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A Health-Care Fix That Works, Now Being Rolled Back Wall Street Journal (subscription) President Trump is correct: Health care is complicated. If you've ever received a hospital bill, you've seen it for yourself. America's health-care system is a tangle of providers, all paid separately for each and every thing they do. One emergency ...

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A Health-Care Fix That Works, Now Being Rolled Back - Wall Street Journal (subscription)

What happened

After a sell-off that's seen its shares drop from over $20 in July to below $13 earlier this month, news that a hedge fund has acquired a 5.7% stake sentshares ofTenet Healthcare(NYSE:THC)soaring 14.2% at 2:00 p.m. EDT today.

On Aug. 7, Tenet Healthcare reported second-quarter financial results that were anything but encouraging. In the quarter,the company's net revenue declined 1.4% to $4.8 billion, and its net loss expanded 19.6%, to $55 million, or $0.55 per share. On an adjusted basis, the company's net loss per share was $0.17. These figures were worse than investors were looking for, and shares were punished as a result.

IMAGE SOURCE: GETTY IMAGES.

Last week, two members of Tenet Healthcare's board of directors resigned, citing "irreconcilable differences." The two members are employees of Glenview Capital Management, a major Tenet Healthcare investor, and their departure triggers the expiration of a standstill agreement later this month. After the standstill agreement expires, Glenview can evaluate other options that could unlock shareholder value in the company, and according to Glenview's press release on that matter, they are committed to remaining a Tenet Healthcare investor. Perhaps this suggests that a proxy fight for control of the board is in the making. As of June 30, Glenview is Tenet Healthcare's largest shareholder, with holdings of 17.9 million shares.

Tenet Healthcare's shares moved up significantly after Glenview's announcement, and Camber Capital Management today revealed in a Securities and Exchange Commission filing that it's amassed a 5.7% position in Tenet Healthcare, adding conviction to the thinking that a management shake-up can unlock shareholder value. As of June 30, Camber Capital reported $1.4 billion in assets invested in 37 positions, including a 4 million share stake in Tenet Healthcare. Currently, Camber Capital owns 5.75 million shares.

After its lackluster performance last quarter, Tenet Healthcare ratcheted back its outlook for the full year. In addition to its operating headwinds, Tenet Healthcare also faces uncertainty regarding the future of Obamacare. Because Obamacare has decreased the uninsured rate, it has had a positive impact on hospital write-offs that are associated with charity care that's provided to patients.

Clearly, Glenview and Camber Capital believe there's value in Tenet Healthcare that can be unlocked. However, it's unclear exactly how that might happen. Until we get greater insight into how Glenview will proceed, or see signs that Tenet Healthcare's business is improving, the volatility that's likely in this stock has me thinking there are better stocks for investors to focus on.

Todd Campbell has no position in any stocks mentioned. His clients may have positions in the companies mentioned. The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy.

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Why Tenet Healthcare Shares Are Rallying 14.2% Today - Motley Fool

A recent sticky Friday found Ms. Barker passing out fliers about open enrollment at a back-to-school fair in East Nashville. To every parent and grandparent who strolled past, she asked, You have health insurance? Nearby was her favorite prop: a wheel that passers-by could spin with a dial that landed on terms like deductible and penalty, which she cheerfully explained to those willing to listen.

For the laws first four enrollment seasons, the Obama administration spent heavily on advertising, recruited celebrities like Katy Perry and companies like Uber to spread the word and scrutinized data to pinpoint potential customers. But this year, community-based enrollment groups, known as navigators, may be largely on their own.

This is going to be the heaviest lift we have ever tried to undertake, said Jessie Menkens, navigator program coordinator for the Alaska Primary Care Association. We will be shouting out for people to recognize this really is not over that regardless of what deliberations are happening in Washington, this is still truly the law of the land.

The approximately 100 navigator groups around the country, which received $63 million in federal grants last year, are not sure the Trump administration will renew those grants, which are supposed to be awarded next month. Matt Slonaker, executive director of the Utah Health Policy Project, said he had had encouraging conversations with officials at the Centers for Medicare and Medicaid Services (known as C.M.S.), but no one will know for sure until the grants are finalized.

Mr. Slonaker also said that at a conference that C.M.S. held for navigators in June, employees of the agency said the federal government would not run any ads to promote open enrollment this year. A spokeswoman for the agency would not confirm whether that was true or answer other questions about the administrations plans.

Other open questions include whether the Trump administration will automatically re-enroll people who did not actively cancel or change their plan, as Mr. Obamas did, and whether it will increase staffing at call centers that help people sign up, given the compressed enrollment time frame.

Insurance companies had asked for the shorter enrollment period, saying it would allow them to collect a full years worth of premiums from Obamacare customers and reduce the number of people who wait until they are sick to sign up. The Obama administration had planned to cut the enrollment period to six weeks starting in 2018, but the Trump administration moved it up to this year.

Leaders of the state-based marketplaces say they feel largely in the dark.

By this time in prior years, the states would have a really good sense of what the federal government was planning so we could plug the holes or leverage what they were doing, said Mila Kofman, executive director of the D.C. Health Benefit Exchange Authority. We just havent seen any details.

It seems clear that Mr. Trump wont be using his powerful Twitter account to encourage sign-ups. Nor are he and Tom Price, his health and human services secretary, likely to be visiting enrollment sites around the country like Mr. Obama and his health secretaries, Kathleen Sebelius and Sylvia Burwell, did.

Mr. Obama visited Nashville to promote the health law in 2015, going to the home of a breast cancer survivor who had benefited from the law, then taking her in his motorcade to an elementary school, where the two of them talked up the law to a cheering crowd.

Last year, Tennessee became a symbol of the laws growing problems. Insurers sought some of the steepest premium increases in the country after posting major losses they blamed on their Obamacare customers high medical costs. Then BlueCross BlueShield of Tennessee decided to stop offering plans in Nashville, Memphis or Knoxville. Statewide enrollment dipped to 200,401 by February 2017, from 231,705 in March 2016.

The state became something of a poster child for the repeal-and-replace effort this year, when Humana announced it was pulling out of the Obamacare markets nationally. That left 16 Tennessee counties with no insurers for next year, a situation Mr. Trump seized on at a rally here in March. (BlueCross BlueShield has since agreed to offer coverage in those counties.)

The Health and Human Services department has produced a series of videos featuring Americans burdened by Obamacare, which Mr. Price has posted on Twitter. In response to a request from Senate Democrats, the Government Accountability Office is investigating the videos as part of a broader look at whether some of the anti-Obamacare actions by H.H.S. have violated restrictions on how federal funds can be spent.

Congressional Democrats said they would be sending a letter to Mr. Price on Friday, demanding detailed information about his plans for marketing and outreach during open enrollment. In the letter, the ranking Democrats on House and Senate committees with jurisdiction over health care said they were concerned the administration was intent on depressing sign-ups.

Its pretty powerful, Ms. Barker said of the administrations frequent attacks on the law, and thats what were up against.

Ms. Barkers salary is paid out of the $1.6 million grant that her nonprofit agency, Family and Childrens Services, receives under the law and shares with three other groups around the state. For now she remains upbeat, especially since Senator Lamar Alexander of Tennessee, the Republican who leads the Senate health committee, recently announced the committee would try to create bipartisan legislation next month to shore up the law.

Im thinking yes, thats great! Ms. Barker said. I use that when I talk to people who are concerned theres a possibility that things will get better, that premiums will go down and this will all get worked out.

At the back-to-school fair, she buttonholed an uninsured father who said he was moving to Memphis, telling him he might be eligible for a special enrollment period and pressing a phone number into his hand. He gave her a thumbs-up as he walked away.

As the event wound down, she made plans to stop on her way home at a TJ Maxx that was going out of business. Its employees, she reasoned, might need new insurance soon.

An earlier version of this article misspelled the surname of the executive director of the D.C. Health Benefit Exchange Authority. She is Mila Kofman, not Mila Kaufman.

A version of this article appears in print on August 21, 2017, on Page A11 of the New York edition with the headline: The Heavy Lift of Recruiting for Tenuous Health Insurance Plans.

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Getting People to Enroll in Health Plans While Trump Attacks Them ... - New York Times

Aurora has been named tops in the country for pediatric health care.

The ranking comes from Vitals, a national health care incentive and engagement program. It researched the 200 largest American cities to find out which have access to the best and worst pediatric care, according to a press release from the city of Aurora.

Aurora was number one in the study. The other top cities were Madison, Wis, second place; Grand Rapids, Mich., third place; Minneapolis, Minn., fourth place; Rochester, N.Y., fifth place; St. Paul, Minn., sixth place; Cleveland, Ohio, seventh place; Salt Lake City, Utah, eighth place; Cincinnati, Ohio, ninth place; and Akron, Ohio, 10th place.

When creating the list of America's Top Cities for Access to Pediatric Care, Vitals analyzed the number of pediatricians available in each city on a per-capita basis for their under-18 population, according to the press release. Patient-reported information such as ease of getting an appointment, pediatrician ratings and wait times were also factored into the final rankings.

"When a child is ill, the primary concern for parents is getting quick access to quality care," said Mitch Rothschild, founder and executive chairman of Vitals, in the release. "Vitals not only helps consumers find top-rated pediatricians near their homes, but also make informed decisions, relying on the wisdom of others who've contributed to the nine million patient ratings and reviews on the site."

Pediatric services in Aurora are provided by a range of medical professionals including Rush Copley Medical Center and its connection with Rush University Children's Hospital; Presence Health and its collaboration with the Lurie Children's Hospital of Chicago; and the multiple locations of VNA Healthcare in Aurora, according to the release.

"Pediatric health care is a primary building block for lifelong success," said Trish Rooney, executive director of Strong Prepared and Ready for Kindergarten, in the release. "We have a strong network of early childhood providers in Aurora, and our health care providers are integral members of the community. It is great to know they are leading the way and setting the standard for pediatric health care for the entire country."

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Study says Aurora tops in country for pediatric health care - Chicago Tribune

Consider this a rallying cry: Hospitals, health systems and networks need to join forces, organize, come together as a community, to proactively fend off hackers, hacktivists, organized criminals and other emerging threats all trying to penetrate healthcare entities to either steal patient data or, worse, destroy it altogether.

Its not just WannaCry, Petya, NotPetya, ransomware in coffee makers (yes, that appears to have really happened) or the newest malware strain, either. Yes, they all startled the industry, if not the world, for a flash. And theyre legitimate threats.

But the greater danger is that CISOs, CIOs and their shops regardless of how tech-savviness, how many specialists they boast or even the number of attacks their ace security team has detected, blocked or survived every single healthcare organization must protect against the next big attack even though there is literally no way to know what it will look like or from where it will come.

[Register Now: Upcoming HIMSS Healthcare Security Forum]

To be fair, this is happening. Some hospitals are working together just not nearly enough. Security frameworks, information sharing centers, industry trade groups already exist.

Its time to start operating as a healthcare infosec community because security is only going to get harder.

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Tom Ridge, the first U.S. Secretary of Homeland Security and former Pennsylvania Governor, said that a community approach has worked in other industries.

Can it succeed in healthcare?

Yes, yes, Ridge said. Yes and the information sharing and analysis centers proved to be very helpful in financial services and energy-related industries. That is a great platform within which to share best practices, to share threat information.

Healthcare has an ISAC of its own, too, the NH-ISAC and Denise Anderson is its President.

Obviously we'd love to see as many people situationally aware as is possible, Anderson said.

In response to Petya, for instance, Anderson said NH-ISAC had a core team of subject matter experts working to collaboratively determine what the problem was and then craft a mitigation strategy. Members, in turn, can take that strategy and put it, or parts thereof, into action.

Thats just one recent example, of course. And Penn Medicine Associate CIO John Donohue said the opportunities to collaborate with other healthcare organizations to improve Penns own security posture are significant.

As we begin to shift more to a proactive cybersecurity stance, timely and accurate intelligence becomes the name of the game, Donohue said.

Penn, for its part, taps into what Donohue described as a network of peers for real-time intelligence on zero-day malware and other trending threats.

That practice is going to become increasingly important as hospitals have more and more apps and devices to protect.

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Depending upon which estimate you prefer, somewhere between 5 and 10 million new devices hook up to the internet every day.

Cyber Threat Alliance President Michael Daniel, who served as the White House Cybersecurity Coordinator for President Obama, said that cyberspace is the only environment expanding on a daily basis and that, in turn, makes the security problem both harder and bigger.

As the number of devices grows, so does peoples reliance on them, and the potential damage that can be done when they are attacked expands as well.

They are much more heterogeneous than we saw in the past, Daniel added. Its not just desktops or laptops, but now its mobile devices and Fitbits, refrigerators, and cars, light bulbs and all the so-called internet of things.

Lets calculate for a minute. A greater variety and number of apps and devices, more new types of cyberattacks, even more adversaries than ever before, and no suggestion that any of those will let up in the near future.

Heres one more to add.

I'm not sure anyone has a true handle on all of the organizations involved in healthcare out there, said NH-ISACs Anderson. Hospitals are not the only organizations that are vulnerable. Dentists, small physician practices, labs, radiological and therapy providers are all very rich targets because they are small and don't have many resources.

The sum of those realities is a pretty grim picture: Healthcare information security is difficult today and its only going to get harder from here.

Not only hospital management but the boards of directors need to embrace the fact that the industry is vulnerable and they really have to prioritize securing IT systems.

Ridge pointed out that hospital IT and security executives should be aware that the world is in a digital war and its not just nation-state against nation-state. Organized cybercriminal groups, hackers and hacktivists, lone wolf attackers are all dangerous.

Corporate leadership, Ridge said, not only hospital management but the boards of directors need to embrace the fact that the industry is vulnerable and they really have to prioritize securing IT systems.

Ridge said a security framework, such as the one National Institute of Standards and Technologys offers, is a baseline. NIST is one option, HITRUST is another.

In addition to the frameworks, the Department of Health and Human Services Health Cybersecurity Communications and Integration Center, the InfraGard cyber health working group and industry trade groups including Healthcare IT News owner HIMSS, as well as the Medical Group Management Association and the American Medical Association, all make certain resources available.

Lee Kim, Director of Privacy and Security at HIMSS, said the combination of frameworks, associations, government groups could be the virtual glue binding together the infosec community healthcare needs.

Penns Donohue said as threats continue accelerating, he finds himself participating more and more in the intelligence sharing community.

As a result of this collaboration Penn Medicine has been able better prepare for vulnerability exploits and minimize the impact of malware attacks, Donohue said.

Healthcare needs to do with its IT systems what financial services, telecom and energy have already done. Be preemptive, not reactive.

The frameworks and sharing tools exist but, of course, so do challenges.

Picking one among the various resources itself can be confusing, if not inhibitive, HIMSS Kim said. Cost is another issue.

But the biggest obstacle is simply not knowing what information to seek and share or how to make that happen and the same goes for what not to share.

Ridge, who is now chairman of consultancy Ridge Global, added that healthcare should emulate other industries.

Healthcare needs to do with its IT systems what financial services, telecom and energy have already done, Ridge said. Be preemptive, not reactive.

Indeed, it has become a necessity for the healthcare industry to overcome those barriers to participation on the way to safeguarding patient information and care delivery for the patients and their families that infosec, IT and medical professionals serve.

We need to be more coordinated as a sector, HIMSS Kim said. Otherwise, we, too, will be pwned!

Twitter:SullyHIT Email the writer: tom.sullivan@himssmedia.com

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Hospitals must band together to beat hackers - Healthcare IT News

Many Americans were disappointed when recent healthcare overhaul efforts failed. Whether they supported the proposed fix or not, many Floridians are now left wondering if they are stuck with all of the downsides of the Affordable Care Act.

They dont have to be, if Congress can regroup and refocus on more modest, achievable changes. One of those should be to stop the health insurance tax from going back into effect in 2018.

Emerging from a divisive healthcare fight has been broad agreement about the need to reduce healthcare premiums, especially on working families, senior citizens, minority communities and small businesses. The HIT tax, which would raise healthcare costs, can play no part in such a solution.

If allowed to return as scheduled, the Health Insurance Tax (HIT) will reach 100 million consumers and business owners in their health insurance bills, taking $156 billion from them over 10 years.

It is especially harmful because the HIT disproportionately affects small businesses and their employees. Family health insurance for a worker employed by a Main Street company, startup or family-owned business will be $500 more expensive each year. For a corner deli or a niche manufacturer, this can add up to many thousands of dollars in extra expenses, and maybe a red number on the bottom line by years end.

We have to consider the consequences of putting government pressure to these companies. Florida is home to nearly 2.2 million small businesses, including 600,000 Hispanic-owned enterprises. They comprise 98.9 percent of our employers and provide jobs for 3 million people.

Small businesses are also growing at a faster clip than the rest of the economy. And U.S. Commerce Department data shows that the minority-owned business sector is becoming a larger share of our economic base, rising from 22 percent to 29 percent of U.S. firms between 2007 and 2012. Florida is even more dependent on minority entrepreneurship. For example, in Miami, 69.2 percent of businesses are Hispanic-owned.

These powerful job creators are especially vulnerable to disruption. More than a third of Florida businesses are less than five years old, according to the U.S. Census Bureaus Annual Survey of Entrepreneurs. And they generally have less capital on hand to absorb unexpected costs.

This is a big part of the reason that of the 152,000 to 286,000 job losses Oliver Wyman predicts will occur due to the HIT tax, the majority will fall on small businesses. In Florida, that is synonymous with a large, negative impact on Hispanic communities.

These are among the many reasons that 400 Democrats and Republicans came together to suspend the HIT for 2017. Their plan was to allow time to craft a lasting solution to get rid of this tax.

Without congressional intervention, the HIT will return Jan. 1. Health insurance companies are already adding the costs to their 2018 premium calculations, so there is only a short window of opportunity before businesses and consumers pay for lawmakers inaction.

JULIO FUENTES, TALLAHASSEE

Editors note: Fuentes is president of the Florida State Hispanic Chamber of Commerce.

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POINT OF VIEW: Don't quit, refocus on healthcare reform wins - Palm Beach Post

By Clara Janzen Staff Writer

Sarah Ashby is afraid of what may happen if the Affordable Care Act (ACA) would disappear, saying the effects on her would be devastating.

