Tag Archives: healthcare

You Can Take Steps to Lower Your Breast Cancer Risk

Fear of breast cancer is widespread, yet many women don’t realize that adopting protective living habits may help keep it at bay. The habits described below may also help to ward off other life-threatening ills, like heart disease and diabetes.

Certainly, women have ample reason to worry about breast cancer. The disease is very common. One woman in eight in the United States will develop it in the course of a lifetime. The American Cancer Society estimates that this year 252,710 new cases of invasive breast cancer will be diagnosed, and 40,610 women will die from the disease.

Regular screening is touted as the most effective way to reduce breast cancer deaths, although experts continue to debate who should be screened, how often and at what ages. But not nearly enough is said about what women can do on their own to lower their risk of getting breast cancer in the first place.

One of the most important actions is an inaction: not smoking. The incidence of smoking has fallen significantly in the last half century, yet every day on the streets of New York I still see young women and teenage girls smoking. A decades-long study conducted among 102,098 women in Norway and Sweden found that, compared with nonsmokers, those who smoked 10 or more cigarettes a day for 20 or more years had a third higher risk of developing invasive breast cancer, and girls who started smoking before age 15 were nearly 50 percent more likely to get breast cancer.

An editorial in The Journal of Clinical Oncology last year stated that as many as 20,000 women in the United States continue to smoke even after a diagnosis of breast cancer. The authors, Dr. Barbara A. Parker and John P. Pierce of the University of California, San Diego, said breast cancer patients who quit smoking can add significantly to the benefits of postoperative chemotherapy and radiation.

Another important factor under personal control is weight. As body mass index, or B.M.I., rises, so does a woman’s risk of developing breast cancer, especially if she carries much of her excess weight around her waist. That’s because abdominal fat is particularly metabolically active, producing growth factors and hormones, including estrogen, that can stimulate the growth of breast cancer cells.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

House to vote Thursday on GOP Obamacare repeal bill

WASHINGTON — After wooing GOP moderates with extra money for patients with pre-existing conditions, House Republicans said they would vote Thursday on a revised bill to repeal and replace Obamacare — setting the stage for a high-stakes showdown on one of President Trump’s top priorities.

House GOP leaders announced the vote Wednesday night after weeks of negotiations, hours of wooing wavering Republicans, and a last-minute sweetener added to the bill: an $8 billion amendment to help patients with pre-existing conditions pay for higher premiums and out-of-pocket costs.

Republican leaders suggested they would have enough votes to pass the bill in the House, although the vote could be a down-to-the-wire squeaker. The decision to schedule the vote will ramp up the pressure on a clutch of still-undecided lawmakers, and Republicans clearly had momentum on Wednesday evening.

“I support the bill with this amendment,” said Rep. Fred Upton, R-Mich., after meeting with President Trump at the White House on Wednesday morning about his proposal to beef up funding to help individuals with pre-existing conditions. Upton is an influential player on health care policy, and he had previously opposed the bill amid concerns it would put insurance out of reach for those with chronic illnesses and other health conditions.

Another holdout, Rep. Billy Long, R-Mo., also switched from a “no” to a “yes” after meeting with Trump and working with Upton on his amendment.

The biggest sticking point so far: the provision in Obamacare that bars insurance companies from discriminating against those with pre-existing conditions. The current GOP bill would dramatically weaken that, by allowing insurance companies charge people with pre-existing conditions —anything from cancer to pregnancy — higher premiums than other consumers.

That change prompted Upton’s push to add the extra $8 billion to help sicker patients pay their premiums and other health care bills. Upton and Long both sit on the House Energy and Commerce Committee, which has played a central role in drafting the GOP bill, called the American Health Care Act.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Aetna, UnitedHealth show increasing appetite for value-based care contracts

The biggest health insurers are moving quickly towards value-based care arrangements, their recent earnings reports show.

While Aetna has long-held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020, Aetna’s medical spend is now 45 percent tied to value, CEO Mark Bertolini said during last week’s fourth quarter earnings call.

“One way we measure our success is by how well we are able to keep our members out of the hospital and in their homes and communities,” Bertolini said. “For example, in 2016, we reduced total acute admissions by approximately 4 percent, and we deployed predictive modeling to target members at the greatest risk of readmission.”

Aetna has achieved a 27 percent reduction in readmission rates using multidisciplinary care teams that engage facilities to develop effective discharge plans, he said.

“Collectively, these clinical programs have driven a best-in-class Stars readmission rate among national competitors,” he said.

Aetna sees more opportunities for reducing utilization over the long-term in readmission rates, and in a reduction in inpatient days. Unit price is still the driver in value-based purchasing, Bertolini said.

“I think value-based contracting is going to continue to be encouraged by even the current administration as a way of getting a handle on healthcare costs,” he said. “We have a healthy pipeline of opportunities. They will not all be joint ventures. I think there are other models emerging.”

