National Association of Health Underwriters News

Leading the News

Government Money Recovered From Medicaid Fraud Tripled.

USA Today (10/20, Kennedy) reports that records from the Department of Health and Human Services show "the federal government has more than tripled the amount of money it has recovered through efforts to stop Medicaid fraud in the past six years." In 2010, the government gained $1.85 billion from fraud prosecutions, compared to $573 million in 2004. "That was spurred by a 57% increase in the amount of grant money to state Medicaid Fraud Control Units (MFCUs) from $131 million to $205.5 million." Alper Ozinal, a spokesman for the Centers for Medicare and Medicaid Services, said that "many of the data analysis techniques used to find Medicare fraud are being expanded to Medicaid."
          Healthcare Reform Gave CMS New Anti-Fraud Tools. ScrippsNews (10/20, Bethel) reports Bob Moos, southwest public affairs officer for the Centers for Medicare and Medicaid Service, said that "the new Affordable Care Act gives the government more tools to keep the unscrupulous out of the Medicare and Medicaid systems," including "more rigorous screening measures," stiffer penalties, and suspension of payments when fraud is suspected.

From NAHU

Thanks to a generous grant from Colonial Life, YAHU is able to offer scholarships to cover the Capitol Conference registration fee. Scholarship recipients are responsible for their own hotel and travel.

The scholarships are for young agents, those agents relatively new to the industry and under the age of 40. This is designed to get those agents involved with the association on a national level and allow them to really experience the benefits of being a member of NAHU.

Capitol Conference is a very powerful learning experience and can give you a jump-start to be more active in our association and industry.

Click here for a scholarship application. Applications are due by November 1!

Legislation and Policy

Wisconsin Plan To Cut Medicaid Costs Elicits Criticism.

The AP (10/20, Bauer) reports, "A plan to cut about half a billion dollars from the state's Medicaid costs put forward by Gov. Scott Walker's administration drew an overwhelmingly negative response at the first of two public hearings Wednesday." The proposal by the Wisconsin state Department of Health Services "calls for shifting more than 200,000 families enrolled in BadgerCare Plus into so-called benchmark plans that have fewer benefits and don't cost the state as much." The state argues that these "changes are needed given the rising cost, loss of federal money and exploding enrollment growth in various Medicaid programs, which currently serve roughly 1.1 million Wisconsin residents, or 1-in-5 of the state's population."

Judge Puts Oklahoma Abortion Law On Hold.

The AP (10/20, Murphy) reports, "An Oklahoma judge on Wednesday temporarily blocked from taking effect a new law designed to reduce the number of abortions performed in the state by restricting the ways in which doctors can treat women with abortion-inducing drugs." The AP notes that "Oklahoma County District Judge Daniel Owens issued the ruling after a conference call with attorneys for both sides." This "temporary injunction prevents the bill from going into effect on Nov. 1."
          USA Today (10/20) reports in its "On Deadline" blog that the bill would require physicians "to follow the strict guidelines and protocols authorized by the US Food and Drug Administration and prohibits off-label uses of the drugs. It also requires doctors to examine the woman, document certain medical conditions and schedule a follow-up appointment." Two of the "drugs at the center of the case are mifepristone and misoprostol."
          Indiana Planned Parenthood Refuses To Separate Abortion Services. The AP (10/20) reports, "Indiana officials contend the state's Planned Parenthood chapter could end a fierce legal dispute over abortion funding by simply separating its abortion business from other services." Yet, "advocates for the organization view the idea as a red herring pushed by critics seeking to entirely defund the country's largest abortion provider." Their doubts are "fueled by experiences from Planned Parenthood chapters in two other states where non-abortion services were targeted even after such a split." The AP notes that "Indiana is one of the major fronts in a nationwide battle between social conservatives and Planned Parenthood."
          Wisconsin GOP Lawmakers Seek To Repeal Law Requiring Contraceptive Lessons. The AP (10/20) reports, "Wisconsin Republicans are defending a proposal to dismantle a state law that requires schools that offer sex education to include contraceptives in their lessons." Notably, state Sen. Mary Lazich (R-New Berlin), "has written a bill that would lift that mandate. She told the Senate education committee Wednesday school boards deserve the flexibility to design their own sex education curriculums, even though her bill would require an emphasis on abstinence."
          Abortion Foes Drawing Attention To Senate Lawmakers. The Hill (10/20, Pecquet) "Healthwatch" blog reports, "Groups opposed to abortion rights are pressuring the Senate to act on a bill passed by the House last week that would prohibit health insurers from offering abortion coverage if any of their customers receives federal subsidies." One such group, "Americans United for Life (AUL), cautioned that passage of the Protect Life Act is less likely in the Senate." AUL also pointed "to Democratic senators' effort to derail a House investigation into Planned Parenthood."
          NYTimes: Protect Life Act Endangers Women's Lives. The New York Times (10/20, A28, Subscription Publication) editorializes, "House Republicans approved an egregious measure last week that would shrink access to abortion to the point of endangering women's lives." At present, "hospitals receiving federal money must administer necessary emergency medical services to pregnant women, including abortion. The Protect Life Act would allow hospitals to refuse to perform an emergency abortion on religious or moral grounds even if a woman's life was at stake." The Times that this proposal "is another warning that supporters of women's reproductive rights need to push back a lot harder."

