Podcast: ‘What The Health?’ Hurricane Harvey And Health Costs

Podcast: ‘What The Health?’ Hurricane Harvey And Health Costs

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Hurricane Harvey and its torrential aftermath disrupted everything on the Texas and Louisiana coasts — including health care. Patients can expect months of chaos, as their providers scramble just to get back to work and sort out medical records. In addition, the storm may end up killing, injuring and sickening many more people, as toxins such as mold and chemical explosions take their toll.

Even so, Harvey could have been worse, says a panel of experienced health care journalists on the latest Kaiser Health News “What the Health?” podcast. That’s because the medical infrastructure, unlike in many previous national disasters, held up relatively well. Hospitals planned for flooding, to the point that underground tunnels connecting one to another could be sealed off with “submarine doors” to keep the water from invading every facility.

Julie Rovner of Kaiser Health News, Joanne Kenen of Politico and Margot Sanger-Katz of The New York Times also discuss what impact the relief effort in Washington could have on an already jampacked September agenda. The pressing need for money to rebuild in Texas and Louisiana could complicate and delay other important congressional decisions, including deliberations on stabilizing or changing the Affordable Care Act.

Also this week: an interview with KHN Editor-in-Chief Elisabeth Rosenthal, author of “An American Sickness,” about why medical care costs so much.

Despite jitters, some health insurers start to prosper

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It has not been a market for the faint of heart.

Supporters of the Affordable Care Act achieved a major victory this past week when, thanks to cajoling and arm-twisting by state regulators, the last “bare” county in the United States — in rural Ohio — found an insurer willing to sell health coverage through the law’s marketplace there. So despite earlier indications that insurance companies would stop offering coverage under the law in large parts of the country, insurers have now agreed to sell policies everywhere.

But a moment of truth still looms for the industry in the coming weeks under the law known as Obamacare. Companies must set their final plans and premiums by late September, even as the Trump administration continues to threaten to cut off billions of dollars in government subsidies promised by the legislation. Insurers are also awaiting Senate hearings set to start Sept. 6 for a hint of what steps, if any, lawmakers may take to stabilize the market.

With congressional Republicans’ yearslong quest to dismantle the Affordable Care Act dead for now, the fate of the landmark law depends in large part on the health of the insurance marketplaces and the ability of insurers to make a viable business out of selling coverage to individuals. When the law passed seven years ago, insurers saw a potential bonanza: tens of millions of brand-new paying customers, many backed by generous government subsidies and required by the new law to have health coverage. Now, about four years after the law’s marketplaces opened for business, most of the industry’s biggest players have pulled out.

Yet the continuing churn among insurers and the anxiety pervading the industry have obscured an encouraging fact: Many of the remaining companies have sharply narrowed their losses, analysts say, and some are even beginning to prosper.

“Outside of the noise,” the surviving companies “are seeing a path forward in this marketplace,” said Deep Banerjee, an analyst with Standard & Poor’s who has examined the financial results of more than two dozen Blue Cross insurers.

“It is still a new market,” he added, “and everyone is adjusting to it.”

The healthier business outlook has been achieved at a big cost to consumers. To stanch their losses, many companies raised their prices substantially for this year while narrowing their networks of providers to hold down costs.

In some cases, companies will seek even higher rates for 2018; the lone insurer left in Iowa is asking for a nearly 60 percent increase, on average.

Among the insurers now making money in the individual market and expanding is Centene, a for-profit company. Some of the Blue Cross insurers, including Health Care Service Corp., which operates plans in multiple states, including Texas and Illinois, and Independence Blue Cross, which has 300,000 customers in Pennsylvania and New Jersey, began to turn a profit in the market this year.

Oscar Health, a venture capital-backed insurance startup, lost roughly $200 million last year but, sensing a more promising future, plans to enter three more states and expand in California and Texas.

Centene made use of its experience, including setting up networks of hospitals and doctors that care for Medicaid patients, to sell coverage. The company now insures about 1.1 million people in the individual market.

“For 2018, we intend to grow this profitable segment of our business,” Michael Neidorff, the company’s chief executive, told investors last month.

Court Strikes Down Overtime Pay Rule

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The Department of Labor rule that would have compelled employers to pay overtime to millions of more workers has been struck down by a federal court in Texas.

Agreeing with business groups and the 21 states that had challenged the Obama administration rule, District Judge Amos Mazzant said the pay level in the changed rules was set too high.

What the Labor Department had done was to nearly double the minimum pay — from $455 to $913 a week — for determining what workers were exempt from overtime and what workers were entitled to it.

“This significant increase would essentially make an employee’s duties, functions, or tasks irrelevant if the employee’s salary falls below the new minimum salary level,” Mazzant said in his ruling.

While that was also true of the old salary threshold, the states and business groups that challenged the DOL argued the new pay level was set so high that it would sweep in millions of workers performing managerial, administrative and professional work.

Under the Fair Labor Standards Act, workers regardless of how much they earn must be paid overtime, except if they fall under certain exemptions, which largely define them as managers and white collar workers. But over the years, the DOL has adopted a financial test setting a minimum pay as a way to simplify the classification.

Thus, those making less than $455 a week are automatically to be paid overtime. And under the duties test, even workers earning more than the $455 a week are entitled to overtime unless they are “bona fide executive, administrative, professional (or) outside sales employees.” Some types of computer jobs also are included.

The revised salary threshold was to have gone into effect December 1 last year. But just weeks before the deadline, Judge Mazzant issued an injunction which left the old pay level — first adopted in 2004 — in place. The Labor Department appealed the injunction, then reversed course after the Trump administration took office. That left the injunction in place and freed the district court to rule on the merits.

In his ruling, Mazzant said the DOL can use a salary test, but only in conjunction with a duties test.

Carolinas HealthCare, UNC Health Care reveal intent to merge

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Health systems say they are entering negotiations to combine clinical, medical education and research units.

rolinas HealthCare System and UNC Health Care announced on Thursday that they are negotiating a merger that would transform them into a health system earning an estimated $14 billion in annual revenue.

Both organizations have signed a letter of intent to join their clinical, medical education and research resources and the letter kicks off a period of exclusive negotiations, with the goal of entering into final agreements by year’s end.

Together, the health systems would be focused on four strategic areas: increasing access and affordability, advancing clinical care expertise, growing their renowned academic enterprise and contributing to the region’s economic vibrancy.

“The opportunities to be a national model and to elevate health in North Carolina are nearly limitless,” Carolinas CEO Gene Woods said in a statement.

Woods would serve as chief executive officer of the new entity and UNC Health CEO William Roper, MD, would take on the role of executive director.

Woods noted that since the two organizations already serve almost 50 percent of all patients who visit rural hospitals in the state, they are well positioned to participate in the reinvention of rural healthcare and to transform cancer treatment.

Levine Cancer Institute, which is part of Carolinas, cares for more than 10,000 new patients a year, and more than a thousand participate in clinical trials through a ‘care-close-to-home’ model at some 25 locations throughout the Carolinas.

“Combined with UNC Health Care’s National Cancer Institute designation, with more than $70 million in joint cancer research grants for clinical trials, we will create a cancer network that is second to none in the country,” Woods said.

Roper added that merging would enable the combined organization to provide a wider range of care services, build clinical destination centers, advance care in pediatrics, transplants and other services and expand their medical education offerings.

Executives of the two health systems also said the partnership would give them the leverage to negotiate better deals with insurance companies and vendors, potentially saving millions of dollars.

The plans for consolidation would be submitted to the Federal Trade Commission for ruling on whether the size of the new entity might inflate the cost of healthcare in the state or limit the choice of doctors and hospitals.

HHS cuts ACA advertising budget by 90%

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The Department of Health and Human Services announced today it’s slashing the advertising and promotional budget for the Affordable Care Act for next year. It’s planning to spend $10 million to promote the law in the open enrollment period that starts in November — compared to the $100 million the Obama administration spent last year.

Why they’re doing it: On a conference call with reporters, HHS officials argued that last year’s promotional spending — which was doubled from the year before — was ineffective because signups for new customers actually went down. They also said the $10 million budget is more in line with what Medicare Advantage and Medicare Part D spend to promote their open enrollments.

Why it matters: The Trump administration is making cost-effectiveness a major theme this year, but it’s sure to be accused of undermining ACA enrollment, given all of the Trump administration’s battles to repeal the law — and given that it also cancelled advertising for the final days of last year’s open enrollment.

One more thing: HHS is also planning to cut spending on “navigators,” who are supposed to help people enroll, by tying their funding to their effectiveness in reaching their enrollment goals last year.

Houston hospitals may not be back to normal for a month

Houston hospitals may not be back to normal for a month

Amid the evacuation of approximately 1,500 patients from Houston-area hospitals, officials are commending the emergency response by health providers — while also cautioning that it may be weeks before the facilities are back to business as usual.

The SouthEast Texas Regional Advisory Council — which has overseen catastrophic medical operations since Hurricane Harvey as part of Houston’s emergency command center — estimates that nearly two dozen hospitals have evacuated patients by ambulance and airplane over the course of the past week.

“The storm was so huge it was uncertain what hospitals might be in harm’s way,” said Darrell Pile, chief executive officer of SETRAC. Had they known Harvey would grow into a Category 4 storm, Pile said, they would have staged evacuations three days in advance. But Harvey was unpredictable from the start — and grew stronger without much warning.

Evacuations have been slow not only because of the perils involved in moving patients but also because it has taken time to find other hospitals to accept them. “Some patients may have had gone to Dallas, San Antonio, Austin, or even Waco,” