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About 15% of Americans with HIV don’t know they’re infected, CDC report says
http://www.latimes.com/science/sciencenow/la-sci-sn-hiv-infection-knowing-20171128-story.html
Half of the Americans recently diagnosed with HIV had been living with the virus for at least three years without realizing it, missing out on opportunities for early treatment and in some cases spreading it to others, according to a new report by the Centers for Disease Control and Prevention.
What’s more, of the 39,720 Americans newly diagnosed with HIV in 2015, one-quarter had been infected for seven years or more without knowing they were ill.
Among all 1.2 million Americans living with HIV in 2015, the CDC estimates that about 15% were unaware of their HIV-positive status. Those people are thought to be responsible for 40% of new transmissions of HIV, according to the study published Tuesday in the CDC’s Morbidity and Mortality Weekly Report.
The human immunodeficiency virus, or HIV, is responsible for causing AIDS. Infection used to be considered a death sentence, until antiretroviral medications capable of suppressing the virus came into broad use in the late 1990s.
For each of the new cases diagnosed in 2015, researchers estimated a rough time of infection on the basis of a patient’s level of disease progression. Based on patients’ initial count of infection-fighting CD4 cells, they gleaned how long the HIV virus likely had replicated unchecked. A normal range for CD4 cells lies between 500 and 1,500; a CD4 count below 200 brings a diagnosis of AIDS.
Although the median time between infection and diagnosis for all Americans was three years, there was considerable variability among patients of different racial and ethnic groups.
For instance, half of African Americans had been infected for 3.3 years when they were diagnosed, while the median time for whites was 2.2 years. This gap was seen despite the fact that African Americans were more likely than whites to have been tested for HIV in the previous year.
For Latinos, the median time to diagnosis was also 3.3 years; for Asian Americans, it was 4.2 years.
The authors of the CDC report surmised that the longer diagnosis delay among nonwhite racial and ethnic groups might reflect an observed trend: For whites, men who have sex with men are the predominant sources of HIV spread, but for other groups, sexual contact between men and women is responsible for a higher proportion of infections.
Age, too, was a key factor, with older patients more likely than younger ones to go years without knowing they were HIV-positive. Half of newly-diagnosed patients 55 and over were HIV-positive for 4.5 years or more without knowing it. Among those 34 and younger, the median delay between infection and diagnosis was about 2.5 years.
Fully half of people with undiagnosed HIV infection in 2015 were living in the South, the CDC said. States with the highest rates of undiagnosed HIV infection — between 16% and 19% — included Nevada, Arizona, Texas, Michigan, Iowa, Indiana, North Dakota and Wisconsin. New Jersey, Pennsylvania, Vermont and South Dakota and Idaho had the lowest rates, between 5% and 10%.
Overall, the three-year gap between infection and diagnosis actually represents progress. In 2011 — the last time the CDC took such measures — half of Americans newly diagnosed with HIV had been infected for 3.6 years or more.
That suggests that public health campaigns started by the CDC, including the “Testing Makes Us Stronger” push rolled out in 11 cities, have made inroads. Two CDC campaigns, launched in 2007 and 2011, set out to encourage testing and early HIV care on the part of African Americans and Latinos, and particularly among men who have sex with men.
Such public health efforts have increased rates of testing among many groups at high risk. Among men who have sex with men, 71% told surveyors they had been tested in the last year, as did 58% of people who inject drugs. Only 41% of heterosexual Americans at increased risk of HIV infection said they had been tested in the last 12 months.
Taking HIV medicine as prescribed allows people with the virus to live a virtually normal lifespan, generally without health complications. Managing one’s HIV infection with medication also significantly reduces the likelihood of transmitting the virus to sexual partners.
“The benefits are clear,” said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Prompt diagnosis is prevention. It is the first step to protecting people living with HIV and their partners.”