The 25-year old Iowa State University student suffers from mental illness that requires medication and therapy. Being under the age of 26, shes still on her parents health insurance because of the ACA. If that were to be taken away, her monthly costs would jump from $56 to $1,200.

The thought that my insurance could be stripped, well, thats terrifying, Ashby said.

Ashby is one of more than 51,000 people in Iowa who would lose their health insurance if the ACA, commonly called Obamacare, would be completely repealed. The burden for their care would then fall on unpaid emergency room visits at local hospitals, and free clinics, officials at those facilities say.

There is no way the clinic could handle such a huge increase, said Dr. Eric Peterson, a physician at the Boone County Hospital who runs the countys free clinic.

In Boone County, 1,530 people are covered by the ACA, a proportionately large number considering the county accounts for 3 percent of the states residents on the ACA, but for less than 1 percent of the overall population.

The first six months of President Donald Trumps term have revolved around repeated and narrowly failed attempts to repeal Obamacare.

The Republican-controlled Senates most recent attempt to repeal smaller sections of the ACA, dubbed a skinny repeal, in late July was just three votes shy of passing, leaving Obamacare supporters without much to celebrate as the fear of repeal is still real.

We are not celebrating, we are relieved, that millions and millions of people will at least retain their healthcare, said a tearful Senate Minority Leader Chuck Schumer following that vote.

The millions and millions of people number Schumer referred to is found within reports from the Centers for Medicare and Medicaid Services (CMS), the federal agency within the United States Department of Health and Human Services, that administers the Medicare and Medicaid programs and oversees HealthCare.gov, the health insurance exchange website created under the ACA. The numbers indicate that around 24 million people in the U.S. would lose health insurance if the ACA were to be completely repealed.

In Iowa, Polk County stands to take the biggest hit because it makes up half of the people in Iowa enrolled under the ACA at nearly 26,000 people. However, Polk County also makes up 14 percent of the states total population, meaning services such as free clinics are more accessible.

If the Affordable Care Act was repealed, taking on the role of caring for those who would lose insurance would be incredibly hard, said Tess Young, the manager of St. Lukes free clinic in Polk City. They (the federal government) cant just take it away. How do they expect people to just be fine?

When asked if Polk County would be able to handle an extra 26,000 people in need of healthcare, Young said, Well, well give it our best shot.

Handling an influx of people would be even more difficult for many other, smaller Iowa counties where services may not be as accessible. Polk County has eight free clinics. The only other county with more than one is Marion County, southeast of Des Moines, which has two. Only 20 of the 99 counties in the state even have a free clinic.

It would really hit smaller hospitals like here in Boone harder than bigger areas, and our hospital is relatively well managed comparatively to other similarly sized hospitals, Peterson said Peterson.

Free Clinics of Iowa Director Wendy Gray said before the ACA went into effect, 10 percent of Iowans were uninsured.

We had 40-plus free clinics that had lines outside of the doors before the clinic even opened, and the reality is we may be there again, Gray said.

Gray and other free clinic directors around the state agreed the ACA hasnt done as much as they had hoped, but that it hasnt been without benefit.

Certainly, it wasnt the drop-off (of people using free clinics) we had hoped for. We learned quickly that having an insurance card doesnt equate to access, Gray said. Health insurance is still unaffordable for many, and reform is a necessity.

Young, the manager of the free clinic in Polk City, agreed the clinic saw a decrease of free clinic users, and added that a lot of the services provided by the clinic changed.

We tried to become more of a way to guide people on how to get insurance after the ACA was passed, Young said.

Peterson, echoed a similar sentiment.

Our numbers decreased after the ACA was passed, but weve seen a gradual increase in people who have been returning, he said.

Much of the problem lies with those who have a serious illness, Peterson said.

One of the proposals (the Senate recently proposed) would be to introduce policies that would be less expensive; however, those exclude pre-existing conditions, he said. So all the healthy people would gravitate towards cheaper plans, but eventually people with pre-existing conditions couldnt afford what they needed.

Free clinics are not set up to handle serious illnesses, leaving a lot of that burden on emergency rooms, Peterson said.

So then hospitals are losing money, and they have to jack up the rates on everyone else, because sick people will wait until the last minute to get treated because they didnt have insurance to deal with the problem when it was simple he said. Its just going to end up with higher payments and taxes for everyone regardless of insurance status.

Ashby said she anticipates having to go on Medicare once she turns 26, because her illness prevents her from working full time, which could allow her to obtain insurance through an employer.

I need the Medicare expansion from the ACA to stay, because otherwise in order to get it, I would have to have a kid, and thats just crazy, Ashby said.

The Medicare expansion under the ACA removed the requirement a woman have a child before she could receive the benefits from Medicare.

The free clinic directors and doctors agreed the ACA needs to be improved, but said they are not seeing that in the proposals put forward by the government.

Obviously, it wouldnt be an issue if it (the ACA) was replaced with something better, but were not seeing that in what the Senate is trying to do, Young said.

Peterson said the repeal of Obamacare without a better option would do more harm than good, and he would like to see Democrats and Republicans work together to address the real issues within the bill.

To a certain degree, (the way the government is handling the healthcare debate) it says a lot about the way we treat the less fortunate, Peterson said. It says a lot about what kind of society we are and what kind of society we want to be.

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Health care repeal in Iowa: By the numbers - Ames Tribune

Members of the Congressional Black Caucus have for years sought to add to Obamacare through healthcare provisions targeting racial disparities, but they are now focused on more narrow efforts for passage, even as lawmakers are seeking solutions for addressing racial tensions.

The group that studies and advances legislation on health disparities in the House, known as the Health Braintrust, was focused early in the year on staving off Republican efforts to repeal and replace portions of Obamacare, formally known as the Affordable Care Act. House members narrowly passed a bill, but the effort failed to advance in the Senate.

"We know we are not going to get a comprehensive bill passed," said James Lewis, spokesman for Rep. Robin Kelly, D-Ill., chairwoman for the Braintrust. "We know there is no appetite for that. We are focusing on trying to tweak around the edges and on finding partners."

A previous version, introduced by Kelly in 2016, would collect more data on disparities, increase the diversity of the healthcare workforce, extend healthcare technology, and address mental health disparities, among other measures. It would focus on diseases that disproportionately affect people of color, like cancer, heart disease, hepatitis, diabetes, and HIV/AIDS.

Members of the Braintrust believe that Obamacare was a key step in achieving their efforts because it increased the number of people who health insurance.

"People of color, especially African Americans, continue to be sicker, have less access to care and die sooner than their white counterparts," Kelly said in an email. "Lower rates of insurance coverage, a lack of doctors and services of these communities, food insecurities, historic distrust of medical professionals and poisoned air and water all contribute to these real and shocking disparities."

Overall efforts to reduce disparities should be even broader, say public health experts who have focused on urging policymakers to consider the "social determinants of health." These factors, like work, education, and neighborhoods contribute to how healthy people are and how long they can expect to live, they say.

Despite improvements, black Americans have long had worse health outcomes than whites. Research for the Centers for Disease Control and Prevention has shown that adults who are black are more likely to have or die from heart disease, stroke, or diabetes. Blacks are nine times more likely to be diagnosed with HIV, 2.5 times more likely to die during pregnancy and 40 percent more likely to die from breast cancer.

Jason Purnell, associate dean for social work at the Brown School at the Washington University in St. Louis, has examined social and economic factors on these health outcomes in his research.

"You can't have the ACA in isolation and expect it to solve problems that really have to do with the very poor nature of our safety net," he said. "Even with the ACA completely intact, unless you're dealing with upstream social determinants of health, you're going to see similar disparities."

The national conversation on the media is centered on race following violence that erupted in Charlottesville, Va., involving white supremacist and nationalist protesters clashing with counter-protesters. At the protest, a man reported to have Nazi sympathies allegedly drove a car into counter-protesters, wounding 19 people and killing 32-year-old Heather Heyer.

Since then, state and federal lawmakers have called for the removal of national monuments and symbols across the country. Purnell said he agrees with their removal, but cautions that more work is needed at the policy level.

"It's much more difficult to try to dismantle some of these other monuments that have been built over several decades that precluded generations of people from having the same opportunities to thrive and build wealth and live long and productive lives," he said.

Lewis said House members are working on addressing some of these issues. Rather than pass a larger bill, he said, he said, they are looking for more targeted areas of agreement, such as addressing dental health or food deserts, which refers to the absence of healthful food options in certain communities.

Several individual pieces of legislation introduced this year aim to do that. For instance, Rep. Danny Davis and Sen. Dick Durbin, both Democrats from Illinois, earlier this year introduced the Trauma-Informed Care for Children and Families Act, which would create a federal task force, expand Medicaid coverage to child trauma services and implement mental health programs in schools. The bill aims to tackle toxic stress, which medical experts use to describe repeated stress after exposure to a traumatic event, such as violence, which impacts mental wellness and can impede learning or lead to high-risk behaviors.

Davis said some Republicans have expressed interest in the legislation.

"It's not a race bill, it's not an ethnic bill and it's not a geographic bill," he said. "It's an American bill. It is a bill that will assist individuals and much of the trauma they have with terrorism being what it is and with the number of terrorist threats and acts."

