Facing a deficit, Los Angeles County healthcare officials have unveiled a cost-cutting plan that calls for closing all but one of the county's dozen clinics and reduces services at its six comprehensive outpatient health centers. The proposal would dramatically retreat from the county's longtime role in providing primary care to the indigent. The clinics and comprehensive centers get about 400,000 primary care visits a year, nearly two-thirds from uninsured patients.
The federal government is proposing cuts to the Medicare and Medicaid programs, so now hospital organizations are lobbying to legislators and warning of cutbacks if the cuts are approved. Pennsylvania and New Jersey hospitals estimate that the proposed budget would reduce payments to hospitals in the two states by $8.4 billion over five years. Almost 50 percent of New Jersey's hospitals are already in the red, and the cuts would drive more hospitals in the state into bankruptcy, according to representatives from teh New Jersey Hospital Association.
Healthways Inc. has announced that it expects its pilot program to determine whether disease management lowers the cost of treating patients with chronic illnesses to meet specified performance targets. The move questions conclusions by Medicare that had caused Healthways stock to plunge.
Premiums for private health insurance plans in Massachusetts sold through the state are likely to rise an average of about 5 percent over last year's prices, according to a state memo. The 5 percent increase is roughly half as much as plans for people covered through their employers.
New York State Attorney General Andrew Cuomo has announced a sweeping investigation into whether health insurance companies have systematically forced patients to pay more than they should when using doctors and hospitals outside their insurer's networks. Cuomo said he intended to sue UnitedHealth Group as part of the investigation. The problem has existed for about a decade, potentially adding hundreds of millions of dollars to the out-of-pocket medical expenses of insured consumers nationwide, Cuomo added.
The latest news out of Missouri is that another state-led initiative to expand coverage for uninsured residents is about to fall by the wayside--an increasingly common trend on the healthcare reform front.
The program known as Insure Missouri was pushed through last year by Gov. Matt Blunt as a way to cover 200,000 Missourians, but is now facing stiff opposition because it goes too far, does too little, would cost too much or some combination of the three (depending on who you ask). The program would leverage existing federal matching funds against premiums paid into the system by individuals and small employers.
Initially the program would offer coverage to working parents and caregivers with children in families earning less than the federal poverty level. Later expansions would subsidize the cost of coverage for low-income working adults and offer a reinsurance plan for small employers. Coverage would be provided by managed care plans through the state's Medicaid program.
That the proposal is coming under fire is not surprising.
A few weeks ago, I wrote a column about San Francisco's legal battles to implement a program offering access to healthcare coverage for all city residents. Shortly after that column ran, I received this e-mail from a Missouri insurance regulator that offered some insight into that state's healthcare reform efforts.
"There's a lobbyist here in Jefferson City Missouri that's fond of comparing health insurance reform efforts to sticking your hand in a bag of rusty nails and broken glass. Legislators and regulators in Missouri recently stuck their hands in that bag. We haven't come up yet and we're already pretty cut up.
It seems to me that the ERISA/HIPPA/COBRA minefield is navigable, but it takes considerable expertise and experience. In Missouri, the bureaucrats (me) that have the expertise and experience couldn't make themselves heard by the legislators who desperately wanted to get a political victory on this issue. In addition, lawmakers in Missouri are term limited. There's just not enough time or capacity to adequately grasp every layer of complexity in our health coverage reform efforts. As a result, Missouri has a new law on the books that we can't implement or enforce without triggering prosecution from at least 4 federal agencies."
A key point in that e-mail is the reference to legislators lacking the necessary experience and expertise to adequately address the healthcare crisis. This problem is not limited to Missouri and seems to have been replicated in state houses across the nation. The problem, however, is not likely to be resolved anytime soon...kind of like the healthcare reform issue.
...And thanks for all the fish.
As an aside, this is my last column for Health Plan Insider. Les Masterson, editor of HCPro's Disease Management Advisor and the voice on the numerous audiocasts that have appeared in this space, will be writing a column for HPI beginning next week.
Brad Cain is editor of California Healthfax and executive editor for managed care with HealthLeaders Media. He may be reached at bcain@healthleadersmedia.com.