UnitedHealthcare is increasingly helping states manage care for their complex, vulnerable and most costly populations, as well as assisting employers with programs to support the needs of retirees and employees with chronic conditions, according to CEO Stephen Hemsley in the insurer’s earnings report.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

From ‘Repeal’ to ‘Repair’: Campaign Talk on Health Law Meets Reality

Asked at a confirmation hearing two weeks ago if he was working with President Trump on a secret plan to replace the Affordable Care Act, Representative Tom Price, Mr. Trump’s nominee for secretary of health and human services, smiled broadly and answered: “It’s true that he said that, yes.”

The committee room, filled with health care lobbyists, consumer advocates and others with a vital stake in the future of the health care law, erupted with knowing laughter at Mr. Price’s careful formulation. For those following the issue closely, it has been an open secret that the fledgling Trump administration is a long way from fulfilling one of Mr. Trump’s most repeated campaign promises.

In a brief aside in an interview with Bill O’Reilly of Fox News broadcast before the Super Bowl on Sunday, Mr. Trump went further than he ever has in acknowledging the reality that any hope of quickly replacing the Affordable Care Act has been dashed.

“Yes, I would like to say by the end of the year, at least the rudiments, but we should have something within the year and the following year,” the president said.

That admission is sure to be a serious disappointment for the president’s most fervent supporters, who sent him to Washington believing that he would move quickly to dispatch the health law.

Soon after he was elected, Mr. Trump reacted to Republican suggestions of a delay in replacing the health act by insisting that repealing and replacing the law must happen at about the same time.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Repeal and Compete

Modern conservatism, at least in its pre-Donald Trump incarnation, evolved to believe in a marriage of Edmund Burke and Milton Friedman, in which the wisdom of tradition and the wisdom of free markets were complementary ideas. Both, in their different ways, delivered a kind of bottom-up democratic wisdom — the first through the cumulative experiments of the human past, the second through the contemporary experiments enabled by choice and competition.

In health care policy, however, conservatives tend to simply favor Friedman over Burke. That is, the right’s best health care minds believe that markets and competition can deliver lower costs and better care, and they believe it even though there is no clear example of a modern health care system built along the lines that they desire.

The dominant systems in the developed world, whether government-run or single-payer or Obamacare-esque, are generally statist to degrees that conservatives deplore. A few of them — notably Singapore’s, the beau ideal of right-wing health care wonks — do have distinctive elements that conservatives favor. But mostly they tend to be much more heavily regulated and subsidized than the system that conservative health policy wonks and policy-literate Republicans would like to see take over from Obamacare.

Which is not to say that the conservative health policy vision lacks empirical grounding. There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow, and good reasons to think that free-market competition produces more medical innovation than more socialized systems.

But still — there is no existing system on a national scale that looks like the health care system that Paul Ryan or Tom Price would design, no wisdom of developed-economy experience that proves that such a system would actually keep overall costs low and prevent too many people from being shut out of insurance markets. So embracing even the smartest conservative Obamacare alternative requires a not-precisely-Burkean leap of faith.

And this, in a nutshell, is why Republicans should give serious consideration to the proposal that Senator Bill Cassidy of Louisiana and Senator Susan Collins of Maine have just put forward as a possible health care reform alternative.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Senators Propose Giving States Option to Keep Affordable Care Act

WASHINGTON — Several Republican senators on Monday proposed a partial replacement for the Affordable Care Act that would allow states to continue operating under the law if they choose, a proposal meant to appeal to critics and supporters of former President Barack Obama’s signature health law.

But the plan was attacked by Democrats as a step back from the Affordable Care Act’s protections, and it was unlikely to win acceptance from conservative Republicans who want to get rid of the law and its tax increases as soon as possible. If anything, the proposal — by Senators Bill Cassidy of Louisiana, a medical doctor, and Susan Collins of Maine, a moderate Republican — may show how difficult it will be for Republicans to enact a replacement for the Affordable Care Act.

Legislation that can pass muster in the more conservative House may not win enough support in the Senate. A bill with broad appeal in the Senate may fail in the House.

Under the proposal, states could stay with the Affordable Care Act, or they could receive a similar amount of federal money, which consumers could use to pay for medical care and health insurance. “We are moving the locus of repeal to state government,” Mr. Cassidy said. “States should have the right to choose.”

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Senate Takes Major Step Toward Repealing Health Care Law

WASHINGTON — Senate Republicans took their first major step toward repealing the Affordable Care Act on Thursday, approving a budget blueprint that would allow them to gut the health care law without the threat of a Democratic filibuster.

The vote was 51 to 48. During the roll call, Democrats staged a highly unusual protest on the Senate floor to express their dismay and anger at the prospect that millions of Americans could lose health insurance coverage.