He also introduced the Sickle Cell Disease Research, Surveillance, Prevention and Treatment Act, which reauthorizes grants for educating people about the disease, a red blood cell disorder that particularly affects people of African descent. Davis credited Rep. Michael Burgess, a Republican from Texas and chairman of the subcommittee on health, for showing his support for the legislation and said he believed it had enough support to guarantee re-authorization.

A bill by Jaime Herrera Beutler, D-Wash., would allow federal health officials to study maternal mortality and would provide grants to states that identify and implement programs that identify areas in which to improve.

"While there is still an obvious need to fix the problems caused or left unaddressed by the ACA, the Preventing Maternal Deaths Act is a good example of Jaime's effort to make progress and not let all efforts to improve healthcare stall in Congress," a spokeswoman for Beutler said. "Rather than having Congress and Washington, D.C. prescribe specific directives, this bill helps create teams of experts to identify and begin to solve these problems at the state level. There's no disputing the data that this troubling trend is hitting some ethnicities -- particularly African American women -- harder than others, and these committees will be well aware of the facts and be ready to take whatever action will be effective in improving survival of moms."

Despite concerns about health outcomes, data show improvements have been made. Though blacks aren't living as long as people in other races, they are still living longer than they used to, according to CDC data. The suicide rate for black men has declined since the 1990s, the only group to experience a drop, and infant mortality dropped by a fifth.

Lawmakers also have noticed that the patterns they have seen haven't necessarily hit every community. While these improvements occurred, mortality rates among whites moved in the opposite direction. Health economists have concluded that this reversal is caused by deaths among whites from opioid overdoses, alcohol poisoning, chronic liver disease, and cirrhosis.

Death rates among blacks are still higher, but nevertheless showed a decline of 25 percent from 1999 to 2015.

For Kelly, these patterns by race are apparent in her district, her spokesman said, as it includes parts of Chicago as well as suburban and rural areas.

"As much as race is a factor in this, more and more we're seeing the same disparities and lack of access to care between the urban communities that are brown and black and the rural communities that are white," Lewis said. "You're seeing these rural communities have problems that urban communities had in the 1980s: commercial blight, unemployment, drug use and overdoses, people moving into criminal behavior."

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Healthcare bills aim to remedy racial disparities in the shadow of Charlottesville - Washington Examiner

Local governments, which historically have offered generous health-care benefits to their workers, are facing tough decisions this budget cycle as health-care costs continue to rise.

To be honest with you, I think its pretty disturbing about what we have run into over the past few years. Its just increased by large numbers, said Athens Mayor Ronnie Marks.

Most local governments project further increases in health-care spending for fiscal 2018, which starts Oct. 1, and most still have not determined how they will pay for the projected increases in their budgets.

In Decatur, Mayor Tab Bowling said city officials have been advised by the Local Government Health Insurance Board, a joint-risk pool that includes several other government entities, to plan on a 6.5 percent increase in premiums next fiscal year.

In Limestone County, officials said they have been advised to expect a 7 percent increase in premiums from their Blue Cross Blue Shield Local Government provider.

Were just like everybody else across the county. Its a struggle, Limestone County Commission Chairman Mark Yarbrough said.

Prior years also have brought spending increases for local governments. Decatur Human Resources Director Richelle Sandlin said insurance rates climbed 4 percent last year and 8 percent the year before that. Limestone County saw identical percentage increases over the same period.

Self-insured governments, which pay their own medical expenses, gambling health-care spending by their employees will be cheaper than paying non-refundable insurance premiums, saw even greater spending hikes.

In Athens, health-care spending climbed 15 percent between fiscal 2015 and 2016, jumping from $4.6 million to $5.3 million. Over the same time period, Morgan County saw an 18 percent increase as health-care claims climbed from $3.02 million to $3.58 million.

The year before, Morgan Countys claims climbed 21 percent, and the county is on track to close fiscal 2017, which ends Sept. 30, about $880,000 over budget on health care.

The rising costs raise the possibility that local governments could pass more of the expenses along to employees, and self-insured governments could end that practice to join risk pools in hopes of stabilizing rapidly climbing expenses.

Asked if Athens would continue to operate as a self-insured government, Marks said all options are on the table. In past years, being self insured has worked to the citys advantage, allowing it to add cash to its reserves in years when health spending was low, but that has not been the case the past few years, Marks said.

These are tough decisions, particularly when youre talking about the possibility of having to cut benefits and things like that, Marks said.

Athens pays 85 percent of employee premiums and 50 percent of retiree premiums.

Self-insured governments typically still pay premiums to insurance companies.

At the end of each quarter, they get whatever remains back in the form of a rebate. If spending exceeds what was paid in, they must pay the difference.

In Decatur, Bowling said it would be up to the City Council to decide whether it will pass any additional expenses along to its 498 covered employees and 225 retirees.

The city pays about 92 percent of premiums, well above the typical 80 percent that most private companies pay, Sandlin said.

In Limestone County, employees with single coverage don't pay any of the $444 monthly premium covered by the county, and the county covers 70 percent of the $1,082 premium for family coverage.

Yarbrough said county officials were still crunching the numbers when asked last week where they would get the money to cover their projected 7 percent increase.

In Morgan County, Commission Chairman Ray Long has ruled out the possibility of a premium increase, at least temporarily. Long said he wont propose increasing what employees pay, but the numbers will be tracked closely.

He was warned that deep cuts, including possible layoffs, likely will be necessary if trends in health-care spending dont reverse.

Morgan County and Decatur both offer web-based tele-medicine services to their employees in bids to reduce health care spending for minor illnesses that can be handled over the phone.

If the governments cut health-care benefits in the effort to cut costs, they could become less competitive with the private sector, which often offers higher salaries for similar positions.

Sandlin said many Decatur workers who came from the private sector accepted pay cuts in return for robust benefits.

Its not apples to apples when youre talking about salaries. Youve got to look at the whole package, she said.

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Local governments face health care crunch this budget season - The Decatur Daily

The editorial regarding the quality of health care at the Albany County Correctional Facility could apply to many of the county facilities in New York ("Conscience and our jails," Aug. 14). The Correction Medical Review Board of the state Commission of Correction has been advocating since its inception in the early 1970s for major improvements in the quality of health and mental health care for prisoners.

In the criminal justice industry, medical care has a comparable value as legal services for the indigent. Money is the usual factor cited when the quantity and quality of the care is deemed inadequate or grossly inept. Sheriffs, county executives and the legislative leadership at the state and local levels should strengthen the requirements for accreditation-level health care for prisoners.

Political support from the Medical Society of the State of New York and New York State Bar Association could facilitate the extension of the urgent and emergent care initiatives of the medical centers to the jails and prisons. It should be expected as part of their overall mission and charter to operate.

Health care should not be administered by the lowest bidder. Legal services should have the same level of support. It's time for the legal and medical professions to assert their pro bono standards for equal protection and care for all persons in the community.

Karl H. Gohlke

Albany

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Prisoners deserve proper legal, health care - Albany Times Union

This article originally appeared on The Conversation.

With members of Congress spending the month of August in their home districts, Republican efforts to do away with President Obamas signature legislative achievement, the Affordable Care Act (ACA), appear stalled, at least temporarily.

However, the Trump administration still appears committed to unraveling the ACA.Most prominent are the threats to withhold cost-sharing reductions, which reduce out-of-pocket payments for low-income consumers on the insurance marketplaces.According to the Congressional Budget Office, cutting these payments would drive up health insurance premiums by 20 percent while costing the federal government close to US$200 billion over a decade.

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Senate Majority Leader Mitch McConnell, accompanied by Senators John Cornyn and John Barrasso, speaks with reporters on Capitol Hill on July 25. A new poll released July 30 found that most Americans want Republicans and Democrats to work together on health care reform. Aaron P. Bernstein/ REUTERS

Ultimately, the future of the ACA remains murky at best, leaving blue states scrambling for alternatives. One of progressives favorite solutions was floated by the California legislature at the height of Republican efforts to repeal the ACA: aplan to develop a single-payer health insurance system.Enthusiastic progressives, reeling from a series of defeats since the election of President Trump, quickly hailed the efforts as a path forward in Trumps America.

Policy experts like me were not surprisedwhen efforts in California petered out, not the least due to themassive price tag of $400 billion annually. Californians had been subjected to similar experiencesover the decades, going back to the 1910s. Time and time again, efforts at comprehensive health reform havefailed in the Golden Stateand elsewhere, such asWashington and Kentucky.

To the dismay of progressives, future efforts are likely equally doomed to failure. While states have been innovators with regards to many policies, fiscal issues and regulatory limitations will most likely preclude states from pursuing sweeping health reform. Here is why.

Financing Health Reform is Challenging

Providing insurance to those who cannot afford it is a costly endeavor, particularly in the United States. Without the financial support from the ACA, whichcurrently provides subsidies in the individual marketplaces and pays for well over 90 percent of the Medicaid expansions, states would be required to allocate funds for this purpose. This would be undeniably challenging.

For one, many states arestill recovering from the Great Recession. Moreover, other important state functions likeK-12 and higher education and criminal justiceare taking up large parts of states budgets.

Perhaps most crucially, unlike the federal government,states are generally not allowed to carry a deficitso budgets need to be balanced in any given year.

