The White House released information Monday about rates and offerings for the 2017 Affordable Care Act Open Enrollment.

Let’s block ads! (Why?)

Let’s block ads! (Why?)

The Environmental Protection Agency had the authority and information to issue an emergency order protecting residents of Flint, Mich., from lead-tainted water a full seven months before it did so, an EPA internal investigation has concluded.

“It is clear that EPA intervention was delayed,” the report from the EPA’s inspector general states. “These situations should generate a greater sense of urgency.”

By June 2015, the EPA regional office “had information that the city of Flint exceeded the lead level at which corrosion control is required, and that Flint was not using a corrosion inhibitor.” It also knew that testing showed high levels of lead in at least four homes. Finally, the regional office “knew that the state and local authorities were not acting quickly to protect human health.”

That is enough to issue an emergency order, the report says. Such action “could have required the city and state to provide alternative water supplies to affected residents, study the extent and severity of lead contamination within the water system, or immediately begin corrective actions to reduce and eliminate lead contamination in the drinking water system.”

And yet, the EPA did not issue an order until January 2016. According to the report, local authorities “believed that the state of Michigan’s actions to address the Flint situation barred formal federal action.” But that was incorrect – the Safe Drinking Water Act states that the EPA can take action if “state actions are deemed insufficient.”

The watchdog’s report concludes that the agency “needs to clarify for its employees how its emergency authority can and should be used to intervene in a public health threat.”

The EPA is among the people and groups under fire for the slow response to Flint’s lead-laced water. An independent task force concluded earlier this year that a state environmental agency called the Michigan Department of Environmental Quality bears primary responsibility, though others are also to blame.

The problem began when Flint switched to a new water source in 2014 for cost reasons. But water from that new source, the Flint River, was not adequately treated with corrosion controls and caused lead from the city’s pipes to leach into the drinking water supply. And as we’ve reported, the city switched back to its original water supply late last year, but it was too late to reverse the damage to the pipes.

The city is in the process of treating its water system and recent test results show that lead levels have improved.

High levels of lead are especially dangerous for children and can cause “learning disabilities, behavioral problems and mental retardation,” the World Health Organization said.

Catching up on the lead crisis in Flint? Our timeline takes you through how the public health disaster unfolded, step by step.

Let’s block ads! (Why?)

Rate hikes are likely on the way for insurance plans issued under the Affordable Care Act, health policy analysts say. Consumers’ out-of-pocket costs are expected to climb in 2017 and some major insurers have signaled they are pulling out of the health insurance exchanges in a number of states.

In a meeting Wednesday with reporters and representatives of groups working to increase enrollment in the health plans, Department of Health and Human Services Secretary Sylvia Burwell acknowledged that the Affordable Care Act’s fourth enrollment season — scheduled to begin Nov. 1 and run until Jan. 31 — is a pivotal time for the federal health law.

“Building a new market is never easy,” she told the group at HHS headquarters. “We expect this to be a transition period for the marketplace. Issuers are adjusting their prices, bringing them in line with actual data on costs.”

Burwell’s comments foreshadow the higher premiums expected when federal officials release details on the health plans to be offered on HealthCare.gov for 2017. Those details are likely to come just days before a presidential election that could determine whether the ACA is repealed or revamped.

While the health law hasn’t been a central issue in the current election season, it has been at the center of a bitter battle between political parties since it was passed in 2010. The House of Representatives has voted more than 60 times to repeal all or part of the measure. The law has survived some court challenges and faces others.

Burwell noted those fights Wednesday when talking about issues that arose in the law’s implementation. “It also hasn’t helped,” she said, “that at nearly every turn, we’ve had to overcome partisan attempts to repeal and undermine the law through legislation and litigation.”

Enrollment in the state and federal marketplaces is expected to grow by about a million people next year — from about 12.7 million to 13.8 million, according to federal estimates released Wednesday. The number of consumers who actually pay premiums and stay in the market is expected to average about 10.5 million per month in 2016 and about 11.4 million per month in 2017.