One by one, Democrats rose to voice their objections. Senator Maria Cantwell of Washington said that Republicans were “stealing health care from Americans.” Senator Ron Wyden of Oregon said he was voting no “because health care should not just be for the healthy and wealthy.”

The presiding officer, Senator Cory Gardner, Republican of Colorado, repeatedly banged his gavel and said the Democrats were out of order because “debate is not allowed during a vote.”

The final vote, which ended just before 1:30 a.m., followed a marathon session in which senators took back-to-back roll call votes on numerous amendments, an arduous exercise known as a vote-a-rama.

The approval of the budget blueprint, coming even before President-elect Donald J. Trump is inaugurated, shows the speed with which Republican leaders are moving to fulfill their promise to repeal President Obama’s signature domestic policy achievement — a goal they believe can now be accomplished after Mr. Trump’s election.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Muted Response From Health Lobby as Affordable Care Act Faces Repeal

WASHINGTON — The speed of Republican efforts to repeal the Affordable Care Act has stunned health industry lobbyists, leaving representatives of insurance companies, hospitals, doctors and pharmaceutical makers in disarray and struggling for a response to a legislative quick strike that would upend much of the American health care system.

The Senate is expected to take the first step by Thursday morning, approving parliamentary language in a budget resolution that would fast-track a repeal bill that could not be filibustered in the Senate. House and Senate committees would have until Jan. 27 to report out repeal legislation. Health insurance and health care for millions of Americans are at risk.

But far from reflecting the magnitude of the moment, the most prominent message from lobbyists that lawmakers saw in their first week back at work was a narrowly focused advertisement from the U.S. Chamber of Commerce demanding the repeal of “Obamacare taxes,” especially an annual fee imposed on health insurance companies to help pay for the expansion of coverage under the health law.

“More than 20 million people could lose their health insurance, and states could lose billions of dollars in Medicaid money,” said Kenneth E. Raske, the president of the Greater New York Hospital Association. But, he added, many health care executives “don’t want to get on the wrong side of the new administration or the Republican majority in Congress.”

Health care professionals are not totally silent, but industries that were integral to the creation of the Affordable Care Act in 2010 are keeping their voices down as Republicans rush to dismantle it. Some Republican lawmakers are openly fretting about their leaders’ repeal strategy, saying they must develop an Affordable Care Act replacement before they repeal it. Five Republican senators proposed on Monday to extend the deadline for drafting repeal legislation by five weeks, until March 3. One of the five, Senator Bob Corker of Tennessee, said the extra time would allow Congress and the Trump administration to “get the policy right” as they try to arrange a smooth transition to a new system of health coverage.

But the naysayers are getting no cover from a major lobbying and advertisement blitz like the ones that blanketed the airwaves in 2009 and 2010.

To block the repeal effort, said Senator Richard J. Durbin of Illinois, the No. 2 Senate Democrat, “we need two or three Republicans to join us.”

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Prices charged by NYC area hospitals vary widely, new report says

In the New York City area, hospitals with the biggest market share tend to charge the highest prices, according to a new report from the New York State Health Foundation.

The report, prepared by Marlborough, Mass.-based Gorman Actuarial, studied pricing in three regions of the state. In downstate New York, the highest-priced facilities negotiated prices with insurers that were 2.2 to 2.7 times more than what the lowest-priced hospitals fetched.

Facilities that are part of New York-Presbyterian, Northwell Health and Montefiore Health System were consistently among the highest-priced facilities, while NYC Health + Hospitals’ facilities were all in the two lowest-priced tiers, according to the report.

The report also found that safety-net hospitals that rely mostly on Medicare and Medicaid for revenue tended to receive lower reimbursements from commercial insurers as compared with hospitals that treat few publicly insured patients.

The study’s authors received unprecedented access to contracts between hospitals and insurance companies, granted by the state Department of Financial Services, which regulates insurers. They described the hospital industry as one where higher prices don’t necessarily translate into higher-quality care, and complex contracts may hinder insurers’ ability to hold down health care spending.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Affordable Care Act losses land N.J. health insurer in rehab

Health Republic Insurance of New Jersey,  one of 23 nonprofit consumer-operated and -oriented health plans established under the Affordable Care Act, has agreed to be taken over by regulators because of its “hazardous financial condition,” the New Jersey Department of Banking and Insurance said Monday.

The Newark, N.J., insurer lost $58.96 million in the six months ended June 30 and is expected to have a negative cash position of $17.3 million in January, according to the department’s petition for a takeover filed Monday in the Chancery Division of the Superior Court of New Jersey.

This year Health Republic tapped the last $10 million of a $94.3 million loan from the federal Centers for Medicare and Medicaid Services, the petition said. That loan was supposed to provide a capital cushion for the start-up.

Health Republic, which insures 35,950 people under individual and small-group plans, will continue paying claims this year while under rehabilitation by regulators, but will not offer plans for 2017.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary