Obamacare Exchanges Already Forcing Private Insurers To Lower Their Premiums

From Oregon, which in many ways is fast becoming a model for how to do health reform right (their recently released low back pain guidelines are also excellent):

In a striking illustration of the promise that the health law holds for consumers, two Oregon private insurers vying to sell coverage on the state’s Obamacare insurance marketplace this October are reevaluating their opening bids for the plans’ monthly premiums. The reason? A side-by-side regional comparison of all proposed 2014 premiums for Oregon marketplace plans became public on Oregon’s marketplace website Thursday, and showed that the two insurers’ planned monthly premiums were far higher than other proposals. That raised fears among the companies’ officials that their plans wouldn’t be competitive on the market later this year, leading them to proactively request a rate reduction — and as more of Obamacare is implemented, state insurance commissioners expect that trend to continue:

“Posting rate comparisons company-by-company is a taste of what is to come,” says Cheryl Martinis of the Oregon Insurance Division.

Judging by the reaction, there’s already an impact.

Providence Health Plan on Wednesday asked to lower its requested rates by 15 percent. Gary Walker, a Providence spokesman, says the “primary driver” was a realization that the plan’s cost projections were incorrect. But he conceded a desire to be competitive was part of it.

A Family Care Health Plans official on Thursday said the insurer will ask the state for even greater decrease in requested rates. CEO Jeff Heatherington says the company realized its analysts were too pessimistic after seeing online that its proposed premiums were the highest.

“That was my question when I saw the rates was, ‘Can we go in and refile these?’” he said. “We’re going to try to get these to a competitive range.”

Although some insurers have been using Obamacare as an excuse to hike premiums despite record profits, such rate hikes have been rarer — and less extreme — since the law’s passage.

 

Provider Nondiscrimination Update

My editorial on the Affordable Care Act’s section that prohibits insurance companies from discriminating against classes of health care providers is now posted at Health Insights Today.

When fully implemented, this federal nondiscrimination policy will for the first time forbid any American health insurance company from refusing to cover services legally provided by a class of licensed health care practitioners (e.g., chiropractors, acupuncturists or clinical social workers) acting within the scope of their state licenses, if it covers those services when provided by a different class of practitioners (e.g., medical or osteopathic physicians). While the Affordable Care Act does not mandate equal payment for equal work (i.e., paying a chiropractor providing a service the same rate as an MD providing the same service), friend and foe alike understand that Section 2706 would make it illegal for insurers to cover any health service for one class of providers licensed to perform it while rejecting coverage for another also licensed to do so. (This nondiscrimination policy does not apply to the two largest government insurance plans—Medicare, which offers partial chiropractic coverage nationwide, and Medicaid, where coverage varies from state to state.)

This part of  the law goes into effect on January 1, 2014. Because it applies to all services that a practitioner is licensed to provide under state law, the implications are quite broad. I’ll be writing more about this in the near future, and presenting on the prevention and health promotion part of this equation at the March ACC-RAC conference in Washington, DC. (ACC-RAC is the annual Association of Chiropractic Colleges Research Agenda Conference).

Preventing Unintended Pregnancies and Abortions Through No Cost Contraception

Research evidence confirms beneficial effects of Obamacare’s contraception mandate.

Here’s the abstract of the article from Obstetrics and Gynecology, along with news and commentary from Think Progress Health:

A new study focusing on low-income women in St. Louis, MO concludes that expanding access to free contraception — just as the health care reform law does through its provision to provide birth control without a co-pay — leads to significantly lower rates of unintended teen pregnancy and abortion. Researchers found that when women weren’t prohibited by cost, they chose more effective, long-lasting forms of birth controland experienced much fewer unintended pregnancies as a result.

Researchers from the Washington University School of Medicine in St. Louis worked in partnership with the local Planned Parenthood affiliate to track over 9,200 low-income women in the St. Louis area, some of whom lacked insurance coverage, during a four-year Contraceptive CHOICE study. The CHOICE project simulated Obamacare’s birth control provision by allowing teens and women to select from the full range of FDA-approved contraceptive options and receive their preferred method at no cost. They found that birth rates among the teens who received free birth control in the CHOICE project were less than a fifth of the national teen birth rate — just 6.3 births per 1,000 teens, compared to 34.3 per 1,000 teens nationwide in 2010 — and abortion rates were less than half of both the regional and national rates.

The Supreme Court Speaks, Health Reform Continues

My editorial on the health reform law has been posted as part of the new issue of Health Insights Today, here. There’s a focus on the potential effects of the law for chiropractic and CAM, along with broader societal effects that will come with implementation (or repeal).

I hope you all click through to the full editorial. Here’s an excerpt.

First, the landmark provider nondiscrimination rule, Section 2706:

Since most readers of Health Insights Today have a strong interest in chiropractic and complementary and alternative medicine (CAM), let’s begin with the provisions directly related to those fields. First and foremost, the Affordable Care Act’s Section 2706 enacts for the first time a nationwide provider nondiscrimination policy, prohibiting insurance companies from denying coverage based on provider type for services provided by licensed health care practitioners. For example, this policy appears to indicate that if spinal manipulation or acupuncture (or any other service within a practitioner’s scope of practice) is covered when performed by a medical or osteopathic physician, insurers cannot have a policy denying such coverage when the service is performed by a chiropractor or acupuncturist. In the past, such discriminatory policies have had the effect of routing patients away from DCs, LAcs and other non-MD/DO practitioners.

The nondiscrimination rule is a landmark step forward and marks the first time that legislation applies such a policy across the entire nation. However, it does not bar all forms of discrimination. Importantly, insurers are not barred from paying some types of practitioners more than others for the same services. Chiropractors and a variety of other non-MD/DO practitioners sought such a ban but did not achieve it in this legislation. Success on that front will have to wait until later.

The full ramifications of Section 2706 will become clearer over time, as uncertainties are resolved through state and/or federal regulatory actions or litigation. For now, it is seen by chiropractic and CAM leaders and attorneys as the most significant piece of federal legislation in many years. The American Medical Association House of Delegates approved a resolution at its June 2012 national meeting that calls for the repeal of the nondiscrimination policy. While vigilance on the part of chiropractic and CAM organizations remains necessary, this AMA repeal effort faces a steep uphill climb unless the November 2012 election brings a president, House, and Senate that repeals the entire Affordable Care Act. Senate Republican Leader Mitch McConnell and House Speaker John Boehner have pledged to seek full repeal in early 2013. 

I ask each of our readers … please familiarize yourself with what is in the law, so that you will be able to evaluate all claims — pro or con — based on facts rather than distortions.  

 

 

 

Homebirth Midwives: Better Outcomes, Moving Toward Broader Acceptance

From John Weeks in the Huffington Post, positive news from out west:

“Midwives have a central focus in our strategic plan. We are hoping Washington State can double out-of-facility births in the next two or three years.”

The speaker was Jeff Thompson, M.D., MPH, chief medical officer of the state of Washington’s Medicaid program. He spoke in a taped interview for Symposium 2012 — Certified Professional Midwives and Midwifery Educators: Contributing to a New Era in Maternity Care. The gathering took place at Warrenton, Va.’s Airlie Center on March 18, 2012.

Thompson, a member of the National Advisory Council for Healthcare Research and Quality, works in the state with the most evidence-based exploration of the value and risks associated with direct-entry, licensed, non-nurse, midwives. His state’s heightened interest began with a state requirement in 1996 that health plans cover midwives. Washington, like 11 other states, presently also covers midwives via Medicaid.

If the certified professional midwives (CPMs) get their way in Congress, CPM services will be reimbursed by Medicaid in all 26 states where CPMs are licensed. Passage would significantly expand access to low-income women across the country. The Access to Certified Professional Midwives Act was introduced in the U.S. House of Representatives in 2011 by Congresswoman Chellie Pingree (D-ME). Passage would energize a slight bump in home births captured in recent data from the Centers for Disease Control.

Study Confirms Weight Loss Surgery Benefit for Diabetics

This new research confirms what was strongly suggested by earlier studies — that bariatric surgery leads to major weight loss, and either directly or indirectly leads to major improvements in the diabetic status of these formerly obese individuals.

I’ve lectured on this topic in my clinical nutrition class and it generally stimulates fruitful class dicsussion. Essentially, we’re looking at a dangerous condition that is almost entirely preventable through diet and exercise. We then see tens of millions of people failing at prevention and then finding themselves in a terrible situation. Once they’ve reached that point, this surgery clearly leads to much improved outcomes. It’s a classic example of radical measures being offered at a late stage for something that should never have reached that point.

It concerns me that we are now seeing, for what to my knowledge is the first time, a serious suggestion that bariatric surgery be provided to diabetics who are even slightly overweight. Again, where is the prevention?

The following quotes are from the National Public Radio coverage of the story, which I’m citing because unlike the MedPage story cited above, this one mentions recommending this surgery for diabetics with a Body Mass Index as low as 26, which is just barely overweight. (Obesity starts at a BMI of 30, and morbid obesity, which is usually when bariatric surgery is provided, starts at a BMI of 40).

This research raises an important question: Should diabetics start getting this operation more often? Paul Zimmet of the International Diabetes Federation, who co-authored an editorial accompanying the studies, thinks they should.

“Diabetes coupled with obesity is probably the largest epidemic in human history. At the moment, bariatric surgery is seen as a last resort. And it should be offered earlier in management,” Zimmet said in a telephone interview.

But others aren’t so sure. The new studies followed only about 200 patients. And while the operations appear to be pretty safe, there can be complications. And the complications can be serious.

“I think we need longer-term follow-up than what was done in these studies to make sure you’re not trading one problem for another,” said Vivian Fonseca of the American Diabetes Association.

Researchers are now testing whether the surgery works on diabetics who aren’t even obese — people with BMIs as low as 26. And doctors and patients are waiting to see if insurance companies will pay for the operations just to treat diabetes.

Earlier this year, I attended (and spoke) at a U.S. Department of Health and Human Services listening session here in Kansas City that focused on what services should be included in an essential benefits package under health reform. For me, the most unexpected part of the event was that of perhaps 30 presenters, four were bariatric surgeons. I was surprised, in part, because I was aware of the research supporting bariatric surgery and had assumed they were in no danger of being excluded.

Now, in light of this new research that was certainly in the pipeline at the time of the hearing, it occurs to me that their presence (which I assume will be duplicated in many other venues), may have been part of a concerted push for a major expansion of their services into the non-obese market.

… in the Real World

This Washington Monthly blog post, “The Affordable Care Act in the Real World,” frames the question in ways that should matter most, in terms of how people’s lives are actually affected by the health reform law.

A priest I knew many years ago once said to me, “Turning real human suffering into an abstraction is among the greatest sins.” .

My children now have health coverage through mine, and our family’s health will now sustain itself through my children’s 26th birthdays. A mouth full of cavities was treated, and vision has been a godsend, and my daughters have the ability to go to the doctor at $20 a pop, instead of the $150 a pop uninsured rate, and they don’t have to go willy-nilly to a clinic setting!

A dear friend of mine skirted death with a ruptured colon, had surgery to the tune of over $80,000 because they were uninsured. and worried about preexisting conditions when it came to reversing the colostomy, qualified for insurance so he doesn’t have to carry around a bag for the rest of his life.

Amen.