Consumers flow in and out of ACA plans because they change jobs, get coverage from other sources and face other factors that affect where and how they enroll in health insurance, including affordability. About 9.2 million of the 13.8 million people who now have ACA coverage are expected to reenroll, according to HHS.

This year, Burwell said, health officials working to increase insurance coverage among the uninsured are intent on making the enrollment process faster and simpler, and will particularly focus on signing up healthier consumers – including people between the ages of 18 and 34, who tend to have fewer ailments. They will also remind consumers of the penalty for not having coverage, which for adults in 2016 is $695 or 2.5 percent of income, whichever is higher. The flat penalty will be adjusted for inflation in 2017.

Federal officials are also focusing enrollment efforts on the 5.1 million Americans who are eligible to purchase health care coverage on the exchanges but buy it elsewhere, according to HHS figures. Of that group, 2.5 million people could be eligible for the law’s financial assistance if they sign up for coverage during open enrollment, which ends Jan. 31.

The outcome of the November elections may well determine the future of the ACA. Republican presidential nominee Donald Trump has promised to repeal and replace the law, while Democratic nominee Hillary Clinton has said she wants to fix the law, making it more affordable for consumers who don’t qualify for subsidies, yet struggle to afford coverage.

Burwell called on Congress to work with her and the Obama administration to make needed changes to the law. “To make more substantial changes — like a public option to encourage competition — we’ll need cooperation from Congress,” she said. “And we are hopeful that soon, we’ll see more bipartisan efforts to make improvement.”

Bipartisan cooperation isn’t likely to happen until the next Congress meets, if then. Much will depend on the outcome of the presidential and congressional elections – on who is in power and whether GOP leaders think the ACA is still a potent political issue, as well as on how willing Democrats are to make changes that appeal to Republicans.

Mary Agnes Carey reports for Kaiser Health News, an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Let’s block ads! (Why?)

The Affordable Care Act prohibits insurers from discriminating against people with serious illnesses, but some marketplace plans sidestep that taboo by making the drugs that people with HIV need unavailable or unaffordable, complaints filed recently with the Department of Health and Human Services’ Office for Civil Rights allege.

The effect may be to discourage people with HIV from buying a particular health plan or getting the treatment they need, according to the complaints.

The complaints – brought by Harvard Law School’s Center for Health Law and Policy Innovation – charge that plans offered by seven insurers in eight states are discriminatory because they don’t cover drugs that are essential to the treatment of HIV or require high out-of-pocket spending by patients for covered drugs.

The center filed complaints against Humana plans in six states: Alabama, Georgia, Illinois, Louisiana, Tennessee and Texas. Cigna plans were targeted in three states: Georgia, Tennessee and Texas. The group filed complaints against five other insurers: three in Pennsylvania, including Highmark, Independence Blue Cross and UPMC Health Plan; a complaint against Community Health Choice in Texas and a complaint against Anthem Blue Cross Blue Shield in Wisconsin.

“What’s most important to us is that there’s a robust enforcement mechanism around the promises … in the [Affordable Care Act] and its regulations, especially the anti-discrimination provisions,” said Kevin Costello, director of litigation at the health law center.

Although the center’s focus is on HIV drugs, the complaints may help people with other chronic illnesses who may face similar hurdles on access to drugs, Costello said.

The HHS Office for Civil Rights investigates and enforces violations of civil rights and health information privacy. The Harvard center complaints were filed in September.

Federal rules prohibit marketplace plans from adopting benefit designs — such as coverage rules or reimbursement rates — that discriminate based on age, illness, race, gender or sexual orientation, among other things. But federal regulators have declined to define discriminatory plan design, noting that they will examine the facts on a case-by-case basis.

They’ve hinted, however, at some specifics in the regulations. They say, for example, that refusing to cover a single-tablet drug regimen, which is often associated with better compliance because a number of different drugs are combined in one pill, or placing most or all of the drugs that treat a specific condition in the highest cost tiers are examples of “potentially discriminatory practices.”

Working with local AIDS groups in several states, the Harvard center examined hundreds of silver-level plans sold on the marketplaces to gauge whether their formularies would allow access to six treatment regimens that are the current standard of care for treating people who are newly diagnosed with HIV. In addition, they looked at the plans’ cost-sharing requirements, Costello said.

