Friday, September 05, 2008

• About 85% of Insurers' Marketing Materials for Prescription Drug Plans Do Not Meet Medicare Guidelines, Audit Finds

 

About 85% of Insurers' Marketing Materials for Prescription Drug Plans Do Not Meet Medicare Guidelines, Audit Finds
[Sep 05, 2008]

      Nearly 85% of the marketing materials used by private prescription drug plans to reach Medicare beneficiaries do not fully meet CMS guidelines, according to a report released Thursday by the HHS Office of Inspector General, CQ HealthBeat reports. The report found that CMS provided the drug providers with faulty sample documents on which they were to base their marketing materials. The sample documents omitted information on the low-income subsidy program and some information about how the enrollment process works.

In addition, the report found that 79% of marketing materials for plans associated with specific pharmacy companies did not tell consumers that they could continue to get their medications from other pharmacies, and 42% did not inform consumers about how they could get their prescriptions filled if the usual mail order option was unavailable. According to CQ HealthBeat, some of the errors in the marketing materials were "relatively minor," including the wrong size font in footnotes (Armstrong, CQ HealthBeat, 9/4). The report found that some marketing materials failed to provide an alphabetical index of the drugs a plan covered (Freking, AP/San Francisco Chronicle, 9/5). The report also found a year-and-a-half delay by CMS to review many of the materials given to consumers in 2006 (CQ HealthBeat, 9/4).

Medicare officials said that many of the issues cited in the report "are not atypical during the initial start-up of a new program" (AP/San Francisco Chronicle, 9/5). CMS spokesperson Jeff Nelligan said, "CMS has generally already implemented the [OIG] recommendations," adding, "Oversight and review is focused on the requirements that are most critical to beneficiary understanding." The report found that CMS has since corrected the sample documents and has finished the review of many delayed marketing materials (CQ HealthBeat, 9/4).

Senate Finance Committee Chair Max Baucus (D-Mont.) said, "It's unconscionable that CMS has let the insurance industry's materials, including essential items like pharmacy directories and summaries of benefits, fail to properly inform seniors 85% of the time" (AP/San Francisco Chronicle, 9/5). He added, "This report reveals a near-total failure by CMS, where officials have insisted that they can regulate the marketing of plans to seniors as well as or better than experienced state insurance agencies," but the "evidence now shows that's not the case." Baucus in a statement said, "You'd better believe the Finance Committee will move to make sure seniors get better services one way or the other" (CQ HealthBeat, 9/4).

The report is available online (.pdf).

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Republican Presidential Nominee McCain Needs To 'Sell Voters' on Health Care, Other Economic Proposals, Dow Jones Reports
[Sep 05, 2008]

      Dow Jones on Thursday examined how Republican presidential nominee Sen. John McCain (Ariz.) "has his work cut out for him in trying to sell voters on his economic plan," including his health care proposal.

"Perhaps McCain's most radical proposal is a dramatic shift away from the way the majority of Americans get their health insurance through their jobs," as his health care proposal would eliminate "both the tax deduction that employers can take for offering coverage and the tax exclusion workers get for taking it" and replace "it with a tax credit that may encourage more people to buy coverage on the individual market," according to Dow Jones. The proposal would replace a tax break for employees who receive health insurance from employers with a refundable tax credit of as much as $2,500 for individuals and $5,000 for families for the purchase of private coverage.

According to Henry Aaron, a senior fellow at the Brookings Institution, although the employer-sponsored health insurance model has problems, McCain's proposal likely would lead employees to purchase less comprehensive coverage and pay higher out-of-pocket costs. He said, "It's important that people understand it would be a very different regime," adding, "I think the switchover would work dandy for my 24-year-old research assistant. It wouldn't work so well for the 50-year-old couple who may not be seriously ill but are still going to be medically underwritten and face significantly higher premiums." In addition, he said, "There are a host of uncertainties regarding a service I think most people regard as very fundamental" (Gerencher, Dow Jones, 9/4).