This leaves tax increases as the only solution for states seeking to get more of their residents insured. From an institutional perspective, increasing taxes is a significant obstacle because in most cases this would require asupermajority of the legislature, as well as a willing governor to accomplish. With Republicans by and large unwilling to go this route, this seems exceedingly unlikely in the foreseeable future.

Yet even for those states finding a path to increasing taxes, significant obstacles remain. Unlike for health reform at the federal level, residents and businesses have a degree ofmobility that allows them to select their location of residency. So increasing state taxes to fund health care expansion could prompt businesses and individuals to locate to other states with lower taxes.

It would likely also mean that poorer and sicker individuals seeking access to health coverage, particularly from neighboring states, would relocate to these states.

Over time, health reform would thus be financially unsustainable.

Health Reform in a Federal System is Complex

Finances aside, there are alsosignificant intergovernmental regulatory realitiespreventing states from moving forward on health reform on their own. Two issues stand out.

For one, a little-known law called theEmployee Retirement Income Security Act of 1974, commonly referred to as ERISA, poses the most crucial obstacle. While mostly intended to address retirement and pensions, ERISA also preempts states from regulating companies that choose to self-insure with regard to health care.

Self-insurance refers to arrangements where companies, instead of relying on insurance company like Blue Cross or Cigna, pay their employees medical claims directly. While companies generally contract for the administration of these arrangements, the employing company bears the entire risk. A striking50 millionemployees, particularly in large companies, are subject to these arrangements.

Second, states also do not have full regulatory authority overindividuals obtaining coverage through Medicaid and Medicare. States are virtually excluded from regulation for the latter and require the cooperation of the federal government for the former.

Combined, this putsmore than 50 percent of insurance marketsout of reach for state-based health reform efforts, making it inherently unviable.

So How Did Massachusetts Do It?

Jae C. Hong / AP Photos

Given these limitations, how was Massachusetts able to implement state-based health reform? It took a confluence of fortuitous circumstances.

First, there wasbipartisan cooperationat both the state and federal level.

Massachusetts Gov. Mitt Romney, President George Bush and Secretary of Health and Human Services Mike Leavitt, all Republicans, were able to come to an agreement with Sen. Ted Kennedy (Democrat of Masachusetts) and Democrats in the state legislature.

Bipartisanship also meant that everyone was invested in the project, at the state and federal level, and sought to make a success.

Second, thefederal government was willing to foot most of the billand provided regulatory support for the states effort.

Third, Massachusetts is arelatively wealthy state that already covered a large percentage of its population.

A confluence like this appears highly unlikely under current political realities.

Moving Forward with GOP Health Reform

States have a long history of developing sound policy solutions. For example,Wisconsin pioneeredboth unemployment insurance and pension schemes that laid the foundation for federal policies during the New Deal.

Yet states are not equally well-equipped to address all policy issues. Comprehensive health reform is one of those issues.

Current GOP proposals would do little to overcome the financial and regulatory barriers to state-based reform.

Indeed, states would be further inhibited bysignificant cuts to the Medicaidprogram. Moreover,waiversincluded in the various proposal, in a marked contrast to the ACA, are focused on allowing states to provide less coverage and fewer benefits.

Allowing policies to besold across state lines, if successful, would further restrict the sovereignty of states to regulate their insurance markets.

Republican efforts to repeal and potentially replace the ACA may not be dormant for long. The Democratic victory in the Senate in July was a shaky one that could be quickly undone, for example, ifSen. Joe Manchin(Democrat of West Virginia) or Sen. John McCain (Republican of Arizona) choose to leave the Senate. The2018 election for the Senate also puts Democrats at a significant disadvantageand Republicans may further enlarge their majority.

Unquestionably, progressive legislators will continue to introduce bills aimed at comprehensive reforms. Yet, history and economics tell us that these efforts are unlikely to make much headway. The structural limitations of states in a federal system may confine their efforts tofilling in the gaps until the federal government further extends coverage.

Simon Haeder is an Assistant Professor of Political Science, West Virginia University.

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Single-Payer Health Care at the State Level is Doomed - Newsweek

SCOTTSVILLE Rep. James Comer outlined his priorities for the country health care, tax reform and infrastructure improvements in a town hall meeting Friday morning in front of a friendly crowd at the Allen County Justice Center.

Comer, a Republican freshman lawmaker who represents Kentuckys 1st Congressional District, also wanted his constituents to know that the House of Representatives is working toward those goals and passing bills. But, the Senate hasnt been able to get its act together to pass those measures, he said. Both chambers are controlled by Republicans.

He cited the House bill to repeal and replace Obamacare, repeal of the Dodd-Frank Act, immigration legislation, a sanctuary city bill and an omnibus bill that included funding for a border wall at the U.S. border with Mexico as examples of proposed legislation the House has passed that either failed or is stalled in the Senate.

I believe were seeing a lot of progress, Comer said. Thats not always the message you get sometimes from the media, not the local media. The national media sometimes focuses on all the bad thats going on and not the good.

Comer said the private sector is beginning to show restored confidence and the stock market is very strong.

But getting legislation passed through Congress is challenging right now. Newscasts often say Congress cant get anything done, he said.

I agree with part of that, but I wish they would be more specific because Congress, the definition of Congress is the House of Representatives and the Senate, and if you will remember, for a bill to become law it has to make it through the House of Representatives and the Senate.

Heres whats wrong with Congress right now. Im going to be very specific. The Senate is having a very difficult time getting to 50. ... Most bills take 60 votes to get passed in the Senate. Well, Im going to go out on a limb and say there is no way they can get to 60 on anything right now. There are 52 Republicans and 48 either Democrats and Independents. To get to 60 right now on any controversial legislation, I dont think is possible in this environment. Im going to go a step further. I dont think they can get to 50 votes.

When people say Congress is dysfunctional, I will agree with that and go on and add its specifically the Senate right now and its not the fault of our senators. I think (Mitch) McConnell is getting a lot of the blame for this. I think hes doing as good a job as he can do. You cant get a senator in a room and make them do anything, especially when they just got re-elected to a six-year term.

Health care tops Comers lists of concerns because he said the current system is not sustainable. When Congress resumes meeting in September, Comer hopes to address both health care and infrastructure. He also expects Congress to take up tax reform.

He also touched on foreign policy and the continuing threat from North Korea, and said he is confident in the United States ability to defend itself against a North Korean missile attack.

Theyre not going to hit America with a nuclear warhead, he said. We have a superior enough missile defense system.

The problem is, what do you do with them after they launch it? You cant not do anything. But Im pretty confident that our military is being rebuilt.

I feel like were on the right track with foreign policy, he said.

The Senate needs to move quicker on legislation, he said.

When Comer opened the floor for questions, Scottsville resident Debbie Kovach wanted to know why the U.S. cant move in the direction of a single-payer health care system.

I dont think thats the way to go. If nothings done to improve health care, thats something that could happen eventually. I still want to see market-based solutions. Now I dont like for-profit health care companies. Health care is not like any other industry, Comer said.

Most of the time he agrees with letting the market decide. But the problem is, there is not much competition in insurance, he said.

There have to be regulations with health care, otherwise insurance companies will decide to drop sick people from their rosters, he said.

We have to have a lot of rules with respect to health care (insurance) companies because I dont trust the health care companies or the big pharmaceutical companies, he said. But, I dont trust the government to do health care, either.

Kovach suggested a national referendum on single-payer health care to let voters decide what they want.

Scottsville resident Allison Dorsey, a retired electrical engineer, said she was impressed with Comer for having a town hall.

Dorsey brought up the violence in Virginia and said she was there to ask Comer, as his constituent, to go on record against racist hate. She expressed disappointment in President Donald Trump for fanning the flames and not calming the waters.

We dont want to repeat the terrible history of the Klan marching by tens of thousands in the Capitol, she said.

Dorsey has benefitted from a diverse world and workplace, she said. She suggested Comer model dialog across the political aisle.

I agree were divided as a nation and we need to unite. ... I felt like the president could have done a little better job with his statement, Comer said, referring to Trumps remarks following the white supremacy march in Charlottesville, Va., that resulted in the deaths of a counterprotester and two officers killed in a helicopter crash.

When Comer heard the news about Charlottesville, he said, he was in Israel and had just visited the Holocaust museum.

Theres no place for racism in America, he said. I hope the president really tries to unite us as a country.

After the meeting, Comer condemned hate groups.

Im opposed to all hate groups on both sides of the political spectrum, he said. There are conservative hate groups and liberal hate groups.

On the conservative side are the neo-Nazis and white supremacy groups and on the liberal side are Black Lives Matter and Antifa, he said.

Follow Night Editor and Senior Reporter Deborah Highland on Twitter @BGDNCrimebeat or visit bgdailynews.com.

Excerpt from:

Health care, tax reform, infrastructure top Comer's agenda - Bowling Green Daily News

Photo: Bob Luckey Jr. / Hearst Connecticut Media

Outpatient care drives increase in health care jobs

Connecticuts health care industry has a strong hiring pulse.

The field added more than 1,000 positions last year, one of the largest jumps during that period among the states economic sectors, according to the state Labor Departments latest Economic Digest. A need to staff growing outpatient operations is driving the growth, which health care executives said they expect to continue as their organizations serve rising numbers of patients outside hospitals.

