Georgia Chapter, American Academy of Pediatrics: 2013

BY RICHARD HALICKS -
THE ATLANTA JOURNAL-CONSTITUTION

The state’s decision not to expand Medicaid under the Affordable Care Act will push more than 400,000 Georgians into a coverage gap in which they don’t qualify for Medicaid but also can’t afford to buy private health insurance, a new report said Wednesday.
The Kaiser Family Foundation’s report is less revelation than confirmation of what experts in the state have predicted. But it underscores that, for a large group in Georgia, Obamacare will have little meaning.

“The problem is that some of these individuals are going to need health care and they are going to continue to wind up in emergency rooms and at physicians’ offices with no way to pay for the care that they need,” said Bill Custer, a health care expert at Georgia State University.

“That care will continue to be paid for by local taxpayers and by people who do buy health insurance and pay for health care.”

The health care law sought to provide health insurance to nearly all the 49 million Americans who don’t have it. The law envisioned that the lowest-income people would go onto a massively expanded Medicaid program; moderate-income people with no insurance would shop on the Health Insurance Marketplace and, in many cases, qualify for a federal tax credit.

The Supreme Court ruled last year, however, that the federal government may not compel states to expand Medicaid. Twenty-six states opted out, and one of the pillars of Obamacare dissolved for half the country. As a result, people who earn between 100 percent and 400 percent of the federal poverty level can shop on the new insurance marketplace and potentially qualify for a federal subsidy. But people who earn less than 100 percent of the poverty level can’t, because the law assumed they would go on Medicaid.

More than 5 million people in the states that have declined to expand Medicaid will fall into the resulting coverage gap, Kaiser’s report said, with the greatest numbers in Texas, Florida and Georgia.

Rachel Garfield, senior researcher with the Kaiser Family Foundation, said the study’s goal was “to put a number on something people have been talking about for a long time: who’s falling through the cracks?”

Garfield said that 31 percent of the state’s uninsured adults would fall into the coverage gap.

The Kaiser Family Foundation, a respected source of independent information on health care, is not connected to Kaiser Permanente, the insurer.

Custer, at Georgia State, has been using state-level census data to study the state’s uninsured population. He has concluded that the Medicaid decision here will result in 400,000 to 500,000 being pushed into the coverage gap.

The federal government will pay 100 percent of the cost of the Medicaid expansion for three years, decreasing to 90 percent in later years. Gov. Nathan Deal maintains the longer-term costs to the state would be untenable.

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Wednesday, October 16, 2013

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Tuesday, October 15, 2013

Air pollution linked to low birthweight babies

Births From Fertility Treatments Hit 5 Million Mark: Report

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Physician assistants step up to fill holes in healthcare system - FierceHealthcare

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Senators Near Fiscal Deal, but the House Is Uncertain - NYTimes.com

House GOP floats a counter to Senate's debt idea | www.ajc.com

Monday, October 14, 2013

Lew Lays Out Impact of Debt Ceiling Inaction on Medicare, Medicaid

Lew Lays Out Impact of Debt Ceiling Inaction on Medicare, Medicaid

By John Reichard, CQ HealthBeat Editor

A debt ceiling deal may be in the works but it isn’t done yet, and any agreement may not last long. What would happen to Medicare and Medicaid if lawmakers don’t increase the nation’s borrowing power?

Judging from a Senate Finance Committee hearing this week, the answer is likely a big interruption in cash flow and sharply lower rates of payment.

The federal government “has numerous large payments that are due shortly after Oct. 17, when we will have exhausted our borrowing authority and will only have cash on hand to meet our obligations,” Treasury Secretary Jacob J. Lew testified on Thursday. In the last two weeks of October, “we have large payments to Medicare providers, Social Security beneficiaries, and veterans, as well as salaries for active duty members of the military.” These could be delayed, he said.

“Doctors receiving reimbursements under Medicare would likely continue to provide services on a timely basis, but they would be operating with significant uncertainty about when they would be paid by the government for their services,” he said.

“For millions of low-income Americans who rely on Medicaid for their health care, the federal government’s payments to states for the federal contribution would likely also be impacted. These providers still have to pay their doctors, nurses, and staff. But absent timely federal payments, many could face real liquidity challenges.”

Medicare beneficiaries could be hard hit in other ways, through delayed payments of Social Security checks and shrinking 401(k)s leaving them less able to pay for basic needs.

“For those waiting on benefits who need those funds to in order to refill their refrigerator, if that money doesn’t flow, they won’t go to that grocery store to shop.”

Lew noted that during the 2008 financial crisis retirements assets shrank. “Now if you create a crisis that causes assets to shrink in value, for retirees, they don’t have a lot of time to catch up.”