Efforts by Palin on Health Care Examined
The Washington Post on Friday examined how the fight that Republican vice presidential nominee Alaska Gov. Sarah Palin "has waged over competition in health care has been one of her signature efforts since she became governor in 2007" and "offers a look at how the little-known GOP vice presidential nominee would approach a complicated policy dispute."

As governor, Palin "inherited a vexing health care problem common to many states: whether to let small clinics compete freely against hospitals for such services as outpatient surgery and MRIs," according to the Post. "Palin and others think that more competition will reduce costs and lead to better care," but hospitals and others "counter that increased competition leads to higher operating costs in areas that are not directly related to health care, such as advertising, that are passed on to consumers," the Post reports. Palin "responded with an aggressive, uncompromising and, to date, unsuccessful push to promote competition -- an effort consistent with her free-market ideals but also welcomed by the medical groups that helped finance her 2006 campaign and an industry lobbyist who served as a top political adviser," the Post reports.

In her speech at the Republican National Convention on Wednesday, Palin said that she "took on the old politics-as-usual in Juneau" and fought special interests and lobbyists. However, "her efforts to reform health care reveal a more complicated picture," as she accepted more than $34,000 from "medical groups that were trying to spur competition" and worked "closely with Paul Fuhs, an Anchorage lobbyist who was helping imaging firms battle hospitals over control of a lucrative trade," according to the Post (Mosk, Washington Post, 9/5).

Broadcast Coverage
In a continuing series called "Meet the Joneses," ABC's "Good Morning America" looks at how the candidates' proposals would affect a California family. Friday's installment examines McCain's health care plan (Strathmann et al., "Good Morning America," ABC, 9/5).

American Public Media's "Marketplace" on Thursday included commentary from economist Glenn Hubbard. According to Hubbard, despite arguments by McCain and other Republicans, government must have a role in efforts to change the health care system (Ryssdal, "Marketplace," American Public Media, 9/4).

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Washington Post Examines Rhode Island Plan To Cap Medicaid Spending in Exchange for Greater Flexibility in Overhauling Program
[Sep 05, 2008]

      Rhode Island Gov. Donald Carcieri's (R) request to CMS last month for a waiver to set limits on state Medicaid spending has "alarmed" congressional Democrats and low-income advocacy groups who said the proposal would reduce access to nursing homes, raise out-of-pocket expenses for low-income families and limit eligibility and enrollment of residents in the program, the Washington Post reports. Carcieri said the request for the waiver was prompted by pressures of a "national economic downward spiral" and the need to address the rising cost of health care, which he called "the single largest expenditure of the state's budget."

The plan would limit the state's Medicaid contribution in 2009 to 23% of the state's general fund budget, or about $754 million. Federal spending would increase annually at a capped rate of 9.2%, which accounts for a 6.8% increase in annual health care costs and a 2.3% increase annually in enrollment, according to a Center on Budget and Policy Priorities analysis, the Post reports.

State officials estimated that under the plan, state and federal expenses for the program would fall short of projected needs by $231 million in 2009 and by $500 million in fiscal year 2013. To address the shortfall, the state's plan calls for more efficient delivery of health care services by increasing the number of in-home and community care service providers for seniors and the disabled, while lowering the dependence on more costly facilities like nursing homes.

The plan also would levy a premium on low-income families that visit an emergency department instead of a primary care physician; raise their copayments and premiums over the current federal limit; and limit their access to optional services and specific facilities through waiting lists and geographical location restrictions.

In the waiver request, Carcieri said, "The Medicaid waiver would allow the state to implement reforms to protect the long-term viability of the program as well as the individuals it services." A spokesperson said state officials are confident about a quick approval of the request.

However, some congressional Democrats "expressed concern" regarding the proposal, according to the Post. In a statement, Sen. John Rockefeller (D-W.Va.) said, "Medicaid provides a federal guarantee of health benefits for those in need, and that guarantee cannot be negotiated away through secret pacts between the Bush administration and governors seeking to cut Medicaid."