The CDC recommends testing all people between the age of 13 and 64 for HIV at least once in their lifetime, and people at higher risk for HIV — including IV drug users and sexual partners of infected persons — at least annually. Healthcare providers may find it beneficial to test some sexually active gay and bisexual men as frequently as every three to six months.
Dr. Brenda Fitzgerald, the CDC’s director, called the new statistics “more encouraging signs that the tide continues to turn on our nation’s HIV epidemic.”
HIV is being diagnosed more quickly, Fitzgerald said. The number of people who have the virus under control is up, and annual infections are down, she added.
“While we celebrate our progress, we pledge to work together to end this epidemic forever,” she said.
Seven Ways Patients Can Protect Themselves From Outrageous Medical Bills
Experts in reducing charges for medical services say patients need to push for detailed answers up front about the true costs of their care.
A doctor offers a surgical add-on that leads to a $1,877 bill for a young girl’s ear piercing. A patient protests unnecessary scans to identify and treat her breast cysts. A study shows intensive-care-level treatment is overused.
ProPublica has been documenting the myriad ways the health system wastes money on unnecessary services, often shifting the costs to consumers. But there are ways patients can protect themselves.
We consulted the bill-wrangling professionals at Medliminal, one of a number of companies that negotiate to reduce their clients’ charges for a share of the savings. After years of jousting with hospitals, medical providers and insurers, their key advice for patients and their families is to be assertive and proactive.
Here are seven steps patients can take to protect themselves:
- Make sure the proposed test or treatment is necessary. Ask what might happen if you didn’t get the service right now.
- Ask the price before the test or treatment. (Prices may not be negotiable if they’re set by an insurance company contract.)
- Write on your financial agreement that you agree to pay for all treatment provided by providers who are in-network, which means they have set rates with your insurance company. (The medical providers may not accept the altered form.)
- If possible, get the billing codes the medical provider will use to charge you and contact your insurance provider to make sure that each code is covered.
- If you are having a procedure see if you can get the National Provider Identifier and/or Tax ID number of the surgeons, anesthesiologists and their assistants. Contact your insurance company to see if the providers are in-network, which results in the negotiated rates.
- Demand an itemized bill, and then look at each specific charge. Medical bills are often riddled with errors.
- Ask if the provider has a financial assistance policy, which could result in a sliding scale discount. Many people qualify, and discounts can range from 20 to 70 percent.
UnitedHealth’s Optum Launches $250M Fund To Invest In Start-Ups
The fast-growing Optum unit of the nation’s largest health insuance company is escalating its interest in startup and innovative ventures, launching a $250 million fund to develop early-stage healthcare companies.
Optum Ventures will be a venture fund “focused on investing in startup and early-stage companies whose innovations will help advance the health care system,” UnitedHealth and Optum executives announced at their investor conference in New York.
Optum Ventures investments will include digital health firms “that use data and insights to help improve consumers’ access to health care services and how care is delivered and paid for, and that make the health care system more reliable and easier to navigate.”
The Optum unit of UnitedHealth Group is already a key driver to the company’s overall growth. The insurer’s Optum line of businesses has generated throughout the double-digit percentage earnings growth across all product and service lines.
Optum provides pharmacy benefits management and technology services and also operates clinics and doctor’s offices. Its growth in the last year helped UnitedHealth overcome hundreds of millions of dollars in losses on sales of individual coverage under the Affordable Care Act.
Now, the growth of Optum will expand into new areas to feed the overall parent’s efforts.
“Optum Ventures is uniquely positioned to help develop and grow startups and early-stage companies through capital investment, Optum’s decades of experience in health care, and our access to the health care marketplace,” said Larry Renfro, CEO of Optum who will be the Managing Partner of Optum Ventures. “Optum Ventures will be the partner of choice for companies developing innovations that help make health care work better for everyone.”
Optum Ventures already has a list of early investments that includes: Apervita, which is developing a cloud-based technology to help speed the delivery of healthcare; Buoy Health, which executives say is working on an “artificial intelligence-powered digital health assistant” to help patients; and other health and analytics startups.