Lew did not dispute an assessment by the panel’s chairman Sen. Max Baucus, D-Mont., that payments by Medicare and other federal programs could fall to 70 to 80 percent of their current rates.

Lew rejected the idea advanced by some GOP lawmakers that the impact of failing to raise the debt ceiling could be reduced by paying some creditors and delaying payments to others.

“How can the United States choose whether to send Social Security checks to seniors or pay benefits to our veterans? How can the United States choose whether to provide children with food assistance or meet our obligations to Medicare providers?” he asked. “Prioritization is just default by another name,” he declared.

Republicans didn’t dispute Lew’s assessment of the impact of failing to lift the debt ceiling. But they bridled at his description of the current crisis as “manufactured,” saying Democrats have repeatedly failed to curb spending and that entitlement spending is on an unsustainable path.

“I think this is a manufactured crisis because we didn’t work on it yesterday,” said Sen. Michael B. Enzi, R-Wyo.

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Sunday, October 13, 2013

Cafeteria Debit Cards Linked to Less-Healthy School Lunches

Poultry Plants Linked to Salmonella Outbreak to Remain Open: USDA

Low-income families push for healthier lives for kids | Latest News | Columbus Ledger Enquirer

CDC quarantine staff reduced during shutdown | www.wsbtv.com

Geography Is Destiny When It Comes To Enrolling In Health Insurance Exchanges - Kaiser Health News

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New insurance networks cut back on doctors, hospitals | www.ajc.com

Thursday, October 10, 2013

Infections in newborns linked to later behavior problems

High Blood Pressure Common Among Overweight Kids

Study: Privately insured patients receive better hospital care - FierceHealthcare

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Negative Effects Noted for 2011 ACGME Requirements --Doctors Lounge

Are We Overmedicating Foster Care Children?

A new GAO report finds that states don't do a particularly effective job of monitoring kids on psychotropic meds.

BY: JONATHAN WALTERS | OCTOBER 8, 2013 GOVERNING MAGAZINE

Mental health issues are front and center in human services. Every day, caseworkers work in an environment where mental health services aren't as robust as they should be and where medication for kids in custody sometimes serves as a substitute for more appropriate care.

A good example of this is in New York state, where a crew of data hounds found that on Fridays, requests for psychotropic meds for kids in custody -- especially those in institutional settings -- spiked. Why? The unavoidable conclusion the data crunchers came to was that weekends at institutional facilities means fewer staff, and fewer staff means that properly attending to kids' needs is tougher. To be blunt about it, it's just cheaper and easier to drug kids than to take care of them in the most therapeutically appropriate way.

Of course, concerns over the use of medication among foster children certainly aren't exclusive to New York. AGovernment Accountability Office (GAO) report released at the end of last year highlights two alarming facts: First, children under state supervision generally aren't getting consistent, appropriate mental health care of any kind, even though mental health issues are a huge part of why kids wind up in state custody. Second, nearly 20 percent of children in foster care are taking psychotropic medication -- three times the rate of children on Medicaid and four times higher than kids covered by private health insurance.

Psychotropic meds, which are used to manage mood and behavioral disorders, can be effective, but the GAO report notes that using them wisely and well takes skill and close monitoring. And according to the GAO, kids who are prescribed medication don't usually receive timely follow-up visits. Furthermore, "mental health researchers and others have stated that there is a need for further research on the safety and effectiveness of anti-psychotics for children," the report's authors wrote, "particularly long-term effects."

Dorothy Miller and Kathleen Noonan, researchers with PolicyLab, the policy research arm of the Children'sHospital of Philadelphia, have been following the issue of psychotropic meds and children for several years. They are quick to emphasize that PolicyLab isn't against the use of medication for children. "If they work, and suddenly a kid is able to stay in school and do well, that's great," says Noonan. Adds Miller, "It's important and helpful to kids who need them, but they have to be monitored. and they should be accompanied by other therapeutic interventions."

Miller and Noonan agree with the GAO report's findings: The extent to which states do a good job of monitoring and tracking is very uneven. It is especially uneven in states where human services are administered by counties with state oversight, they note. But there are states that have become models for how to deal with the issue. Miller and Noonan point to Texas as such a state. "They made a bold, strong move in favor of kids," says Noonan.

Legislation signed by Gov. Rick Perry that went into effect last month expands oversight of psychotropic medication in two ways. First, the law requires that kids who've been prescribed medication be seen by their prescribing physician at least every 90 days. Second, the legislation requires that judges overseeing a child's foster care case be informed of behavioral and pharmacological treatments at all court hearings.

While it is clearly important to focus on the complicated mix of drugs and kids, perhaps it is more important to focus on the issue of mental health overall. The GAO report notes that "30 percent of foster children with a potential mental health need had not received any mental health services within the previous 12 months or since the start of the child's living arrangement, if less than 12 months."

