Nasty charges of bribery. Senators cut off midspeech. Accusations of politics put over patriotism. Talk of double-crosses. A nonagenarian forced to the floor after midnight for multiple procedural votes. In the heart of the holiday season, Senate Republicans and Democrats are at one another's throats as the healthcare overhaul reaches its climactic votes. A year that began with hopes of new post-partisanship has indeed produced change: Things have gotten worse. Enmity and acrimony are coursing through a debate with tremendous consequences for both sides as well as for the legislative agenda in the months ahead. The toxic atmosphere is evident on the floor, on television talk shows, and in the hallways of the Capitol. Despite the fact that Democrats appear to have the 60 votes in hand to push through their legislation, Republicans say they intend to force a series of six procedural showdowns that would keep the Senate in session right through Christmas Eve.
Buried in the deal-clinching healthcare package that Senate Democrats unveiled over the weekend is an inconspicuous proposal expanding Medicare to cover certain victims of "environmental health hazards." The intended beneficiaries are identified in a cryptic, mysterious way: individuals exposed to environmental health hazards recognized as a public health emergency in a declaration issued by the federal government on June 17. And who might those individuals be? It turns out they are people exposed to asbestos from a vermiculite mine in Libby, MT. For a decade, Senator Max Baucus, Democrat of Montana, has been trying to get the government to help them. He is in a position to deliver now because he is chairman of the Finance Committee and a principal author of the healthcare bill.
It is no accident that three of Louisiana's best-known politicians have been at the center of the national healthcare debate. Last month, Anh Cao, the congressman who represents New Orleans, created a ruckus as the sole Republican to vote for the healthcare bill in the House. Shortly afterward, Senator Mary L. Landrieu, a Democrat, became a crucial vote in support of healthcare after winning $300 million in Medicaid aid for Louisiana, drawing loud criticism from Republicans for her deal-making. And the governor, Bobby Jindal, a former state secretary of health, has been one of the most prominent Republicans to offer an alternative proposal for a healthcare overhaul. Because of the unique way it delivers healthcare to the poor, a model that has a long history, Louisiana has a great deal at stake in the outcome of the debate in Washington, which could drastically alter the state's traditional system. Especially in light of the state's desperate need for investments in medical care in the years since Hurricane Katrina, Louisiana politicians of both parties are scrambling to make sure their priorities are addressed in the legislation.
Nearly 1 in 100 American 8-year-olds struggle with autism, Asperger's syndrome or a related developmental problem, according to a new study. The estimate is the highest to date of so-called autism spectrum disorders from the Centers for Disease Control and Prevention, which tracks health trends. The spectrum includes a range of disorders, from severe autism to milder forms like Asperger's to "pervasive developmental disorder," a nonspecific diagnosis given to many children with social difficulties or some kinds of learning and sensory problems. The finding is based on an analysis of medical and school records of some 400,000 children around the country; the researchers did not meet or interview the children. Prevalence estimates for these disorders have increased so sharply in recent years—to 1 in 150 in 2007, from 1 in 300 in the early 2000s—that scientists have debated whether in fact the disorder is more common, or diagnosed more often as a result of higher awareness.
Thirty million people without health insurance stand to gain coverage under a deal announced on Saturday by Senate Democrats. To get the 60 votes needed to pass their bill, Democrats scrapped the idea of a government-run public insurance plan, cherished by liberals, and replaced it with a proposal for nationwide health plans, which would be offered by private insurers under contract with the government. The legislation also includes a proposal that would limit insurance coverage of abortion. The provision, which was the last piece of the puzzle to fall into place, was negotiated by the Senate majority leader, Harry Reid, Democrat of Nevada, to win the support of Senator Ben Nelson, Democrat of Nebraska, who is an opponent of abortion. Under the agreement, states could choose to prohibit abortion coverage in the insurance markets, or exchanges, where most health plans would be sold. But if a health plan did cover the procedure, subscribers would have to make two separate monthly premium payments: one for all insurance coverage except abortion and one for abortion coverage.