Optum Ventures, which will have offices in Boston and Menlo Park, Calif., will operate as a separate independent company funded by Optum under the leadership of partners A.G. Breitenstein and Virginia McFerran, who both have a history of involvement in health and technology. “Breitenstein and McFerran have years of experience in starting, advising and leading innovative health care enterprises,” Optum said in a statement.
Trinity Health’s operating income nearly doubles in most recent quarter
Livonia, Mich.-based Trinity Health ended the first quarter of fiscal year 2018 with operating income of $80 million, nearly double the operating income of $43.3 million the 93-hospital health system recorded in the same period of the year prior, according to recently released bondholder documents.
Trinity Health said revenues increased 2.9 percent year over year to $4.4 billion in the first quarter of fiscal year 2018. The revenue growth was largely attributable to higher patient volumes and payment rates. Trinity Health said patient volume increased year over year in 11 of its 20 regional markets.
After factoring in expenses, which increased 2.1 percent year over year, as well as losses on interest rate swaps and lower investment income, Trinity ended the first quarter of fiscal year 2018 with net income of $399 million. That’s compared to the first quarter of fiscal year 2017, when the health system posted net income of $467.5 million.
Marketplace Confusion Opens Door To Questions About Skinny Plans
Marketplace Confusion Opens Door To Questions About Skinny Plans
Consumers coping with the high cost of health insurance are the target market for new plans claiming to be lower-cost alternatives to the Affordable Care Act that fulfill the law’s requirement for health coverage.
But experts and regulators warn consumers to be cautious and are raising red flags about one set of limited benefit plans marketed to individuals for as little as $93 a month. Offered through brokers and online ads, the plans promise to be an “ACA compliant, affordable, integrated solution that help … individuals avoid the penalties under [the health law].”
Legal and policy experts have raised concerns that the new plans could leave buyers incorrectly thinking they are exempt from paying a penalty for not having coverage. Additionally, they say, plans sold to individuals must be state-licensed.
Apex Management Group of Oak Brook, Ill., and Pennsylvania-based Xpress Healthcare have teamed up to offer the plans, and executives from both companies say they don’t need state approval to sell them.
In California, Insurance Commissioner Dave Jones has already asked for an investigation.
“Generally speaking, any entity selling health insurance in the state of California has to have a license,” Jones said earlier this month. “I have asked the Department of Insurance staff to open an investigation with regard to this company to ascertain whether it is in violation of California law if they are selling it in California.”
Asked about a possible investigation, Apex owner Jeffrey Bemoras recently emailed a statement saying the firm is not offering the plans to individuals in California.
Bruce Benton, spokesman for the California Association of Health Underwriters, which represents the state’s health insurance agents, said his organization has not heard of Apex or Xpress and does not know of anybody who is selling their skinny plans in California.
These skinny plans — sold for the first time to individuals in other states across the country — come amid uncertainty over the fate of the ACA and whether President Donald Trump’s administration will ease rules on plans in the individual market. Dozens of brokers are offering the plans.
“The Trump administration is injecting a significant amount of confusion into the implementation of the ACA,” said Kevin Lucia, project director at Georgetown University’s Health Policy Institute. “So it doesn’t surprise me that we would have arrangements popping up that might be trying to take advantage of that confusion.”
David Shull, Apex’s director of business development, said “this is not insurance” and the plans are designed to meet the “bulk of someone’s day-to-day needs.”
In his email, Bemoras wrote that “Apex Management group adheres closely to all state and federal rules and regulations surrounding offering a self-insured MEC [minimal essential coverage] program.” He added: “We are test marketing our product in the individual environment, [and] if at some point it doesn’t make sense to continue that investment we will not invest or focus in on that market.”
Price-Tag Appeal, But What About Coverage?