There are lots of reasons for this, not the least of which is a lack of skilled mental health care professionals willing to deal with a population that's typically covered only by Medicaid. But some states are tackling that larger issue. Massachusetts' Child Psychiatry Access Program and Washington's Partnership Access Line are cited by the GAO as programs that have improved access to mental health care for kids in custody.

Still, we are way behind in providing the sort of appropriate, high-quality mental health services that will be necessary in the long run if we're going to really help kids escape multigenerational cycles of state involvement.

CDC Scales Back Surveillance Efforts in Face of Shutdown

CDC Scales Back Surveillance Efforts in Face of Shutdown

By Rebecca Adams, CQ HealthBeat Associate Editor

The government shutdown has forced the Centers for Disease Control and Prevention to dramatically scale back its monitoring of illnesses nationally and across the globe as well as its assistance to local health departments, agency director Tom Frieden said Tuesday.

“From outside of the agency, it may be very hard to understand just how incredibly disruptive this is for our efforts to protect Americans,” Frieden told HealthBeat in an interview.

Since the government shut down on Oct. 1, House Republicans passed stand-alone continuing funding bills for the National Institutes of Health and the Food and Drug Administration. They have not yet passed a separate continuing resolution for the CDC, although some House Republicans say they want to do so.

“We do not have a commitment yet” from House GOP leadership for a floor vote on a CDC funding measure, said Rep.Jack Kingston, R-Ga., who chairs the appropriations subcommittee that oversees Department of Health and Human Services funding and is pushing for a vote on a continuing resolution for the CDC. “I hope would happen sooner rather than later. A lot of it just depends on the calendar and the evolution of discussions. So as things develop, the leadership knows of my desire to move it. I think they’re sympathetic to it but they’re looking at some mega-picture scheduling issues.”

As far as the overall budget negotiations go, Kingston said, “We’re all in a holding pattern. Once you’re past the first day or two, then the next you know it’s a few weeks. On the rank and file level, I’m not optimistic it’s going to reopen anytime soon and the issues are tremendous.”

Senate Democrats and President Barack Obama have said they won’t accept a piecemeal approach to reopening the government and there is no indication when the House may pass a comprehensive funding resolution that Democrats will accept.

More than two-thirds of CDC employees — almost 9,000 people — were furloughed because of the shutdown. Overall, 52 percent of the Department of Health and Human Services was furloughed.

One example of problems that the CDC is not able to handle as fully as usual is a recent outbreak of salmonella that started in California but spread to 18 states and has caused roughly 300 illnesses. Because of the shutdown, only a small number of the CDC food borne disease staff have been allowed to work, although CDC officials have brought some of them back.

What worries Frieden most is the uncertainty of whether the government is missing another major disease outbreak or other threat.

“We’ve got free-floating anxiety,” said Frieden, adding, “Where is there a problem that’s spreading that we’re not recognizing?”

The agency has suspended the daily updates on global outbreaks it provides to other federal officials involved in public health and emergency response.

A telephone hotline for the public to report concerns about disease that routinely fielded 100 questions a day is now closed, Frieden said.

Nine of 10 global disease detection systems around the world have shut down, said CDC spokeswoman Barbara Reynolds. In a typical year, the centers respond to about 200 outbreaks and detect 6 to 10 new pathogens. Officials are particularly concerned about threats such as Ebola and new pathogens such as MERS-CoV and H7N9 flu that are circulating around the globe. But the centers — scattered throughout Latin America, Central Asia, Southeast Asia, the Middle East, South Africa and the Western Pacific regions — are blocked from doing active surveillance during the shutdown. Only a system in the Republic of Georgia, which is funded in a different way, remains active.

At international ports within the United States, the CDC staff has dropped from five to eight officials to one. As a result, the number of cases of disease that were reported dropped in half from the week before the shutdown to the first week of the shutdown.

About 85 percent of the CDC’s officials who monitor the spread of influenza throughout the nation are furloughed. The agency will no longer be able to produce its weekly snapshots informing medical providers and government officials where the outbreak is worsening, which can affect the distribution of flu shots and other supplies.

For some of the CDC’s operations, a couple of weeks of lost data can skew the results for an entire year.

Frieden likened the problem to one of a huge ship in the ocean that loses its navigational system. A couple of days without surveillance is a manageable.

“But if you lose it for a week or two, you can get very off track and it can get dangerous,” he said.

For every day that passes, Frieden and his top officials are reassessing whether they have the legal justification to bring back some furloughed workers.

“The challenge is this balancing act,” Frieden said. “We have to obey the law and have to do everything we can to protect people’s lives at the same time.”

For instance, the CDC is scheduled to inspect some labs that work with dangerous pathogens. “Do we do that or not?” Frieden said.