They found, for example, that this year Anthem silver plans in Wisconsin cover only four of the 16 drugs or combination products that are recommended to meet the current standard of care, and they fail to cover any single-tablet regimens. In Illinois, the center charged that Humana’s silver plans place 16 of the 24 most commonly prescribed HIV drugs in the highest cost-sharing tier, which requires patients to pay 50 percent of the cost. With estimated monthly costs ranging from $377 to $684 for different drug regimens, enrollees in the Illinois Humana plans would have to pony up between 8 and 14 percent of their average monthly income, according to the complaint.

“All Humana health insurance plans offered through the Health Insurance Marketplace fully comply with state and federal laws and regulations,” said Alex Kepnes, Humana’s director of corporate communications. He added, “Humana shares the concerns of HIV/AIDS organizations regarding the high cost of HIV/AIDS drugs and we are committed to working with them to lower prescription drug costs.”

Similarly, Anthem spokesman Scott Larrivee said, “Anthem Blue Cross and Blue Shield is committed to providing all of our members with access to the care and services they need, including appropriate coverage of medications for the treatment of HIV/AIDS. Anthem Blue Cross and Blue Shield in Wisconsin covers more than a dozen medications for the treatment of HIV/AIDS and all required therapeutic drug categories are included on our formulary/drug list which is compliant with (marketplace) requirements.”

Cigna spokesman Mark Slitt said his company doesn’t comment on pending legal matters.

The center’s work builds on an earlier discrimination complaint filed in 2014 with the Office for Civil Rights by two advocacy groups, the AIDS Institute and the National Health Law Program, against four Florida insurers that were selling marketplace plans. That complaint, against some of the same insurers highlighted by the Harvard center, charged that the insurers placed all the HIV drugs in the highest cost-sharing tier. The Florida insurance commissioner reached agreements with the four plans to move the HIV drugs to generic tiers and reduce cost sharing, and the same arrangement will continue in 2017, said Carl Schmid, deputy executive director of the AIDS Institute.

“We’ve been talking about these issues for years now,” Schmid said. “These things need to be addressed, and it could be through enforcement” by the Office for Civil Rights.

Marketplace coverage of drugs to treat HIV and other serious conditions have improved somewhat in recent years, according to research by Avalere Health, a consulting company. An analysis found that in the case of five classes of drugs that treat cancer, HIV and multiple sclerosis, fewer silver plans in 2016 placed all the drugs in the class in the top tier with the highest cost sharing or charged patients more than 40 percent of the cost for each drug in the class.

Speaking about HIV drugs, Caroline Pearson, a senior vice president at Avalere, said that while access and costs in marketplace plans are improving, they vary widely from plan to plan. Employer plans tend to offer better coverage, she said.

The new complaints may put more pressure on the Office for Civil Rights to address this issue, said Katie Keith, a steering committee member for Out2Enroll, a health insurance advocacy group for the lesbian, gay, bisexual and transgender community.

“It’s smart to do this in multiple states,” she said. “People are really pushing for more concrete guidance.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

Let’s block ads! (Why?)

Nearly 1 in 5 children each year suffers a psychiatric illness, according to research estimates. But a national shortage of medical specialists and inpatient facilities means that many still go untreated — despite national efforts to improve mental health care.

New research is driving home the consequences. Scientific abstracts presented Monday in Las Vegas, at the annual meeting of the American College of Emergency Physicians, offer insights into how frequently patients with mental health issues land in the emergency room — often because opportunities to intervene earlier are missed. Pediatricians and child psychiatrists say children are among the hardest hit.

The researchers analyzed data compiled by the National Hospital Ambulatory Medical Care Survey, which tracked mental health visits to hospital emergency departments between 2001 and 2011.

Compared with physically ill patients, people with mental health conditions rely more on the emergency department for treatment and are more often admitted to the hospital from the ER, the scientists found. Also, they tended to be stuck in the ER longer than people who show up in the ER with physical symptoms.