Advocates Unhappy About Demise Of CLASS Act.

Politico (10/20, Norman) reports, "The death of health reform's long-term care insurance program was so unceremonious that its supporters...got about 30 minutes' notice of the funeral." Last Friday, HHS "released a report that said there was 'no viable path forward' to implementing the CLASS Act, a major -- if little-advertised -- piece of the administration's signature Affordable Care Act." This announcement "was a slap in the face to CLASS advocates, who knew a report was imminent but did not suspect it would be a death certificate." Politico notes that earlier this year, HHS Secretary Kathleen Sebelius had "expressed optimism that the law provided enough regulatory authority to design a benefit and premium structure through the rule-making process that would put" CLASS "on firm fiscal footing."
          USA Today: "Staggering" Costs Of Long-Term Care Persist. USA Today (10/20) says in an editorial that long-term care costs for older Americans "can be staggering." This fact "was a driving force behind a provision in the new health reform law that would have created a long-term care insurance program called the Community Living Assistance Services and Supports (CLASS) Act." The Affordable Care Act "mandated that the CLASS program be sound and self-financing for 75 years, but Obama administration officials couldn't figure out how to make the numbers work." As a result, the Administration "suspended the program." USA Today says that regardless of the CLASS Act's ultimate fate, the problem of paying for long-term care for millions of baby boomers persists.
          Likewise, Norman Ornstein, a resident fellow at the American Enterprise Institute, writes in CQ (10/20, Subscription Publication) that opponents of the CLASS Act are "cheering" its demise, yet "at some point they, and everyone else, need to confront the larger societal problem. In fact, we will end up confronting a major part of it, like it or not, sooner rather than later." Ornstein argues, "The CLASS Act was a failure, but the need for something like it remains and will grow." Indeed, without another program to address long-term care costs, "we could end up with the bigger nightmare."
          Expert: Administration Should Have Found Solution For CLASS. In a USA Today (10/20) op-ed, Howard Gleckman, a resident fellow at The Urban Institute, writes, "The Obama administration blundered when it abandoned the Community Living Assistance Services and Supports (CLASS) Act." The program "would have been the first step down an important road -- moving the financing of long-term care services in the United States away from the welfare-like Medicaid program to a self-funded insurance system." Gleckman says that while CLASS had some problems, HHS "Secretary Kathleen Sebelius could have made some technical, but very important, changes to make CLASS workable. An industry actuary hired by HHS recommended many ways to do that, but Sebelius chose to walk away from the program."

Report: Michigan Families To Save Around $1,556 From Healthcare Reform.

According to the Detroit News (10/20) a Families USA report says that Affordable Care Act "will save each Michigan household $1,556 in 2019," although the amount will vary by family income. "Households earning under $30,000 a year will save $3,175, the report found. Families with income between $30,000 and $50,000 annually would be $1,651 better off, and those making $50,000 to $100,000 would save $1,316," although those earning over "$250,000 a year would end up being $4,023 worse off."
          The Detroit Free Press (10/20, Anstett) reports, "Rep. John Dingell, D-MI, a long-time supporter of health reform who joined a telephone media briefing on the report, said reforms also will wipe out 'a fog bank of lies, ignorance and denial' from insurance companies about rising insurance costs."

Public Health and Private Healthcare Systems

LATimes Urges California Employers To Help Fix Healthcare System.

The Los Angeles Times (10/20) editorializes, "While Democrats and Republicans tussle over whether to repeal the federal healthcare reform law, employers and individual consumers have to make choices about how to cope with the ever-increasing cost of health insurance and medical care." A trade group called the Bay Area Council provided "some guidance on that front this week, urging businesses to promote a more affordable, higher-quality healthcare system." The Affordable Care Act "will help on that front, the council argues...but there is much for employers, insurers and healthcare providers to do as well." The group "urges California employers to use their healthcare dollars to start fixing the system," and not wait for health reform to be implemented. The Times says that this is "a message from the Bay Area that should be heeded throughout the state."

In 2009, Over 46,000 Massachusetts Residents Fined For Not Having Enough Healthcare.

The Boston Herald (10/20, Chabot) reports Massachusetts Health Insurance Connector Authority spokesman Richard Powers "said between 46,000 to 49,000 people were fined in 2009 for having no insurance or having less insurance than the state demands," adding that "officials haven't sorted the data to identify why the 2010 and 2011 fines were handed out." Former Gov. Mitt Romney's health-care reform was "thrust the issue into the national spotlight" following "blistering criticism from GOP presidential candidate Newt Gingrich."

Majority Of Medicare Drug Plans For The Poor Fall In Ratings.

CQ (10/20, Norman, Subscription Publication) reports an "Avalere Health study of the plans' 'star ratings' used by the Centers for Medicare and Medicaid Services (CMS) found that of the 245 plans open to poor people, 67 percent had a drop in their star ratings" from the previous year. "No plan open to poor people in 2012 has a five-star rating," and just 16 had a four-star rating. "In 2012, 52 percent of the low-income plans will have 2 or 2.5 stars," up from three percent in 2011. According to the report, "the drop in ratings for plans open to low-income people mirrors a drop in ratings overall for all Medicare prescription drug plans" due to the ratings changing to put more emphasis "on items such as medication adherence, instead of process items."

Appeals Court Hears Arguments Over Arizona Medicaid Cap.

The Arizona Republic (10/20, Reinhart) reports, "Attorneys for low-income Arizonans who have been denied coverage under the Arizona Health Care Cost Containment System, the state's Medicaid program, are appealing a lower court ruling that upheld an enrollment cap on a program for childless adults." An attorney for Arizona's Medicaid program, Joe Kanefield, argued before "a three-judge panel of the Arizona Court of Appeals that a voter-approved measure allowing everyone under the federal poverty level to qualify for health coverage doesn't force the Legislature to pay for it." In their questions, the appellate judges focused "on what voters believed they were voting for when they passed Proposition 204...how lawmakers interpreted their obligation and how much power the court wields over the Legislature."
          The East Valley Tribune (10/20, Fischer) reports that attorneys for the state argued that the proposition was "a legally meaningless request to the Legislature." However, Tim Hogan, representing those who can no longer get care under the new standards, "said the language of the 2000 measure was carefully crafted to give lawmakers no wiggle room."

Senior Market News

NIH Launches Fitness Campaign For Those 50 And Older.

USA Today (10/20, Lloyd) reports, "The National Institutes of Health launched a new fitness campaign on its website Wednesday for people ages 50 and older. Richard Hodes, director of the National Institute on Aging, talked with USA Today's health reporter Janice Lloyd about the latest studies showing the benefits of exercise and the new program." Hodes emphasized that "physical activity can prevent loss of independence and prevent injury. You're never too old to increase your level of physical activity." By improving physical fitness in the middle years, people can experience a healthier and more independent old age.

Also in the News

CDC: 11% Of Americans Take Antidepressants.

ABC World News (10/19, story 8, 1:50, Sawyer) reported, "We got a stunning window onto American life today -- new numbers showing that one in 10 of us is on an antidepressant. That's a 400% increase in the last 15 years. And women, especially middle aged women, are two and a half times are as likely to be on those pills as men."
          The Washington Post (10/20, Stein) "The Checkup" blog reports, "More than one out of every 10 Americans over the age of 12 -- 11 percent -- takes an antidepressant, according to a new analysis from federal Centers for Disease Control and Prevention's National Center for Health Statistics." For the study, "researchers analyzed data collected from 12,637 people who participated in the center's National Health and Nutrition Examination Surveys." Notably, "antidepressants are the third most-commonly prescribed drug among Americans of all ages, and the most frequently used by Americans ages 18 to 44."
          The CNN "The Chart" (10/20, Bixler) blog explains that individuals "over 40 are more likely to take antidepressants than younger people." However, "it was another finding that surprised lead study author, Laura Pratt, an epidemiologist with the Centers for Disease Control. Only one-third of people with severe depression take antidepressants." Pratt observed, "That means many people with severe depression are not getting treated."

CMS Releases Guidance On EHR Incentive Payment Program.

Modern Healthcare (10/20, Conn, Subscription Publication) reports the Centers for Medicare and Medicaid Services (CMS) "published a guidance to hospitals that are about to attest under the Medicare electronic health record incentive payment program as a double-check that they have what it takes to become meaningful users of certified electronic health-records systems." In a statement, the agency said it was seeking "to make sure everyone understands what attestation entails."

Economic Inequality May Profoundly Influence Health.

The Time (10/20, Szalavitz) "Healthland" blog reports that economic inequality "has a profound influence on a population's health, in every socioeconomic group from rich to middle class to poor," researchers say. "In countries such as Japan and those in Scandinavia, which have the lowest levels of socioeconomic inequality in the developed world, the populations also enjoy overall greater life expectancy, lower infant mortality, reduced obesity, heart disease and mental illnesses, and lower rates of murder and addictions, compared with nations with high inequality like the UK, and even more so, the US." Researchers theorize that "socioeconomic inequality creates an environment in which people with the most stress can't counter its negative health effects."