The new plans promise to be a solution for individuals who say that conventional health insurance is too expensive. Those looking for alternatives to the ACA often earn too much to qualify for tax subsidies under the federal law.
Donna Harper, an insurance agent who runs a two-person brokerage in Crystal Lake, Ill., found herself in that situation. She sells the Xpress plans — and decided to buy one herself.
Harper says she canceled her BlueCross BlueShield plan, which did meet the ACA’s requirements, after it rose to nearly $11,000 in premiums this year, with a $6,000 annual deductible.
“Self-employed people are being priced out of the market,” she said, noting the new Xpress plan will save her more than $500 a month.
The Xpress Minimum Essential Coverage plans come in three levels, costing as little as $93 a month for individuals to as much as $516 for a family. They cover preventive care — including certain cancer screenings and vaccinations — while providing limited benefits for doctor visits, lab tests and lower-cost prescription drugs.
There is little or no coverage for hospital, emergency room care and expensive prescription drugs, such as chemotherapy.
Harper said she generally recommends that her clients who sign up for an Xpress plan also buy a hospital-only policy offered by other insurers. That extra policy would pay a set amount toward in-patient care — often ranging from $1,500 to $5,000 or so a day.
Still, experts caution that hospital bills are generally much higher than those amounts. A three-day stay averages $30,000, according to the federal government’s insurance website. And hospital plans can have tougher requirements. Unlike the Xpress programs, which don’t reject applicants who have preexisting medical conditions, most hospital-only plans often do. Harper says she personally was rejected for one.
“I haven’t been in the hospital for 40 years, so I’m going to roll the dice,” she said. And if she winds up in the hospital? “I’ll just pay the bill.”
About 100 brokers nationwide are selling the plans, and interest “is picking up quick,” said Edward Pettola, co-owner and founder of Xpress, which for years has sold programs that offer discounts on dental, vision and prescription services.
Caveat Emptor
Experts question whether the plans exempt policyholders from the ACA’s tax penalty for not having “qualified” coverage, defined as a policy from an employer, a government program or a licensed product purchased on the individual market.
The penalty for tax year 2017 is the greater of a flat fee or a percentage of income. The annual total could range from as little as $695 for an individual to as much as $3,264 for a family.
Trump issued an executive order in October designed to loosen insurance restrictions on lower-cost, alternative forms of coverage, but the administration has not signaled its view on what would be deemed qualified coverage.
Responding to questions from KHN, officials from Apex and Xpress said their plans are designed to be affordable, not to mimic ACA health plans.
“If that is what we are expected to do, just deliver what every Marketplace plan or carriers do, provide a Bronze, Silver Plan, etc. it would not solve the problem in addressing a benefit plan that is affordable,” the companies said in a joint email on Nov. 14. “Individuals are not required to have an insurance plan, but a plan that meets minimum essential coverage, the required preventive care services.”
Bemoras, in a separate interview, said his company has been selling a version of the plan to employers since 2015.
“As we see the political environment moving and wavering and not understanding what needs to be done, the individual market became extremely attractive to us,” Bemoras said.
Still, experts who reviewed the plans for KHN said policies sold to individuals must cover 10 broad categories of health care to qualify as ACA-compliant, including hospitalization and emergency room care, and cannot set annual or lifetime limits.
The Xpress/Apex programs do set limits, paying zero to $2,500 annually toward hospital care. Doctor visits are covered for a $20 copayment, but coverage is limited to three per year. Lab tests are limited to five services annually. To get those prices, patients have to use a physician or facility in the PHCS network, which says it has 900,000 providers nationwide. Low-cost generics are covered for as little as a $1 copay, but the amount patients pay rises sharply for more expensive drugs.
“I’m very skeptical,” said attorney Alden J. Bianchi of Mintz Levin, who advises firms on employee benefits. “That would be hard [to do] because in the individual market, you have to cover all the essential health benefits.”