We have added positions to prepare for and support the growth of our practice, said Sally Frank, chief operating officer of Orthopaedic and Neurosurgery Specialists, which has offices in Greenwich and Stamford.

Demand for outpatient care

Hiring has been particularly brisk in the southwestern corner of the state. Western Connecticut Health Network which runs Norwalk, Danbury and New Milford hospitals has brought in some 1,400 people for new and existing positions since October. The new hires have included primary care physicians, physician assistants, nurses and supporting clinical and administrative staff including home care, coders and patient financial analysts.

Western Connecticut Health Network now employs about 6,000.

In Fairfield County and other parts of the state, the job creation has concentrated in outpatient services. Health care organizations throughout the state last year added about 1,100 outpatient posts, an increase of 1.3 percent. Employment in hospitals and nursing-residential facilities was basically flat.

Throughout the state, health care providers are expanding their outpatient ranks to support new facilities.

On adjacent lots on Long Ridge Road, the Stamford Health and Yale New Haven Health systems have both opened outpatient centers during the past two years.

More than 90 employees staff the Stamford Health complex. The Yale New Haven Health center operates with 57 employees and another 18 doctors are based there part time.

Systemwide, Yale New Haven Health employs about 22,000, adding about 1,400 positions between 2015 and 2016.

The trend is going to outpatient facilities, said Melissa Turner, Yale New Haven Healths vice president of talent acquisition. And for some people, outpatient care provides an attractive work-life balance because theyre working more regular hours Monday through Friday.

Officials at Stamford Health were not available for comment this week.

Among other recent outpatient additions, Stamford Healths 97,000-square-foot Integrated Care Pavilion on the Stamford Hospital campus and Yale New Haven Healths Womens Cardiovascular Center on Valley Drive in Greenwich both opened last year.

Smaller health-care groups have also ramped up their hiring. ONS has added 35 jobs since the beginning of the year; 27 of those positions focused on physical therapy.

There is an extra challenge with being a premier practice, Frank said. The people we hire have to perform at a superior level.

Another independent health-care practice, Advanced Radiology, has also grown significantly to supporting its imaging centers. It now employs about 200, compared with some 170 about five years ago. It opened its seventh complex, in Wilton, earlier this year.

This is patient driven, Dr. Mary Cooper, senior vice president of clinical services at the Connecticut Hospital Association, said in an interview earlier this year. All of us want the availability of high-quality care thats convenient. None of us want to spend time away from families, jobs and other commitments by being an inpatient in the hospital.

Health care wages ran close to the states overall 2016 average of about $70,000. Employees in outpatient care earned an average of about $67,000 last year, a 2 percent increase over the equivalent amount in 2015. Hospital staff received about $66,000 on average, a 1 percent gain over the previous years level.

More growth

Local health care executives expect hiring to maintain its current pace in the foreseeable future. Western Connectiut Health Network officials said they plan to add positions in the areas that have seen the most growth in the past year.

We are investing in health and wellness, leading population-health management, adopting new technologies and system capabilities and advancing innovative research for optimal health outcomes for our communities, said Cathy Frierson, WCHNs senior vice president of human resources.

Advanced Radiology CEO Clark Yoder said he anticipates the contingent at the new Wilton center growing from about a half-dozen to 10 by the end of the year to accommodate expanded hours there.

ONS also plans to hire more staff. Following up the expansion earlier this year of its Stamford center, it is opening at the end of this month offices in Harrison, N.Y.

Amid the proliferation of outpatient services, health-care executives said hospital personnel would remain indispensable.

The trend is going to outpatient facilities, but we still have in-patient care to keep top of mind, Turner said. We are mobilizing to meet the needs of patients in both clinical settings.

pschott@scni.com; 203-964-2236; twitter: @paulschott

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Outpatient care drives increase in health care jobs - The Advocate

The Congressional Budget Office released on Tuesday yet another damning report on health care, this time highlighting the damage President Donald Trump will do if he continues his Affordable Care Act sabotage campaign.

Over the next few weeks, during which the government and insurers must sort out what will happen to Obamacare insurance markets next year, everyone in the administration and every member of Congress must recognize that they have no more time to entertain repeal-and-replace fantasies. The fate of the health-insurance markets on which millions of people rely hangs on their willingness to accept reality.

The Trump administration has shown some flexibility. The Department of Health and Human Services last week offered insurers an extra few weeks to file rates for next year. Earlier, Alaska got $323 million in federal money to backstop its individual insurance market in a reinsurance arrangement that could drive down premiums and serve as a model for stabilizing insurance markets across the nation. Though Trump has repeatedly vowed to let Obamacare collapse, these moves show willingness to bolster, not undermine, the insurance markets that Obamacare created.

Yet the administration has stoked more uncertainty than it has allayed, leaving the health system in peril. The White House has been deciding month-to-month whether to keep important subsidy payments flowing to insurance companies - payments that were simply assumed during the Obama administration. Without these payments, insurers would have to jack up premiums or leave Obamacare markets next year. The CBO estimated Tuesday that average premiums would jump by 20 percent next year if the Trump administration pulled them. Moreover, because of how the payments interact with other elements of the health-care system, the government would end up losing money - $194 billion over a decade.

Though it would be irrational to subvert the health-care system and the budget, Trump has repeatedly threatened to do so. His officials also have taken steps in that direction, pulling advertisements meant to encourage people to enroll in health insurance, cutting programs that helped people sign up, railing about Obamacare's "victims" and generally insisting, against the facts, that the law is a disaster. The administration's moves to weaken the individual mandate, which requires all Americans to carry health coverage and underpins the Obamacare system, have led insurers to contemplate increasing premiums or leaving the system.

The president wanted and failed to overhaul Obamacare. That does not excuse him from faithfully executing the law. Unless Trump wants to be blamed for health-care chaos, the administration's mixed messages must stop. Trump should commit to keeping the subsidies going permanently, to enforcing the individual mandate and to working with Congress on a bipartisan bill that would bolster insurance markets.

The broad strokes are clear: Democrats would ensure that subsidy payments are made permanent and Republicans would get more flexibility for states in administering Obamacare. More money should also go into reinsurance programs like Alaska's. Though such a bill might come too late to hold down 2018 premiums, serious legislative activity could persuade insurers to stay in the market, riding out next year with the promise of a more stable situation in 2019.

All of this would be easier if the administration would commit to a strategy of stewardship, not sabotage.

The Washington Post

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Other Views: Commit healthcare stewardship, not sabotage - The Bakersfield Californian

Theheadlinesfrom Capitol Hill give the impression that Congress is debating the future of U.S. healthcare. Thats somewhat misleading. The debate is about health insurance, not healthcare.

It is an important distinction. Insurance is a ticket to enter the healthcare system. Healthcare is what the system delivers. To be sure, if Congress rolls back insurance coverage, it will prevent millions of Americans from gaining timely access to healthcare. That is abad outcome in itself and worthy of the attention its getting.

Nonetheless, a real debate over healthcare would begin with an accurate diagnosis of our ailing system. We have theworlds most expensive healthcare, and despite the superior quality of American providers, science and technology ourlife expectancyandinfant mortality ratesare the middle of the pack among developed nations.

The cost, quality and patient experience of care varies widely among doctors and hospitals. Despite billions of dollars of investments in information technology, medical records still dont follow patients across providers, and we lack the real-time data insights that fuel quality improvement in other industries. Finally, our healthcare system emphasizes treating people when they are sick not keeping them well.

Federal policy on its own cannot improve the sectors leadership, culture, cost or quality. Those of us who provide care must step up and accept accountability for the results we deliver. But the federal government can help us chart a course toward more patient-focused, coordinated and cost-efficient care by giving us the right incentives, setting consistent rules and removing the roadblocks.

Thats why a new debate should begin with the topic that is currently missing from the headlines: payment.

We pay for most healthcare services today one by one, a system called fee-for-service. The more services a doctor or hospital delivers, the more they get paid. Sicker patients earn them (us) higher payments and drive each healthcare team member to concentrate on the services they alone deliver, not the patient as a whole person. As a result, we care for people in a fragmented, inefficient and costly fashion.

Conversely, if we were to pay providers based on the quality and cost of care they provide, they would more likely focus on keeping people well, managing patient illnesses and preventing costly interventions that send people to the hospital. This is known popularly as value-based care. It may be a poor choice of phrases, conjuring up K-marts blue-light special instead of Tiffanys light blue box, but the point is the right one: payment should reward the value of services not the volume. Value-based payment holds providers accountable for the quality of their care, and puts their payments at risk if they dont deliver.

The federal government can play a decisive role in moving the ball forward. Medicare alone accounts for20 percent of all healthcare spending. Under both Democratic and Republican administrations, Medicare has begun to embrace value-based payments.

But instead of accelerating this trend, the Trump administration has proposed slowing it down, albeit to avoid overwhelming small physician practices. If we stay on this course, it will penalize early adopters like Prevea Health and many of my fellow American Medical Group Association members, which have invested millions reengineering systems to provide value-based care. The administration should be helping lead the way, not putting on the brakes.

We also lack timely access to Medicare and commercial payer claims data about the very patients we serve. Data is the lifeblood of quality improvement, and without it, we lack the feedback we need to improve patients health outcomes. Congress can fix this by requiring both federal and commercial payers to provide access to this data.