Specifically, the researchers found that about 6 percent of all the emergency department patients — of all ages — had a psychiatric condition. More than 20 percent of these psychiatric patients were admitted to the hospital, compared with just over 13 percent of the medical patients. About 11 percent of these patients with mental health problems required transfer to another facility, compared with 1.4 percent of the patients with physical ailments.

About 23 percent of mental health patients stayed in emergency care for longer than six hours, and about 1.3 percent for more than 24 hours. Only 10 percent of medical patients were under treatment in the ER for more than six hours, and just half a percent were there for more than 24 hours.

The researchers have not yet determined the distribution of ages among the patients in their study who came to the ER because of mental health symptoms. Anecdotally, though, ER patients with psychiatric problems tend to include more children and elderly patients than you’d expect to see based on the age range of the general population, says Suzanne Lippert, a clinical assistant professor in emergency medicine at Stanford University and lead author on the study.

The findings highlight what can happen when patients can’t find good outpatient treatment for mental health problems, Lippert says. The evidence also underscores, she says, that when psychiatric patients arrive at the ER in a crisis, there is often no good place where they can continue treatment, once the immediate issue has been addressed.

Patients who come to the ER because of physical ailments can usually be sent home, Lippert says, “because we know they’ll be evaluated by [their] doctor in one or two days.” But psychiatric patients don’t always have that option because of gaps in the mental health care system.

And young patients may be affected the most, says Dr. Steven Schlozman, a research psychiatrist at Harvard Medical School and associate director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital. He was not affiliated with the research.

“It’s a numbers game,” Schlozman says. “Unless you live in a large urban area, you’re very unlikely to find a child psychiatrist.”

Lippert’s study found that the most severely ill psychiatric patients typically spent more time in the ER. Patients with bipolar disorder, depression or psychosis and those diagnosed with multiple conditions were more likely than others to be held in the ER longer than 24 hours.

A national shortage of inpatient beds for psychiatric patients is part of the problem, Lippert says. She has seen patients have to wait longer than a week to get the inpatient treatment they need.

Such delays in cramped, overused emergency quarters hurt patients, says Dr. Thomas Chun, an associate professor of emergency medicine and pediatrics at Brown University. Doctors often agree a child needs to be transferred, he says, only to find no outside beds available.

“We are the wrong site for these patients,” says Chun, who was not involved in Lippert’s study. “Our crazy, chaotic environment is not a good place for them.”

Meanwhile, the young patients are even less likely to get reliable care after they are discharged from the ER. Whether they need regular follow-up with a psychiatrist, or a transfer to specialized facility, the resources often aren’t in place. The American Academy of Child and Adolescent Psychiatry estimates there are only 8,300 such specialists in the U.S., for more than 15 million young patients.

Dr. Lindsay Irvin, a pediatrician in San Antonio, says the dearth of psychiatrists who specialize in treating young people means many young patients simply don’t get the mental health treatment they need. By the time they wind up in the ER, she says, undiagnosed depression may have progressed to suicidal intent. And after leaving the ER, many are lost to follow-up.

“They’ll land in a pediatric or family practice,” Irvin says, where most primary care doctors haven’t been trained “to navigate the ins and outs of psychotropic meds.”

Lippert and her colleagues also found that the emergency psychiatric patients were more likely to be uninsured than medical patients were. About 22 percent of mental health patients lacked coverage, versus 15 percent of patients treated for physical conditions.

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Let’s block ads! (Why?)

Skyrocketing prices for essential medicines like the EpiPen, are generating public outcry, congressional hearings and political promises for policy fixes. In the meantime, the increases continue to hit pocketbooks — even of people who don’t rely on these expensive drugs. In a state like West Virginia, where dire budget shortfalls have been a problem over the last few years, the problem is especially pronounced.

Kimberly Earl, of Charleston, W.Va., is feeling the pinch. She has four children, all of whom need medication.

“I have a 13-year-old who’s a pediatric cancer survivor,” she says. “I have two children who are allergic to foods, medication and environmental factors, and both of those children both have asthma.”

