health law

Two new reports from the Centers for Disease Control and Prevention shows the danger of overprescribing antibiotics and narcotics to patients, ProPublica reports. In ProPublica's interview with Dr. Thomas Frieden, the CDC's director, he said that attempts by government to address overprescribing don't attack doctors' autonomy: "We're not saying tell doctors what to do and not to do. We’re not saying treat this way. We’re saying make explicit your reasoning and set up your protocol, as long as it’s evidence-based. What we’re basically saying is we need to reduce unwarranted variability. So, come up with an algorithm, come up with a protocol, and then stick to it unless you have a valid and documented reason to depart from it. I don’t think that undermines physician autonomy at all. I think that empowers doctors to make a considered evidence-based decision on what their policy will be as a general rule and then to increase the likelihood that that policy is followed for all of their patients."

Millions of Americans are stuck in a health coverage gap created by the Supreme Court strucking down the Obamacare mandate that states expand Medicaid and the refusal of many states to voluntarily expand their existing Medicaid programs, The Wall Street Journal reported this week. The WSJ reports on one woman who earns $7,000 as a cleaner, which is too little to get help buying coverage on the healthcare insurance exchanges and too much to get coverage in Alabama's Medicaid program.

Twenty-four Republican-led states have declined the expansion, WSJ also reports. That might be changing in some states: "Some GOP-led states are revisiting their decision as complaints pile up over the coverage gap—and its consequences for businesses—in such states as Utah and Florida. The state senate in New Hampshire last week reached a tentative deal to expand Medicaid. In Virginia, newly elected Democratic Gov. Terry McAuliffe hopes to get legislators to reverse his Republican predecessor's stance against expansion," according to WSJ.

The Washington Post editorialized this week that Virginia should expand Medicaid because "people above and below them get help from other federal health-care provisions — and while Virginia’s citizens pay federal taxes to fund the coverage expansion but get none of those dollars back."

The Chicago Tribune reports on how a "little-known" provision in the Medicaid health-insurance expansion is going to increase the practice of the government asserting liens on patients' assets to recoup expenditures on medical costs: "The issue arises because of a provision in the long-standing laws governing Medicaid that compel states to recoup certain medical costs after a person dies, either via liens placed on an individual's home or claims on their assets." Liens are not asserted in private insurance policies bought on state-based insurance exchange.

The Tribune reports that new Medicaid patients could face liens even if they don't seek medical care: "In another twist, all new Medicaid patients in Illinois were placed into so-called managed-care programs, in which the state pays insurers on a per-member per-month basis. That means people like Rosato will be racking up health care costs even if they don't seek any medical care. In theory, that money could all come out of their estates once they die."

Some states, included Oregon and Washington, have tweaked their regulations to apply recovery efforts only to long-term care, The Tribune further reports. However, Illinois has not.

The Centers for Medicaire & Medicaid Services said it will provide guidance to states sometime soon.

Medical Economics reports that Health Insurance Portability and Accountability Act (HIPAA) is hindering the ability of healthcare providers to coordinate care, including with patients who want family and friends to have access to their health records: "According to a report in the January 22/29 Journal of the American Medical Association (JAMA), privacy and security regulations aren’t keeping up with the convergence of technology and an increased emphasis on care coordination." 

United Nations Special Rapporteur James Anaya said at a meeting earlier this month that one of the challenges for indigenous peoples' health is "how indigenous women living near oil, gas and mining operations are '"vulnerable to sexually transmitted diseases, including HIV/AIDS, which are often introduced with a rapid increase of extractive workers in indigenous areas,'" The First Perspective, Canada's source for news about indigenous peoples, reports. Anaya, who is the rapporteur on the rights of indigenous peoples, also noted the United Nations Declaration on the Rights of Indigenous Peoples requires "'in its articles 21, 22(1), 23 and 24 a framework for protecting and promoting indigenous peoples’ health. Together, these articles affirm indigenous peoples’ equal right to the 'highest attainable standard of physical and mental health' (art. 24); their right to improve their economic and social conditions (art. 21); and their right to 'determine and develop priorities and strategies for exercising their right to development' (art. 23)."

The Republican governor of Utah has announced an expansion of Medicaid, Huffington Post reports. Many Republican states have resisted the expansion of Medicaid under Obamacare as too expensive. But Governor Gary Herbert "pointed to the 60,000 individuals in the state who will gain coverage under the state's expansion of the program, saying it's 'not fair' to leave them without a solution," Huffington Post further reports.

The Medicaid expansion was a key part of ensuring that lower-income Americans, including many working poor, would get health-care coverage under the new mandate that all Americans have health insurance. But the U.S. Supreme Court said that the expansion could not be mandated to the states by the federal government. That has left it up to the states on whether they'll accept federal dollars to implement the expansions.

While only 24 percent of people purchasing health insurance through the federal exchange are between the age of 18 and 34 (which is 14 percentage points lower than what the law needs to keep premiums low), The Washington Post's Ezra Kkein reports that younger, healthier people tend to sign up only when the penalty is about to hit. This enrollment behavior happened when Massachusetts rolled out its state insurance exchange. " Obamacare's enrollment pattern looks a whole lot more like Massachusetts than I would've thought given the disastrous launch and the challenging political environment," Klein blogs. Open enrollment ends April 1.

The Washington Post reports on new data that shows that health spending, as a share of the economy, has shrunk. The Post further reports: '"There are two explanations,' says David Cutler, a Harvard economist who served as a health care adviser in President Obama's 2008 campaign. 'One is the recession was a big and drunken episode that has a very long hangover. The alternative view is that something big has actually changed.'"

The Inspector General of the U.S. Department of Health & Human Services has issued final safe-harbor regulations for payments and business practices related to electronic health records. Some of these payments and practices would otherwise implicate the federal anti-kickback statute. EHR Intelligence reports that federal regulators have extended the safe harbor until Dec. 31, 2021, with three goals: to incentivize the adoption of EHRs, align the date on which the safe harbor will sunset along with the ending of incentives for the meaningful use of such EHRs, and to provide protection against “'foreseeable future fraud risks.'”

As health-care expands in an effort to cover all Americans, the Medicaid expansion could mean that more people over the age of 55 will face liens being placed on their assets for their care, according to a report in BenefitsPro. "Washington and many other states, including California, Florida and New York, interpret the [federal] regulations to mean that they should use liens to try to recover any money spent by Medicaid on any care for people ages 55 and older, not just for long-term care specifically," BenefitsPro also reports. But regulators in Washington issued an emergency rule to limit lien recoveries only to Medicaid funds spent on long-term care in order to reduce a disincentive for people to sign up for health-care coverage, BenefitsPro concludes