HBO's The Wire Should Highlight Maryland's Health Care System

As outreach efforts intensify in the last three weeks before Open Enrollment on state healthcare marketplaces, many states worry that their uninsured populations won't receive the message.  Maryland is one state that worries about whether it can successfully enroll its state's 800,000 uninsured residents.

One of the main issues reaching Maryland's uninsured is the lack of available data to help state officials locate those residents. In an effort to change this, officials are using "upgraded electronic health records to develop maps highlighting where Marylanders overuse emergency rooms for care -- one indicator of the uninsured -- or where pockets of disease develop."  (Baltimore Sun, 9/7/13.)  While census data can identify concentrations at the city and county levels, this improved data will provide more targeted information that will help identify demographics down to the community level.

[dhmh.maryland.gov]

Once communities with high numbers of uninsured are identified, state and community health leaders plan to target "pharmacies, grocery stores, and street festivals" to find those in need of care and inform them of their options.

This new data is important because enrollment in Medicaid under health care reform's expansion allowance could make or break the success of the new law which requires high levels of enrollment in order to succeed. New data identifying smaller pockets of uninsured will make targeted education efforts possible, which may, in turn, generate enrollment.

[deathandtaxesmag.com]

With all these changes and data challenges afoot, perhaps Maryland's health care system would make a fascinating theme for The Wire, should producers decide to shoot an encore season.  It may be yet another way to educate communities about burgeoning health care options. And I'm sure its 4 million viewers wouldn't be disappointed, either.

Friday Variety: College Student Healthcare, An Arizona Law Bites the Dust, & Texas and California Agree on ACA

So Many Health Plans for College Students

Under the ACA, college students have many health plans to choose from.  First, if you're under 26 years old, the law allows you to stay on your parents plan if they have health insurance that offers coverage for family members.  Whether you're financially independent, single, or married, a person under 26 can stay on their parents' plan.

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Second, students can elect to purchase a health plan offered by their college.  However college students should be aware that self-insured schools -- that is, schools who who pay claims directly, instead of hiring an insurance company to do so -- do not have to meet the ACA's essential benefits requirement that otherwise mandates health plans to provide the full menu of "essential" health benefits.

Third, recent federal government regulations clarified that even if students who are eligible for student health plans at self-insured schools, they may still qualify for subsidized coverage on a state Marketplace, or exchange. Coverage purchased on the exchange would start in January, however, so college students would need to obtain coverage elsewhere for the Fall 2013 semester.

Finally, an even lower-cost option for college students may be Medicaid - the federal-state insurance program for low-income people.  Prior to the ACA, Medicaid coverage was reserved for children, pregnant women, and people with disabilities. However since the passage of federal healthcare reform, some states have expanded Medicaid coverage to include low-income adults, including college students.

Arizona Cannot Cut Planned Parenthood out of its Medicaid Program

The 9th Circuit struck down struck down an Arizona law that attempted to bar Medicaid patients from receiving care from medical providers who perform elective abortions, such as Planned Parenthood. The three-judge panel ruling was unanimous.

Texas and California Agree: Long Live the ACA

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Elected officials from both Texas and California traveled throughout their respective states yesterday to tout the ACA.  Rep. Lloyd Doggett (D-TX) sang the ACA's praises to constituents in East Austin.  Doggett also took time to criticize Texas Senator Ted Cruz for his attempts to defund the law.

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Simultaneously, CA Sen. Barbara Boxer spoke to a health center in North Hollywood about the importance of spreading the word about the ACA.  She emphasized that insuring CA's 7 million uninsured residents will have a big effect on the success of the law.  "California is key." Boxer said.  "As California goes, I think so goes the Affordable Care Act."

Friday Variety: The Uninsured Gap, Veterans' Mobile Health, & (of course) Abortion

The Uninsured Gap

In the 27 states that have not committed to expanding Medicaid, many individuals and families could fall into a health insurance "black hole" where coverage would continue to be unaffordable.  In those states, individuals or families whose income amounts to 99% of the federal poverty level would not be eligible for Medicaid or premium subsidies on their state health insurance exchange. However individuals or families making 101% of the federal poverty level would be eligible for those premium subsidies that would make purchasing health coverage more affordable. 

According to a new analysis by the Kaiser Commission on Medicaid and the Uninsured, about 6.4 million people will be uninsured next year, unless those 27 states change their minds and agree to expand Medicaid coverage.  Nearly 2/3 of the uninsured live in 21 of the states that are not expected to expand as of January 1, and the six states that are on the fence.  The Kaiser Commission analysis reported that 55 percent of the uninsured live in Texas, Florida and Georgia alone.

Veterans' Mobile Health

The Department of Veterans Affairs has begun "testing the viability and potential of mobile health technologies after launching several pilot projects," according to Healthcare IT News. One such pilot is a Veteran Appointment Request App.  The App offers approximately 600 veterans the ability to request primary care and mental health appointments from their computer or mobile device.

Additionally, the Family Caregiver pilot is offering iPads to 1,000 caregivers of serious injured veterans of the Iraq and Afghanistan wars enrolled in the program.

Abortion Rights Groups to Challenge Texas Bill

On Thursday, Texas Governor Rick Perry signed the controversial abortion bill into law.  The law includes some of the nation's toughest restrictions on abortion, effectively forcing the closure of all but 5 of the state's 42 abortion clinics, unless those clinics can can upgrade their facilities within a year after the law takes effect this October.

Opponents of the bill may file a lawsuit against the state of Texas to stop the implementation of the law.  Executive Director of the Texas ACLU, of of several organization considering a legal challenge to the bill, stated, "There are no decisions about litigation, but I think that maybe the course we have to follow."

According to Planned Parenthood v. Casey, the Supreme Court case that followed Roe v. Wade, state laws cannot erect substantial obstacles to women seeking abortions.  If the Texas law causes the widespread closure that many have projected, this "serious obstacle" standard may have a fighting chance in court.

Medi-Cal Benefits Reinstated, says 9th Circuit Panel

The 9th Circuit Court of Appeals on Friday ruled that federal Medicaid program prohibits California's 2009 healthcare budget cuts.  The state law halted Medi-Cal coverage (California's Medicaid program) of adult dental, podiatry, optometry, and chiropractic care, among other services.

To understand why federal preemption carried the day, it is important to understand the balance of federal and state governance of Medicaid. Medcaid benefits are jointly funded by the federal government and individual states. While states have the autonomy to decide how to run their respective Medicaid programs, the federal government has the final word on many aspects of the program, including required benefits.  

In this case, when an association of rural healthcare clinics sued to block the budget cuts, a U.S. District Court judge agreed with California that the slashed services were optional under the federal Medicaid Act, and he granted summary judgement in favor of the state. Even the U.S. Centers for Medicare and Medicaid (CMS), the federal agency that works with states to administer Medicaid, approved the cuts as "optional services." 

A 9th Circuit panel, however, said it would not defer to the agency's approval, pointing to the federal law that "unambiguously defines" those benefits cut by California among the the healthcare that Medicaid must provide. (The case in the 9th Circuit is California Association of Rural Health Clinics vs. Douglas, 10-17574)

1.4M More Now Medi-Cal-Eligible in CA

Just one day after The California State Legislature passed the main budget bill, lawmakers passed a key piece of the ACA on Saturday, expanding Medi-Cal (CA's version of Medicaid) to 1.4 million low-income people.  

Under the ACA, the federal government will fund 100% of states' Medicaid costs until 2016 for all states who choose to expand Medicaid coverage. After 2016, according to the federal medical assistance percentages (FMAPs) in the ACA, federal assistance for state Medicaid programs will begin to phase down to 90% in 2020.  The amount of FMAP a state gets is based upon the state's relative wealth, with lower per capita income states receiving higher FMAPs.

Democrats included a provision in the legislation that allows for future lawmakers to reconsider the expansion if the federal government’s share drops below 70 percent.

Friday Variety: Anthem Rate Hikes, Gene Patenting, & Arizona Medicaid Bill

Anthem Blue Cross To Raise Small Business Premiums
California Insurance Commissioner Dave Jones has intensified his campaign against rising health insurance rates by asking officials working with Covered California to bar Anthem Blue Cross from it's state health exchange. Jones stated that Anthem's intends to increase small business health insurance premiums (businesses with 50 or fewer workers) by 11%.  He called this rate hike "unreasonable" and accused the company of overstating its projected medical costs and improperly adding fees related to federal healthcare law.

Under state law, Jones can assess rate hikes and request to exclude them, but he lacks the authority to block Anthem's rate increase from taking effect this month (Terhune, Los Angeles Times, 6/13).

Anthem spokesman Daryl Lang says that Anthem's rate hikes are consistent with the economic reality of rising healthcare costs, and that its exclusion from the exchange would hinder competition.

Nonetheless, Anthem has actually imposed three rate hikes for small businesses over a seven-month period:

• 10.6% rate hike announced in January;
• 10.5% rate hike announced in March; and
• 7.6% rate hike scheduled to take place July 1 (Robertson, Sacramento Business Journal, 6/13)

(Read more: http://www.californiahealthline.org/articles/2013/6/14/jones-wants-anthem-excluded-from-small-business-exchange.aspx#ixzz2WCmqnuKy)

Meanwhile, Jones has praised UnitedHealth Group Inc. for cutting worker premiums for such small businesses.

Covered California will announce final health plans and rates for small businesses this August.

Supreme Court Rules Human Genes May Not Be Patented

The Supreme Court announced a unanimous ruling Thursday that naturally occurring human genes may not be patented. As a result, the costs of of getting gene tests are likely to drop as other companies can now compete with Utah-based Myriad Genetics, against whom the claims in this case were brought.

Synthetically produced genetic material, however, may still receive patent protection.

Arizona "Sweet Victory:" Medicaid Expansion Bill Passed

Thursday afternoon, the Arizona legislature approved a Medicaid expansion bill after a three-day special session.  This approval comes five months after Arizona Gov. Jan Brewer vowed to pass Medicaid expansion in her state. The bill, part of the state budget, must clear a final vote in each chamber before it goes to Brewer for her signature.