Last year, two of her children needed new EpiPens — which come in a 2-pack. (The dose of epinephrine each pen delivers is designed to be used in an emergency, to stop a severe allergic reaction.) The Earls have private health insurance, but had yet to meet their $10,000 family deductible for 2015. They didn’t have enough money for two boxes of EpiPens at the $600 price — even with a $100 discount from the drug’s manufacturer. So the family improvised.

“We took the pens and we split the two pens between two kids,” Earl explains. “I actually took the pens out and wrote on the top — ‘use this one first’ on the current pens, and ‘use this one second’ on the expired pens. So each kid was walking around with one current pen and one expired pen. And we were just hoping that if there was an issue they wouldn’t have to use that second pen.”

While Earl paid for the drugs out of pocket, about a third of West Virginians are insulated from these direct costs because they are covered by Medicaid. The state expanded Medicaid under the Affordable Care Act, giving lower-income people the government-sponsored insurance. Most Medicaid patients don’t have premiums or copays.

But in the end, rising drug prices affect everybody in West Virginia. When lawmakers consider the state’s budget, they only have so much revenue to divvy up among priorities that include health care services, roads and schools, says Dr. James Becker, the medical director of Medicaid in West Virginia.

“So when the cost of a drug goes up dramatically,” he says, “that impacts our system and we have to step in and make adjustments to regulate the drug appropriately.”

The West Virginia Department of Health and Human Resources can regulate the cost of drugs by negotiating lower prices through the federal rebate program. The rebate program is a complex system, but basically comes down to this: The more Medicaid patients enrolled in the program, the more bargaining power the government has to make drug companies lower their prices. Another way Medicaid manages costs is by including older, cheaper, but still effective drugs in its formulary, rather than relying on more costly new brands.

But even with these measures, the overall increase in the price of medications has forced some shifting of funds in other parts of the state budget, says Ron Stollings, a Democrat and state senator from Boone, W.Va.

“Certainly for Medicaid funding in West Virginia, [the hike is drug prices] is a huge cost,” says Stollings, a former chairman of the state senate’s health committee. “So when we have to put money into funding Medicaid, we have to cut funding for higher education and secondary education; we have to put off paving projects, etc.”

Stollings says these rising Medicaid costs — partially due to higher drug costs — fall on the taxpayer, who may end up paying more state taxes to fund the budget.

“If you’re a taxpayer, it impacts you,” Stollings says. “If you’re an insured person it will impact your premiums, and if you are on Medicaid you may get this expensive medication, but they may be ratcheting down coverage for other things.”

Medicaid is a large portion of the West Virginia’s budget, right behind public education. And it will probably get even bigger next year, as the state picks up more of the Medicaid expansion costs from the federal government.

This story is part of a reporting partnership with NPR, West Virginia Public Broadcasting and Kaiser Health News.

Let’s block ads! (Why?)

Let’s block ads! (Why?)

Women are less likely to die of breast cancer than they were a decade ago, but not all women are benefiting from that trend.

White women saw more of a drop in death rates than black women — 1.9 percent a year from 2010 to 2014, compared to a 1.5 percent decrease for black women, according to a report published Thursday by the Centers for Disease Control and Prevention.

And while the death rates for women under 50 declined regardless of race, older black women are more likely to die of breast cancer than are white women.

That’s especially troubling because 40 years ago, black women were less likely to get breast cancer. That’s changed. Black women’s breast cancer risk is now the same as that of white women’s, and black women are 41 percent more likely to die of the disease.

There can be some good reasons for the rise in the number of black women being diagnosed with breast cancer, like more women getting screening mammograms. But there are bad reasons, too.

The CDC report cites calorie-dense foods, lack of exercise and increasing rates of obesity as potential reasons.

And while this report found similar reductions in deaths among younger black and white women, older white women saw their death rates drop by 2 percent a year, compared to 1 percent in black women.

Access to care is one big reason why, according to Otis Brawley, chief medical and scientific officer for the American Cancer Society.

“Forty to 50 percent of black women get less than optimal care for breast cancer, whether it’s mammography or treatment,” Brawley says.

They’re not alone in that; poor white women are also much less likely to get adequate care, and more likely to die as a result.