The details can be confusing, partly because federal law allows group health plans — generally those offered by large employers — to provide workers with self-funded, minimal coverage plans like those offered by Apex, Bianchi said.
Apex’s Shull said in a recent email that the firm simply wants to offer coverage to people who otherwise could not afford an ACA plan.
“There will be states that want to halt this. Why, I do not understand,” he wrote. “Would an individual be better off going without anything? If they need prescriptions, lab or imaging services subject to a small copay, would you want to be the one to deny them?”
Some consumers might find the price attractive, but also find themselves vulnerable to unexpected costs, including the tax liability of not having ACA-compliant coverage.
Harper, the broker who signed up for one of the plans, remains confident: “As long as Xpress satisfies the [mandate], which I’m told it does, my clients are in good hands. Even if it doesn’t, I don’t think it’s a big deal. You are saving that [the tax penalty amount] a month.”
Five health-care fights facing Congress in December
Health-care issues are at the top of Congress’s hefty December to-do list.
Republicans spent much of the year on a failed bid to repeal and replace ObamaCare. That’s left several programs and taxes hanging in the balance as the year draws to a close, in addition to the latest health-care drama thrust into the GOP tax-reform debate.
Here are five of the biggest health-care issues Congress will face next month.
Will Republicans repeal the individual mandate?
Weeks ago, Sen. Tom Cotton (R-Ark.) began to push for a repeal of the individual mandate to be added into the GOP tax overhaul. It worked, at least in the upper chamber.
To Democrats’ dismay, the Senate Finance Committee passed a tax-reform bill before breaking for Thanksgiving that included repeal of the ObamaCare mandate that Americans without health insurance pay a fee.
The House already passed a bill out of its chamber on a party-line vote — legislation that didn’t include repealing the individual mandate. But leaders have said they’re open to it if the Senate is able to muster enough votes to pass tax reform with the repeal.
It appears that the upper chamber might be able to pull it off.
Sen. Susan Collins (R-Maine) has said the repeal shouldn’t be in the bill, but hasn’t said she would vote against the tax-reform bill if it was included. Sen. John McCain (R-Ariz.) hasn’t rung any alarms that he would vote against the bill, saying he wants to see the whole package before deciding, and applauding the Finance Committee for holding hearings on the measure.
In a boost to the effort, Sen. Lisa Murkowski (R-Alaska) wrote in the Fairbanks Daily News-Miner Tuesday that she backs repealing the individual mandate. All three senators voted against a scaled-down version of an ObamaCare repeal bill in late July, effectively sinking the measure.
GOP leaders have signaled that a bipartisan stabilization bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) could pass if the individual mandate is repealed. On Sunday, Collins said she would like the Alexander-Murray bill, along with a bipartisan bill to provide funding for high-cost enrollees she introduced, to pass before tax reform does.
Sen. John Cornyn (Texas), the Senate’s No. 2 Republican, said that the deal is “likely” to be included in an end-of-the-year package.
But that effort could face resistance from Democrats, who have balked at repealing the individual mandate, and say that runs counter to the bipartisan spirit that Alexander-Murray was crafted under.
Will Congress reauthorize critical health programs it let lapse?
It’s been nearly two months since funding for the Children’s Health Insurance Program (CHIP) and community health centers expired. Advocates are holding out hope that lawmakers will reauthorize both before the new year, but are frustrated that Congress failed to reauthorize the dollars by a Sept. 30 deadline.
Roughly 9 million low- and middle-income children rely on CHIP for health coverage. Some states have asked the Centers for Medicare and Medicaid Services for funding to hold them over in the interim, and the agency has awarded about $607 million in redistributed funds to states and U.S. territories.
Community health centers have been crafting contingency plans as they wait for Congress to reauthorize a fund that amounts to 70 percent of their federal funding. These centers are a large source of comprehensive primary care for over 26 million of the nation’s most vulnerable people.
