By Guest Blogger
The Cultural Hall Podcast
Originally posted February 26, 2015

Here is an excerpt:

Frequently I hear conservative Mormons counter these sorts of scriptures with an assertion that for us to be blessed for our charity, it has to be voluntary, not government mandated. In my opinion this line of thinking is not only flawed, but carries an inherent selfishness which is contrary to the spirit of charity. It clearly states that charity is about getting blessings for doing it, not about truly caring for those who need it, which I submit is a far greater betrayal of Christ-like concepts of charity than government compulsion is. Second, so many of the same people loudly using that argument are just as loudly asserting their right to legislatively mandate their concept of morality. It makes no sense that we are morally justified in imposing our morals when it comes to who can get married but not on using taxes dollars to care for the needy. I can’t speak for anybody else, but my marriage is infinitely more personal and sacred to me than my taxes are.

Even those who are stuck on LDS concepts of “self-sufficience” have nothing to complain about here. Healthy Utah is structured to include a work requirement (the most popular reason to prefer it to traditional Medicaid in the Dan Jones poll which shows Utahns overwhelmingly support the Governor’s proposal). This is not at all unlike LDS welfare programs which encourage doing our part to care for own needs (but also encourage helping those who need it).

The entire blog post is here.

Wednesday, January 21, 2015

Getting mental health services can be hard, despite law requiring parity

By Lisa Gillespie
The Washington Post
Originally published January 5, 2015

Even though more Americans than before have access to health insurance because of the Affordable Care Act, getting mental health services can still be challenging.

A report released in November concludes that despite a 2008 mental health parity law, some state exchange health plans may have a way to go to even the playing field between mental and physical benefits. The report, released by the advocacy group Mental Health America, was paid for by Takeda Pharmaceuticals U.S.A. and Lundbeck U.S.A., a pharmaceutical company that specializes in neurology and psychiatric treatments.

The report listed the states with the lowest prevalence of mental illness and the highest rates of access to care as Massachusetts, Vermont, Maine, North Dakota and Delaware. Those with the highest prevalence of mental illness and most limited access are Arizona, Mississippi, Nevada, Washington and Louisiana.

The entire article is here.

Thursday, November 13, 2014

Equitable Access to Care — How the United States Ranks Internationally

Karen Davis, Ph.D., and Jeromie Ballreich, M.H.S.
N Engl J Med 2014; 371:1567-1570
October 23, 2014
DOI: 10.1056/NEJMp1406707

Here are two excerpts:

According to a 2013 Commonwealth Fund survey of adults in 11 high-income countries, the United States ranks last on measures of financial access to care as well as of availability of care on nights and weekends. Uninsured people in the United States are particularly likely to report encountering barriers to care.

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The United Kingdom, France, Germany, Norway, Sweden, and Switzerland stand out as leaders in ensuring equitable financial access to care. Switzerland, which provides coverage through nonprofit private insurance plans with deductibles, ensures that cost sharing is lower for lower-income individuals. The United Kingdom, Norway, and Sweden have public health care systems for the entire population with little or no patient cost sharing and allow a limited role for private insurance. France has a public insurance system, and Germany has a social insurance system with competing private “sickness funds.”

Friday, October 10, 2014

Doctors Net Billions From Drug Firms

By Peter Loftus
The Wall Street Journal
Originally posted September 30, 2014

Drug and medical-device companies paid at least $3.5 billion to U.S. physicians and teaching hospitals during the final five months of last year, according to the most comprehensive accounting so far of the financial ties that some critics say have compromised medical care.

The figures come from a new federal government transparency initiative. The 2010 Affordable Care Act included a provision dubbed the Sunshine Act, which requires manufacturers of drugs and medical devices to disclose the payments they make to physicians and teaching hospitals each year for services such as consulting or research. The Centers for Medicare and Medicaid Services compiled the records into a database posted online Tuesday, though the agency said that about 40% of the payment information won't identify the recipients because of data problems.

The entire article is here.

Wednesday, September 17, 2014

Expansion of Mental Health Care Hits Obstacles

By Abby Goodnough
The New York Times
Originally published August 28, 2014

Here is an excerpt:

The new law is a big opportunity for mental health providers to reach more people of all income levels. But in Kentucky and the 25 other states that chose to expand Medicaid, the biggest expansion of mental health care has been for poor people who may have never had such treatment before.

Still, private providers face considerable headaches in taking on Medicaid patients, beyond the long-term deterrent of low reimbursement. Ms. Wright, for instance, is still waiting to be approved by some of the managed care companies that provide benefits to Medicaid recipients. Eager to build her client base, Ms. Wright has taken on a handful of new Medicaid enrollees for free while she waits for those companies to approve her paperwork.

“It’s been months and months,” she said. “It’s always there in my mind: Am I going to make it?”

The entire article is here.

Thursday, August 21, 2014

Thousands of Inmates in Illinois sign up for Obamacare for MH Treatment

By Rick Pearson
The Chicago Tribune
Originally posted August 4, 2014

Cook County Sheriff Tom Dart, attempting to cope with what he says is a growing mental health crisis among inmates at the county jail, said up to 9,000 people who have been incarcerated have signed up for health insurance under the Affordable Care Act in an attempt to get the care they need.

“Systemically, over the course of decades, we’ve sort of carved back all the mental health services to the point where there is this question, we’ve carved it back to next to nothing,” Dart said on “The Sunday Spin” on WGN AM-720.

The entire story is here.

Friday, July 11, 2014

Why haven't more states expanded Medicaid yet?

By California Healthline
www.philly.com
Originally posted June 26, 2014

Two years after Roberts issued the majority opinion upholding the Affordable Care Act, the decision to expand Medicaid is far from settled. Despite predictions that all states will eventually embrace Medicaid expansion, a significant number continue to hold out.

At last count, 26 states and the District of Columbia intend to expand Medicaid, while four are actively considering it and 20 have no plans to expand the program at this time.

The Medicaid expansion was considered the sleeper issue in the legal case against the ACA that ultimately made its way up to the Supreme Court. Stakeholders were closely watching issues like the constitutionality of the individual mandate, not thinking Medicaid would be significant. And yet, in a surprise decision, the Supreme Court effectively took the teeth out of one of the law's major efforts to expand health insurance, by making it illegal to penalize states for not participating in the Medicaid expansion.

The entire article is here.