U.S. women may be the big winners when it comes to healthcare reform, not only those who are uninsured, but those with insurance, researchers say. The report by the Commonwealth Fund, a U.S. non-profit group that conducts independent research on health policy, estimated once fully implemented, the Affordable Care Act would cover nearly all women, reducing the uninsured rate among women from 20 percent to 8 percent. Twenty percent of U.S. women—18.7 million—ages 19-64 were uninsured in 2010, up from 15 percent—12.8 million—in 2000, the report found.
One in five patients in Massachusetts is now under some kind of global payment. Blue Cross Blue Shield launched this experiment in Massachusetts in 2009. Michael Chernew, and a team of researchers at Harvard Medical School, recently took a look at what happened in the first two years. The 11 physician groups and hospitals that joined in 2009 and 2010 did a better job than physicians in traditional medical contracts of making sure that patients received standard check-ups, cancer screening tests and other preventive care. Overall they trimmed spending by just under 3 percent.
The U.S. Department of Justice and the inspector general in the Department of Health and Human Services are investigating Medicare billing practices at Vanderbilt University Medical Center. The probe, which was acknowledged by medical center officials, dates back several months and includes requests for extensive records for services provided to Medicare patients in the four intensive care units at Vanderbilt. Internal Vanderbilt memos reviewed by The Tennessean indicate the inquiry is focused on records showing when physicians were scheduled to staff the medical center's intensive care units.
Consider Maryland—a state that has been moving aggressively to implement the ACA since President Obama signed it in 2010. The state expects to hit all the federal deadlines to be ready to go in January 2014. An estimated 730,000 Maryland residents do not have health insurance, according to Joshua M. Sharfstein, M.D., secretary of the state's department of health and mental hygiene and chairman of the board the state created to implement its public exchange. Sharfstein expects half of those people will be insured under the ACA—half through commercial policies bought in the state exchange and half through Medicaid. Sharfstein also expects that the law will be a big net positive for the state's overall budget over the coming decade as it sharply reduces the cost of free care to the uninsured.
Gov. Rick Perry might have rejected the opportunity to run a state health insurance exchange outlined in the federal healthcare law, but that doesn't mean state agencies won't work closely with Washington regulators to offer Texans a way to buy insurance. Texas Health and Human Services Commission officials are waiting to hear from the U.S. Department of Health and Human Services about many of the details on how to proceed ahead of the planned rollout of the exchange in 2014, Goodman said. The Texas Department of Insurance is also expected to play a role but was characteristically tight-lipped about its involvement with the federal government.
A battle is brewing here in Florida, where Gov. Rick Scott took to national television soon after the ruling to announce that he would reject the expansion. Mr. Scott describes Medicaid as a dysfunctional program, saying the portion of the state budget devoted to it is growing at more than three and a half times the rate of general revenues. Hospital associations around the country have already signed off on cuts to reimbursement rates under the healthcare law on the assumption that the new paying customers they would gain, partly through the Medicaid expansion, would more than cover their losses.