Some have already instituted hiring freezes. Others are examining which services they could cut or scale back. If the funding lapses, staff could be laid off, facility renovations or expansions could be canceled or delayed and hours of operation could be reduced.
Though the uncertainty has caused angst for health centers, they haven’t yet seen a monetary impact. But that impact could come on Jan. 1 for 25 percent of centers and on Feb. 1 for another 17 percent, because that’s when their new grant periods begin.
The Health Resources and Services Administration plans to help out on a prorated, monthly basis, according to a spokesperson.
But advocates hope it won’t come to that. The House passed a bill to fund CHIP for five years and community health centers for two. It passed on a party-line vote, as Democrats criticized how Republicans planned to pay for the bill.
The Senate Finance Committee passed a bipartisan, five-year CHIP extension, but hasn’t yet released offsets. Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) have introduced a bipartisan bill to extend community health center funding for five years.
Will Congress fund the opioid response?
In late October, President Trump declared the opioid epidemic a national public health emergency.
But the move didn’t come with millions of new dollars to combat the crisis, nor did it include a funding ask to Congress. This has frustrated Democrats and many advocates, who say a significant infusion of federal funds is needed to make an emergency declaration effective.
It’s not clear if money will come.
Senate Democrats introduced a bill to provide $45 billion over 10 years to address the crisis — a nod to a similar amount of funding Republicans included in an ObamaCare repeal bill, in part to attempt to offset changes to Medicaid.
But Republicans haven’t named a dollar figure. With a jam-packed December, advocates worry the new year could begin without more money to help curb the crisis of prescription painkillers and heroin that’s ravaged the country.
As for the administration, Hogan Gidley, White House deputy press secretary, said in a statement that “we will continue discussions with Congress on the appropriate level of funding needed to address this crisis” but didn’t say how much that would be.
What does Congress do on ObamaCare taxes?
Behind the scenes, industry lobbyists are working hard to ensure several ObamaCare taxes won’t kick in come January.
The medical device industry wants a full repeal of a 2.3 percent tax on the sale of certain medical devices, such as pacemakers and MRI machines.
“We feel we’re very much in play and that is for full repeal,” said Greg Crist, a spokesman for the medical device trade association AdvaMed. “We’re talking with staff and leadership for the right vehicle.”
The insurance industry is pushing for at least a one year delay of the health insurance tax. Both taxes were delayed in a 2015 spending bill, though for different durations; the medical device tax was paused for two years, and the health insurance tax for just 2017.
Ways and Means Chairman Kevin Brady (R-Texas) addressed the ObamaCare taxes during a marathon hearing on House Republican’s tax-reform bill, saying the legislation wasn’t the right vehicle to repeal or delay them. But, he added, he is working to do so by the end of the year.
“As the ranking member and members on both sides of the aisle know — we have been working with them over the past month to find a path forward,” Brady said. “We are working on common-sense temporary and targeted relief from many of these taxes to be acted on in the House before the end of the year.”
Employer groups are also pushing for a delay of the so-called Cadillac tax, a 40 percent fee levied on pricey employer-sponsored plans slated to begin in 2020. Critics of the tax argue a delay is needed now because employers will begin planning for 2020 next year.
Will Congress help Puerto Rico fund its Medicaid program?
The storm-ravaged island territory could be out of federal dollars for its Medicaid program in a matter of months.
Federal disaster funds haven’t been earmarked to go to the joint state-federal health insurance program for low-income and disabled Americans. On Nov. 17, the White House asked Congress for $44 billion for disaster relief. The notice mentioned Puerto Rico’s Medicaid program, but didn’t put a dollar amount on it.
“Though the Administration expects to work with Puerto Rico and the Congress on medium-term liquidity issues through a future request, the Administration is aware of legislation being considered to address Medicaid sooner,” the letter stated.
Puerto Rico Gov. Ricardo Roselló has asked for $1.6 billion annually for five years. Democratic lawmakers and advocates have been pushing to fulfill that request.
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HENRY KOTULA 