health law

Several insurers who waited out the first round of health insurance applications through online exchanges are going to be selling policies through the exchanges next year, the New York Times reports. Even if insurers wait a year or two to enter the exchanges, they can still compete for customers because "people buying coverage in the individual market tend to be focused on price and may quickly switch plans if better deals become available," Larry Levitt, a Kaiser Family Foundation health policy expert told the Times.

An estimated $474 million in federal appropriations were spent on developing four state-level Obamacare exchanges that are "now in shambles," Politico reports. Massachusetts, Oregon, Nevada and Maryland now either have to move their residents onto the federal exchange or rebuild their systems, Politico further reports: "Nevada, for one, is still trying to figure out its future. Oregon has decided to switch to HealthCare.gov. Maryland wants to fix its own exchange, maybe by incorporating what worked in Connecticut. Massachusetts actually wants to do both — build a portal from scratch while planning a move to the federal exchange as a backup."

One of the main challenges to actualizing the promise of electronic health records in improving patient care is that they are developed as part of proprietary systems and are not always interoperable. FierceHealthIT asks if a $11 billion contract to develop electronic health records for the Department of Defense could "be a game-changer for healthcare in the United States due to its sheer size and scope." The system will integrate a commercial electronic health records system to cover the DoD's nearly 10 million beneficiaries, FierceHealthIT reports.

The Centers for Medicare and Medicaid Services has clarified that most of the rules of when liens are asserted by the government to recover the money spent on Medicaid health care for long-term care will apply to people who are getting Medicaid under the Affordable Care Act expansion, The Southern reports. States are entitled to asset recovery for all health care benefits, but CMS hopes that states will only impose liens and try to recover from estates for nursing home cases, The Southern also reports.

Separately, NJ.com reports that the "Affordable Care Act encourages states to expand their Medicaid rolls so single people and childless couples can now qualify if poor enough. That means thousands of newcomers to Medicaid may not realize that ultimately they may have to repay the piper."

The FBI is looking into the problems that led Oregon to scrap its problematic health insurance exchange, the Wall Street Journal reports. The exchange was never fully functional, WSJ adds. Oregon is joining the federal exchange instead: "The state will going forward join roughly three dozen other states and use the federal exchange, which itself suffered multiple setbacks in 2013 but has since mostly recovered," WSJ reports.

Government-funded scientists are connecting "terabytes of patient medical records" at 11 sites across the country, The Washington Post reports. The result would be possibly the largest repository of medical information in the country, containing the medical information of 26 million to 30 million Americans. The new repository also raises privacy and propietary concerns, presenting "tricky ethical questions about who owns and controls the data, how to protect patient privacy and how research questions will be prioritized," The Post also reports.

"'The raw data is not what is being shared. That remains with the institution that the patient trusts,' said Devon McGraw, director of the health privacy project for the Center for Democracy and Technology," The Post further reports.

The project arises out of a Affordable Care Act provision  to create an independent nonprofit to help doctors and patients make better-informed decisions about their care, The Post further reports.

Many more people are eligible for Medicaid under the Obamacare expansion: adults with incomes under 133 percent of the poverty level. Can the government recover the expenses paid out for these new Medicaid enrollees through liens on their properties and recoveries from their estates?

The Health Affairs blog reports on how the Centers on Medicare and Medicaid Services is advising states on applying liens to consumers who are getting Medicaid under the new expansion. Elderly Americans often get their long-term care paid through Medicaid, but there has been a concern that people "would voluntarily impoverish themselves, transferring assets to their children or to others to make themselves eligible for Medicaid," the blog reports. Medicaid can impose liens on people's houses and other assets to get that long-term care paid back. Now the questions is how the rules about liens should be applied to people who are newly eligible for Medicaid under the Obamacare expansion.

The first upshot, the blog reports, is that liens can't be placed on the property of new Medicaid enrolees. The second upshot is that CMS advises states to try to recover from the estates of new Medicaid receipients who receive long-term care, but not other types of care: "In sum, most of the rules that apply to traditional Medicaid recipients with respect to [long-term care services and supplies] LTSS (except for lien requirements) are likely to apply to [modified-adjusted gross income] MAGI-eligible individuals who receive LTSS.  CMS intends, however, to take steps to avoid applying estate-recovery rules to [modified-adjusted gross income] MAGI-eligible individuals who do not receive LTSS to keep this from becoming a barrier to Medicaid expansion eligibility."

The U.S. Supreme Court appeared split on whether private for-profit companies have to provide insurance coverage for contraceptives to their employees, even if it violates their owners' religious beliefs, the Christian Science Monitor reports. Swing vote Justice Anthony Kennedy "asked skeptical questions of both sides, but one interaction with US Solicitor General Donald Verrilli might signal trouble for the Obama administration’s position. Kennedy asked Mr. Verrilli whether the administration’s position might mean that for-profit corporations could be forced to pay for abortions for their employees regardless of any religious objections of company owners. 'No,' Verrilli said immediately. A federal law prohibits such a government command, he said. 'But your reasoning would permit that,' Kennedy persisted."

Electronic health records are being adopted by health care providers at an increasing pace, including due to incentives from the federal government. But "modern EHRs are often overly focused on data entry and typically provide poorly designed data displays with rudimentary functions for searching and organizing patient data. The data entry steals physician time away from direct patient care," Forbes reports. The Government Accountability Office has said the incentive program for EHRs doesn't have the ability to demonstrate that patient care is improved by EHRs, Forbes also reports.

Drug and medical-device companies are scaling back payments to doctors for promotional talks "as transparency increases and blockbuster drugs lose patent protection," ProPublica reports: "Eli Lilly and Co.’s payments to speakers dropped by 55 percent, from $47.9 million in 2011 to $21.6 million in 2012. Pfizer’s speaking payments fell 62 percent over the same period, from nearly $22 million to $8.3 million. And Novartis, the largest U.S. drug maker as measured by 2012 sales, spent 40 percent less on speakers that year than it did between October 2010 and September 2011, reducing payments from $24.8 million to $14.8 million."

The Physician Payment Sunshine Act, going to effect this year, is going to require all pharmaceutical and medical-device companies to publicly report payments to physicians, ProPublica reports.