An company that advises dozens of health insurers nationwide says the real problem with mammograms is radiologists who aren't reading them correctly. In response to a controversy last month, when a federal task force recommended against annual breast cancer screenings for women in their 40s, National Imaging Associates reviewed more than 400,000 mammograms. The issue, according to the task force, is that there are too many "false positives"—findings that women might have cancer, when, in fact, they do not. After an exhaustive review over the past few weeks, a high-ranking official at National Imaging—a unit of Magellan Health Services Inc., of Avon, CT—reached a different conclusion: Poorly performing radiologists are the root of the problem.
Maumee, OH-based St. Luke's Hospital is considering merging with another local hospital group—most notably Mercy or ProMedica Health System—as it continues to be shut out of lucrative insurance contracts, its chief executive says. The independent nonprofit Maumee hospital had an operating loss last year of $8.8 million, an amount based on the business of caring for patients that is expected to be even higher this year. Although it has upward of $70 million in reserves to keep it going, a merger or other arrangement may be necessary unless St. Luke's can negotiate better health insurance contracts with existing or additional insurance providers, said Dan Wakeman, St. Luke's president and chief executive officer.
Under a new law, effective July 1, healthcare facilities will be prohibited from forcing nurses and other healthcare workers to work beyond their scheduled shifts. Nurses and other medical professionals have been lobbying for such legislation for years. The new law is aimed at improving patient safety.
Alabama will get a $39.1 million "performance bonus" for expanding enrollment and improving access to healthcare for children through Medicaid and CHIP, HHS announced today.
The Christmas bonus represents more than half of the $72.6 million in bonuses to nine states that was included in the Children's Health Insurance Program Reauthorization law, which also sets performance goals that states must meet to qualify for a bonus.
The eight other states receiving bonus money are: Alaska ($789,000); Illinois ($9.1 million); Louisiana ($1.5 million); Michigan ($3.7 million); New Jersey ($4.2 million); New Mexico ($5.1 million); Oregon ($1.6 million); and Washington ($7.2 million).
States had to meet two performance goals under CHIPRA to get the bonus. First, they had to adopt at least five of eight listed program features—such as providing 12 months of continuous eligibility, using a joint application for both Medicaid and the CHIP, and streamlining eligibility renewal processes—that are known to encourage enrollment and retention of eligible children. States also had to document significant increases in Medicaid enrollment among children in the past year.
A short-term boost in Medicaid reimbursement rates authorized by the $787 billion American Recovery and Reinvestment Act also provided relief to states with weak economies, enabling them to extend care to eligible children.
Today's announcement follows the release of a study http://www.kff.org by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured, which credited ARRA and CHIPRA with enabling 26 states to expanded and/or simplified their Medicaid and CHIP programs in 2009.
CMS also released a letter to state health officials today with instructions on the criteria for qualifying for a bonus payment in future years.
Three home health agencies in New York City will pay nearly $24 million to settle whistleblower allegations that they billed Medicaid for medical services provided by untrained aides.
State and federal prosecutors say the three agencies used hundreds of home health aides who had received little or no required training to provide medical care for the city's elderly, frail, and indigent. As a result, Medicaid was billed for millions of dollars for services the aides were not qualified to provide.
New York's Medicaid program requires home health aides to complete a minimum 75-hour, supervised training program and be licensed by the Department of Health or the State Education Department.
"The size of this settlement underscores the seriousness of the allegations and the importance of vigorous oversight of the Medicaid program and the medical care of our loved ones," said New York State Attorney General Andrew M. Cuomo. "Being treated at home is an important option for many New Yorkers, and the companies that provide this service at taxpayer expense have an obligation to ensure that the healthcare workers they employ are qualified for the job."
The New York Attorney General's "Operation Home Alone" program has found statewide fraudulent practices and schemes by home health aides, the schools that purportedly train them, and the agencies that recruit and employ them. The investigation has found, for example, that some HHA training schools sold bogus HHA certificates to untrained people.
The investigation also settles allegations from two whistleblower complaints. Whistleblower Maurice Keshner will receive approximately $1.6 million from New York's recovery from Nursing Personnel. Whistleblower Deborah Yannicelli will receive approximately $994,080 from New York’s recovery from Extended and Excellent.