But data is also a double-edged sword. Currently, Prevea is required to submit data to numerous payers in different formats. And we are not alone shouldering this incredible burden on financial and workforce resources that could be spent on patient care.

One study reported inHealth Affairsfound that physicians in four common specialties spend, on average, 785 hours per physician and $15.4 billion annually dealing with the reporting of quality measures. Congress should require federal and commercial payers to standardize the data submission and reporting processes.

In the depths of the Great Depression, FDR said, The country demands bold, persistent experimentation. It is common sense to take a method and try it: If it fails, admit it frankly and try another. But above all, try something.

Bold, persistent experimentation is what we, as healthcare leaders, need to be asking of Congress. We know the healthcare system we have isnt serving our best interests. The debate we should be having in Washington and throughout our country is about creating a system that will.

AshokRai, M.D., is president and CEO of Prevea Health and the incoming chairman of American Medical Group Association,an Alexandria, Va.-based association representing multispecialty medical groups and integrated systems of care.

The views expressed by contributors are their own and are not the views of The Hill.

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The healthcare debate we're not having - The Hill (blog)

By Todd G. Buchholz By Todd G. Buchholz August 17 at 7:25 PM

Parrots can learn economics, claimed Victorian economist Alfred Marshall. Just teach the parrot to squawk supply and demand. So if a parrot can learn, why cant the U.S. government?

House and Senate GOP health-care plans, like Obamacare itself, have squawked loudly about subsidizing demand but said little about the supply of doctors, nurses and drugs. That is economic malpractice.

It is also so 20th-century. In an era of Amazon, Uber and Airbnb, the non-health-care economy is getting a shock treatment of new supply that is boosting accessibility while restraining prices. Health care needs a supply-side shock, too, and government can help.

Health care is not entirely immune to supply-side pressures. When Lasik eye surgery appeared in 1999, thousands of eye surgeons jumped into the act and prices fell by about 25 percent in 10 years. Shortly after the Food and Drug Administration approved Botox for furrowed brows in 2002, dermatologists, nurses and spas jumped in, keeping prices from rising. The government does not subsidize these cosmetic procedures.

We are seeing other hints of supply-side improvements in medicine. In California, Heal.com will send a doctor to your house for $99. Does it work? In San Diego, Heal.com receives a 4.5 score on Yelp. Nearby hospitals receive a 3.0.

Now, of course, the hospital handles many more dire cases than a drive-up doctor making house calls. But note this: Many hospital patients are labeled LWOT (left without treatment). These are cases in which sick or injured patients feel so frustrated with waiting times that they drive off. In one California hospital, more than 20 percent of emergency-room patients are LWOT.

An aging population is pushing up demand, and without more supply, prices will catapult higher. Doctors are aging, too: More than 30 percent are 60 or older. Forecasts project a physician shortage ranging from 46,000 to 90,000 by 2025, especially among specialists.

Already, one quarter of the federal budget goes to Medicare and Medicaid. Taxpayers will find themselves frustrated with packed waiting rooms and higher taxes. So what can Washington do to help spark a supply-side shock in health care? Here are four important steps:

First, we need new medical schools. The United States accredited no new medical schools from 1986 through 2004. Recently, in response to the looming shortage of doctors, a number of new schools have been announced, for example, at the University of Nevada, Seton Hall and Washington State. Yet new schools face formidable licensing costs and delays from federal, state and local boards, which can deny accreditation for serious reasons such as unhygienic equipment as well as nonmedical worries such as the dimensions of parking garage spaces. Government agencies can work together to fast-track approval processes.

Second, state governments should give greater authority to nurse practitioners and physician assistants to open their own practices and encourage walk-in clinics, such as CVSs Minute Clinic and Walmarts Care Clinic. Research shows that, compared with doctors offices, such clinics deliver cheaper and equivalent care for patients who presented symptoms of ear infections, sore throats and urinary tract infections.

Third, the Food and Drug Administration should pursue reciprocity for drug approval with other advanced countries. Under current law, if a drug is approved by the European Medicines Agency, Americans cannot buy it unless the FDA slogs through its own long, expensive protocol. And theres precedent: In 2013, a potentially lethal meningitis outbreak spread through Princeton Universitys dorms. Princeton begged the government to allow it to buy a common vaccine made by Novartis in Switzerland. The bureaucrats eventually relented. Why cant the FDA permit reciprocity with other advanced countries for other cases?

Finally, legal reform could also save patients money. Fear of lawsuits cuts the effective supply of health-care services in two ways: First, malpractice insurance payments encourage early retirement. Second, fear prods practicing doctors to order unnecessary procedures, leaving fewer resources for those who need treatment. More than 80 percent of physicians say that they prescribe tests for fear they will be sued if they do not. The American Board of Internal Medicine has specified 45 tests that are often prescribed without merit, from annual electrocardiograms to imaging for temporary lower back pain.

Americans need more doctors, more nurses and more prudent care.Trying to solve health-care problems by focusing just on demand is like trying to cut rope with only the bottom blade of a scissors. Youll likely struggle to get the results you desire, and you might even hurt yourself.

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All of these health-care plans are so 20th century - Washington Post

Single-payer health care is still a controversial idea in the U.S., but a majority of physicians are moving to support it, a new survey finds.

Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way 58 percent opposed single-payer. Whats changed?

Red tape, doctors tell Merritt Hawkins. Phillip Miller, the firms vice president of communications, said that in the thousands of conversations its employees have with doctors each year, physicians often say they are tired of dealing with billing and paperwork, which takes time away from patients.

Physicians long for the relative clarity and simplicity of single-payer. In their minds, it would create less distractions, taking care of patients not reimbursement, Miller said.

In a single-payer system, a public entity, such as the government, would pay all the medical bills for a certain population, rather than insurance companies doing that work.

A long-term trend away from physicians owning their practices may be another reason that single-payer is winning some over. Last year was the first in which fewer than half of practicing physicians owned their practice 47.1 percent according to the American Medical Associations surveys in 2012, 2014 and 2016. Many doctors are today employed by hospitals or health care institutions, rather than working for themselves in traditional solo or small-group private practices. Those doctors might be less invested in who pays the invoices, Miller said.

Theres also a growing sense of inevitability, Miller said, as more doctors assume single-payer is on the horizon.

I would say there is a sense of frustration, a sense of maybe resignation that were moving in that direction, lets go there and get it over with, he said.

Merritt Hawkins emailed its survey Aug. 3 and received responses from 1,003 doctors. The margin of sampling error is plus or minus 3.1 percentage points.

The Affordable Care Act established the principle that everyone deserves health coverage, said Shawn Martin, senior vice president for advocacy at the American Academy of Family Physicians. Inside the medical profession, the conversation has changed to how best to provide universal coverage, he said.

Thats the debate were moving into, thats why youre seeing a renewed interest in single-payer, Martin said.

Dr. Steven Schroeder, who chaired a national commission in 2013 that studied how physicians are paid, said the attitude of medical students is also shifting.

Schroeder has taught medicine at the University of California-San Francisco Medical Center since 1971 and has noticed students increasing support for a single-payer system, an attitude they likely carry into their professional careers.

Most of the medical students here dont understand why the rest of the country doesnt support it, said Schroeder.

The Merritt Hawkins findings follow two similar surveys this year.

In February, a LinkedIn survey of 500 doctors found that 48 percent supported a Medicare for all type of system, and 32 percent opposed the idea.

The second, released by the Chicago Medical Society in June, reported that 56 percent of doctors in that area picked single-payer as the best care to the greatest number of people. More than 1,000 doctors were surveyed.

Since June 2016, more than 2,500 doctors have endorsed a proposal published in the American Journal of Public Health calling for a single-payer to replace the Affordable Care Act. The plan was drafted by the Physicians for a National Health Program (PNHP), which says it represents 21,600 doctors, medical students and health professionals who support single-payer.

Clare Fauke, a communications specialist for the organization, said the group added 1,065 members in the past year and membership is now the highest since PNHP began in 1987.

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Doctors warm to single-payer health care - Salon

The Trump administration, faced with increasing pressure from Republican members of Congress, backed away from causing an immediate crisis in healthcare marketplaces and agreed Wednesday to continue making payments to insurance companies that are widely viewed as critical to keeping the industry stable.

President Trump and his top aides have flirted for months with cutting off the money, known as cost-sharing reduction payments, which help subsidize insurance co-payments and deductibles for low-income and moderate-income Americans. Doing so would be one step toward causing the Affordable Care Act to implode as Trump has sometimes put it.

The decision to make this months payment, due next week, signaled that the administration has decided against immediately precipitating a collapse, potentially giving Congress time to pass a bipartisan package of fixes to some of the laws problems.

Leading Republican members of Congress have pressed the administration to keep making the payments, fearing that any move to cut them off would cause chaos in insurance markets. Trump has said voters would blame Democrats for any problems with the markets, but few Republican elected officials share that view.

The pressure to continue the payments increased Tuesday when the Congressional Budget Office reported that cutting off the payments would actually increase federal spending. Ending them would cause insurance premiums to rise sharply and thereby increase the cost of other government subsidies, the budget office said.

A White House official confirmed Wednesday that the administration had decided to make this months payment, which will total about $600 million. The question of whether to make future payments remains under review.