“We need to focus on getting good care, high-quality care to everybody,” Brawley adds. “We need to realize that in the United States of America in 2016 a substantial proportion of Americans with cancer get absolutely atrocious care.”

Let’s block ads! (Why?)

When doctors want to help untangle confusing and sometimes contradictory findings in the scientific literature, they often turn to specially crafted summary studies. These are considered the gold standard for evidence. But one of the leading advocates for this practice is now raising alarm about them, because they are increasingly being tainted by commercial interests.

For many years, these studies — called meta-analyses and systematic reviews — seemed to solve a big problem. Doctors who had once relied on each other’s expert opinions to select the best treatments gradually turned to careful scientific studies instead.

But the number of studies mushroomed and often came to different conclusions. So in the 1990s, doctors and medical advisory committees started relying on studies that combined results from many different research projects to streamline the search for answers.

These kinds of studies are “extremely important,” says Dr. John Ioannidis, a professor of medicine health research and policy at Stanford University. He has conducted many of these types of studies over the course of his career. “They’re trying to make some sense out of a very convoluted scientific and medical literature.”

But Ioannidis says unfortunately things have gotten out of hand. First, “the problem is that there are just too many meta-analyses,” Ioannidis says.

In a recent study on the subject, titled “The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-Analyses,” he chose as an example studies involving antidepressant drugs. “There are 185 of them published in the literature within seven years, which means about 25 of them published every year for the very same drugs and the very same indication, major depression,” Ioannidis said.

What’s worse, they’re increasingly being generated by scientists who have financial interests in the outcome, Ioannidis found.

“About 80 percent of them have been funded or have some other conflicts of interest with manufacturers of these drugs,” he says. “If you look at what their conclusions are, those that have been authored by industry employees, practically all of them, with one exception, have claimed that there are no caveats about antidepressants.”

You have to read deep into the studies to find warnings about potential suicide risks, for example — if downsides are mentioned at all.

That’s potentially misleading to doctors who turn to this kind of analysis to get a quick take on what works and what doesn’t. Ioannidis says the drug industry has started using meta-analysis for commercial purposes, rather than as a disinterested look at the evidence.

“They can get the results or at least the interpretation that fits their needs. So you have the most powerful and most prestigious design in current medical evidence, and it can be easily manipulated as an advertisement, as a marketing tool.”

And that defeats one of the main purposes of these studies, which is to make an overflowing scientific literature more manageable.

Peter Kramer, a clinical professor emeritus at Brown University and author of Listening to Prozac, took a deep dive into meta-analyses when he was writing his latest book, Ordinarily Well. He found the situation even worse than Ioannidis suggests.

“In some ways my doubts are stronger than his,” Kramer told Shots.

Some analyses he looked at were trying to parse very subtle differences — for example, comparing two very similar antidepressants. You could get any answer you want, depending on how you set up the study, Kramer says.

And the problems he found aren’t simply commercial conflicts of interest. For example, he saw biases among academics who were wedded to the notion that placebos are just as good as actual drugs for depression.

“Even on that side of the equation, where there’s no adverse sponsorship but just an allegiance to an idea, I thought it wasn’t always the case that everybody’s hands were on the table,” Kramer said.

But financial conflicts are easier to identify. Five years ago, the National Academy’s Institute of Medicine (now called the National Academy of Medicine) suggested dozens of standards that should apply to systematic reviews of the research literature.

The influence of funders is a concern, says Dr. Alfred Berg, a professor emeritus of family medicine at the University of Washington who chaired one of the committees.

“If there’s obvious sponsorship from an organization that might have a conflict of interest, that’s probably not a good idea,” he says. It’s reasonable to suggest that scientists with clear financial conflicts of interest should not be producing these studies. “Is it going to happen in my lifetime?” Berg says. “Probably not!”

Pfizer, one of the many drug companies that fund meta-analyses involving their own products, declined an interview request. But the company noted in an emailed statement that the drug company “shares data from its clinical trials with outside members of the research community for them to conduct their own independent meta-analyses.”

Fortunately, scientific journals are starting to do a better job of making sure researchers disclose their financial interests. It’s up to readers now to take heed.

Let’s block ads! (Why?)