Jeff Nelligan, a CMS spokesperson, said the Bush administration is in discussion with Rhode Island officials "to reach agreement on an approvable proposal." The administration also offered to brief Senate Finance Committee Chair Max Baucus (D-Mont.), Rockefeller and other Democrats about the plan but a date has yet to be set, the Post reports (Montgomery, Washington Post, 9/5).

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California Gov. Schwarzenegger Might Veto Health Care-Related Bills
[Sep 05, 2008]

      California lawmakers last weekend approved several bills aimed at providing consumers protection against certain health insurer practices, but industry experts say the proposed changes still fall short of comprehensive health reform, the San Francisco Chronicle reports. Gov. Arnold Schwarzenegger (R) has until Sept. 30 to sign or veto the bills, but he has said he will not sign any bills until the state Legislature passes a budget, which is currently two months overdue.

While some of the bills' provisions are similar to elements of Schwarzenegger's attempted overhaul of the state health insurance system earlier this year, none of the measures is guaranteed approval by the governor, the Chronicle reports. Daniel Zingale, senior adviser to Schwarzenegger, said the Legislature did not make changes favored by the governor and altered bills in ways that might make him less likely to approve them. According to Zingale, Schwarzenegger supports a ban on the practice of balanced billing -- addressed by one of the bills -- but disagrees with the minimum physician payment rate provision included in the bill.

Legislation mandating that insurers spend 85% of premium revenue on patient care was part of Schwarzenegger's health care reform proposal, it is "unclear" if he will sign the measure because it does not include other provisions of his health care reform proposal, according to the Chronicle. Zingale said, "The governor has said in the past he didn't want to do this in piecemeal fashion."
In addition, Schwarzenegger likely will veto a bill that would establish a single-payer health insurance system in the state, as well as bills that would require health plans to provide maternity benefits and expand their coverage of mental illnesses (Colliver, San Francisco Chronicle, 9/4).

Senate President Pro Tempore-elect Darrell Steinberg (D-Sacramento) said, "We're going to need to make health care a bigger priority next year, because we obviously didn't come close to completing the work" (Rau, Los Angeles Times, 9/4).

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Kentucky Governor, Lt. Governor Promote Initiative To Simplify KCHIP Application Process
[Sep 05, 2008]

      Kentucky Gov. Steve Beshear (D) and Lt. Gov. Dan Mongiardo (D) this week are scheduled to make eight stops on a statewide tour to promote a plan designed to expand health coverage to more children under the Kentucky Children's Health Insurance Program by 2010, the Kentucky Enquirer reports. Beshear on Wednesday said that it is "shameful and shortsighted" that about 90,000 children in the state do not have health care, even though about 65,000 of them are eligible for coverage under KCHIP. About 55,000 children currently are enrolled in the program (Yetter, Kentucky Enquirer, 9/4). Beshear said the objective of the initiative is to make it easier for 35,000 more children to enroll in KCHIP by implementing several changes, such as eliminating an in-person interview, the Lexington Herald-Leader reports.

Other changes include employing 28 more staff members to process applications and providing more outreach for the program; developing a simpler application form and giving applicants time to provide missing information; training employees at federally qualified health care centers, no-cost clinics and health departments to help applicants; recruiting applicants through existing programs, such as no-cost and reduced-cost lunch programs; and sending postcards to parents of newborns with information about KCHIP.

The changes to expand enrollment, which will cost the state $31.1 million and require $81.3 million in federal funds over the next two years, will be implemented in eight weeks. At a meeting on Tuesday with the Herald-Leader editorial board, Beshear said the new measures also would reduce the state's expenses for chronic diseases, which account for a significant portion of the state Medicaid budget, and reduce residents' dependence on hospital emergency departments (Vos, Lexington Herald-Leader, 9/4).