The announcement drew praise from Sen. Lamar Alexander (R-Tenn.), the head of the Senate committee that handles healthcare legislation.

The decision to continue the subsidies helps 18 million Americans who dont get insurance from the government or on the job, Alexander said in a statement.

When Congress returns from its recess in September, lawmakers should quickly pass legislation that would continue the payments through next year, Alexander said.

The continuation should be linked to changes in the current law to give states more flexibility on the kinds of insurance policies that consumers can buy, he added.

But some conservative lawmakers and organizations were quick to voice their displeasure, calling the payments a bailout of insurance companies.

That opposition illustrated the difficulty Alexander and like-minded lawmakers will face in trying to round up Republican support for legislation to stabilize a healthcare law the party has long wanted to repeal.

And if Congress does not quickly settle the issue, the continued month-to-month uncertainty about the payments is likely to cause insurers to hike premiums.

Already, industry executives have publicly blamed the uncertainty for higher premiums for next year. Insurers are coming up on deadlines next month for setting their premiums for next years open enrollment period.

The part of the healthcare law at issue greatly lowers the cost of insurance for millions of low- and middle-income consumers by requiring insurers to hold down deductibles and co-payments.

That requirement can save thousands of dollars for families with big medical bills who can qualify for the cost reductions if their incomes are below about 2 times the federal poverty level.

The requirement to hold down co-payments and deductibles, however, costs insurance companies a lot of money. To make them whole, the government reimburses them with the monthly payments.

Since early this year, the administration has refused to commit to continue sending the checks.

In late July, after Republicans failed in their effort to repeal the healthcare law, Trump said that he wanted to let Obamacare implode. An abrupt cutoff of the cost-reduction payments would be among the quickest ways to make that happen.

The cost-sharing reductions have long been a controversial part of the healthcare law.

Republican lawmakers went to court in 2014 to challenge the payments, saying Congress had never appropriated money for them. A federal district judge in Washington agreed last year. The Obama administration appealed, and the ruling has been on hold ever since.

At one point, Trump administration officials talked of dropping the appeal as a way to kill the payments. That option faded this month after Democratic state attorneys general won the right to intervene in the case, which would allow them to keep the appeal alive if Trump pulled out.

Although many of Trumps advisors oppose the payments, the budget office report Tuesday put them in a difficult position.

The report from the nonpartisan budget office said that cutting off the payments would have paradoxical effect of increasing federal spending.

Thats so because insurers would still be required to hold down deductibles and co-payments for low- and moderate-income consumers. To avoid losing money, some insurers would pull out of the marketplaces. Most, however, would raise premiums, the budget office projected.

The premiums for the medium-cost silver plans on the exchanges, which are the most popular plans among consumers, would go up by about 20% to 25% over the next couple of years if the cost-sharing payments ended, the budget office said.

The cost of those higher premiums would land primarily on taxpayers, not on individual consumers. Thats because nearly 80% of people receiving coverage on the marketplaces also receive a second kind of government assistance to help pay monthly premiums. As overall premiums rise, so will the cost of those other government subsidies.

The net result would be to increase the federal deficit by almost $200 billion over the next 10 years, the budget office said.

If the subsidy payments were ended, insurers pulling out of the market would leave about 5% of the population in counties with no marketplace insurer, the budget office also projected.

david.lauter@latimes.com

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Trump administration agrees to continue healthcare subsidy for now - Los Angeles Times

Pittsburgh Post-Gazette

Health care still an employee priority as businesses eye uncertain future Pittsburgh Post-Gazette Health care remains a primary concern for most employees in the job search process, though some companies say that age impacts how important of a consideration those benefits are. At Leroy Metz's Downtown law firm Metz Lewis Brodman Must O'Keefe, ...

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Health care still an employee priority as businesses eye uncertain future - Pittsburgh Post-Gazette

But perhaps the most interesting and potentially groundbreaking company created in connection with the Affordable Care Act is Aledade, a start-up founded in 2014 by Farzad Mostashari, a doctor and technologist who was the national coordinator for health information technology at the Department of Health and Human Services in the Obama administration.

Aledade, which has raised about $75 million from investors, has an agenda so ambitious it sounds all but impossible: Dr. Mostashari wants to reduce the cost of health care while improving how patients are treated. He also wants to save the independent primary care doctor, whose practices have been battered by the perverse incentives of the American health care system.

And here is the most interesting part: His plan is working.

A few weeks ago, I visited two primary care practices in southeast Kansas that have worked with Aledade for more than a year. Their operations had been thoroughly remade by the company. Thanks to Aledade, the practices finances had improved and their patients were healthier. On every significant measure of health care costs, the Aledade method appeared to have reduced wasteful spending.

The whole idea is to align incentives between society and doctors and patients, Dr. Mostashari said, adding that Aledade has helped reduce hospital readmissions and decrease visits to specialists in many of its markets. Were reducing unnecessary and harmful utilization and improving quality of care.

Of course, such promises are not new at the intersection of health and technology. Many companies have made big bets and blown up among them Theranos, the lab testing start-up, which turned out to have been more puffery than product. Aledade faces its own share of hurdles, including whether its investors can ride out a long and costly expansion before it starts to realize any big paydays.

Still, its plan which mainly involves using software to achieve its goals looks promising.

The American health care system is a fragmented archipelago, with patients moving through doctors offices and hospitals that are often disconnected from one another. As a result, many primary care physicians who often see themselves as a kind of quarterback who calls the shots on a patients care have no easy way to monitor a patients meandering path through the health care system.

Aledades software addresses that by collecting patient data from a variety of sources, creating a helicopter view. Doctors can see which specialists a patient has visited, which tests have been ordered, and, crucially, how much the overall care might be costing the health care system.

More important, the software uses the data to assemble a battery of daily checklists for physicians practices. These are a set of easy steps for the practice to take call this patient, order this vaccine to keep on top of patients care, and, in time, to reduce its cost.

For example, say youre a doctor at a small practice in rural Kansas and one of your patients, a 67-year-old man with heart disease, has just gone to the emergency room.

In the past, wed only find out our patients were at the hospital maybe weeks afterward, said Dr. Bryan Dennett, who runs the Family Care Center in Winfield, Kan., with medical partner, Dr. Bryan Davis. With Aledade, Dr. Dennett is now alerted immediately, so we can call them when theyre at the emergency room and say, Hey, what are you doing there? Come back here, we can take care of you!

It is not just emergency room visits. Aledade tells doctors which of their patients is eligible for preventive care like vaccines or an annual wellness visit. The doctors said that during such visits they have discovered several conditions that would have ballooned into much bigger problems without treatment. The software lets doctors know when their patients have been discharged from the hospital, allowing them to schedule transitional care management visits.

Such visits are a gimme for the health care system they have been proved to reduce hospital readmissions (which are extremely costly), and patients say they find them valuable in navigating the health care system. And because these visits are so effective at lowering overall health care costs, Medicare pays doctors a higher rate to provide such care meaning that primary care doctors can make money by following Aledades alerts.

Yet even though Aledade thinks of itself as a technology company, its doctors said its software is the least interesting thing it does. Independent primary care doctors tend to be cautious about technology, especially if it seeks to thoroughly alter how they work. So the real battle Aledade faces is to integrate technology into doctors practices and to do so in an nonintrusive and pleasing way. The softwares instructions must also prove financially rewarding for clinics, while still somehow saving money for the overall health care system.

To do all this, Aledade which now operates in 15 states and has relationships with more than 1,200 doctors has had to become more than a software company. It has hired a battalion of field coordinators who visit practices and offer in-depth training and advice.

The company has also taken advantage of several health care ideas that were introduced or accelerated by the Affordable Care Act. One of these is known as the accountable care organization, or A.C.O., which lets groups of health care providers unite to coordinate care for a patient. Studies have shown that such a structure lowers overall medical costs; under the Affordable Care Act, Medicare encouraged the formation of these organizations by promising to share any savings it realizes with doctors. Aledade took the accountable care organization idea and made it its primary business model. (The structure was reaffirmed by a 2015 law passed overwhelmingly by Congress, so a repeal of the Affordable Care Act would not have affected its structure.)

For Aledade, the upshot is that it will only make a lot of money if it actually succeeds in reducing health care costs.

Say Medicare thinks that its going to spend $100 million next year on our patients in Kansas, Dr. Mostashari said. A lot of this is from bad stuff hospitalization, complications, you know, bad stuff. So we come in and say, if we can work with the primary care doctors to reduce bad things from happening while increasing quality, then we can save money for Medicare. Medicare says we thought we were going to spend $100 million on those patients, and we only spent $90 million. So, Medicare keeps half of the savings, and the other half of it goes to Aledade which we split with the doctors.

In addition to Medicare, Aledade has begun signing up several commercial health insurance companies under similar cost-savings plans. But given that the company gets paid only when it cuts health care costs (while improving health outcomes), Aledade and its investors are making a gamble.

In its first year of operation, for instance, Aledade managed to cut many costly procedures, yet its savings did not meet Medicares benchmark meaning it realized virtually no revenue from the savings program.

The results for its second year are due in October. This time, because Aledade said its savings grow over time, the company is likely to begin making money. Were very confident in our model, Dr. Mostashari said.

Email: farhad.manjoo@nytimes.com; Twitter: @fmanjoo

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