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Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
[Sep 05, 2008]

      While mainstream news coverage is still a primary source of information for the latest in policy debates and the health care marketplace, online blogs have become a significant part of the media landscape, often presenting new perspectives on policy issues and drawing attention to under-reported topics. To provide complete coverage of health policy issues, the Kaiser Daily Health Policy Report offers readers a window into the world of blogs in a roundup of health policy-related blog posts. "Blog Watch," published on Tuesdays and Fridays, tracks a wide range of blogs, providing a brief description and relevant links for highlighted posts.

Insure Blog hosts the most recent edition of Health Wonk Review, a biweekly compendium of more than two dozen health policy, infrastructure, insurance, technology and managed care bloggers. A different participant's blog hosts each issue.

Thomas Miller on the Health Affairs Blog discusses a new paper that estimates the cost of covering the uninsured (here), saying that "some of the authors' assumptions and methods can be questioned," but they had to "maneuver through difficult statistical terrain" and "we know more than we did before." Based on the paper, Miller concludes that "there's just not much of a residual of implicitly subsidized health costs to be potentially picked up by shifting those costs to private payers of higher premiums."

Maggie Mahar of the Century Foundation's Health Beat Blog examines the consequences that an insufficient primary care system has on access to health services.

The Health Business Blog's David Williams argues that new mandatory minimum medical loss ratio legislation in California "won't achieve its goals."

The Health Care Blog's Joshua Seidman critiques state-managed consumer health sites for failing to use a patient-centered approach to design, saying such sites should "meet consumers' needs rather than try to convince consumers about what they should care about with respect to management of their health."

The Healthcare Economist's Jason Shafrin writes that although providing health insurance to uninsured children would increase the amount of care they receive, it will "likely not" equalize the number of well-child visits between insured and uninsured children because of demographic differences -- including income and education levels -- between the two groups.

Healthcare Manumission's John Joseph Leppard IV writes that Democratic presidential nominee Sen. Barack Obama's (Ill.) health plan "offers us no substantial departure, in theme, from the status quo ... but rather places his faith in the same tired themes of government expansion and influence."

Health Populi's Jane Sarasohn-Kahn discusses a study (here) from the Center for Studying Health System Change on hospital and physician price and quality transparency and concludes that "we're not 'there' yet" in part because current information isn't available to the public or "useful to them."

Paul Testa of the New America Foundation's New Health Dialogue discusses the Republican platform on health care and notes that while platforms are vague indications of legislation a candidate might propose, they give voters a glimpse of a party's "vision" for a policy issue.

Robert Gordon and James Kvaal on The New Republic's The Plank critique a Wall Street Journal opinion piece praising Republican presidential nominee Sen. John McCain's (Ariz.) tax proposals related to health care, arguing that they provide "no benefit" to middle-class Americans because the tax credit for health insurance "won't keep up with rising premiums over time" and because "for every dollar in tax cuts, there must be another dollar in tax increases."

John Geyman on Physicians for a National Health Program Blog discusses new health reform coalitions and their proposals, saying, the groups are "committed to preserving the private health insurance industry, and keeping single-payer national health insurance off the table."

Several bloggers commented on the selection of Alaska Gov. Sarah Palin (R) to be McCain's vice presidential candidate and her views on health:

• Cato@Liberty's Michael Tanner writes that "Palin's record should be considered limited but encouraging."
  
  
• Igor Volsky of the Center for American Progress Action Fund's Wonk Room discusses a council established by Palin that "promoted" consumer-driven health care.
  
  
• Health Care Policy and Marketplace Review's Bob Laszewski says Palin's "minor forays into health care policy could hardly be described as heavyweight attempts at health care reform. But both are consistent with the McCain market-based strategy to remake America's health care system."
  
  
• Joe Paduda of Managed Care Matters notes that health care in Alaska is among the most expensive in the nation and that the Commonwealth Fund ranked the state's children's health care in the bottom quartile.
  
  
• Jacob Goldstein of the Wall Street Journal's Health Blog reports that Palin proposed repealing Alaska's certificate-of-need program, which enables the state to regulate the construction of new health facilities.

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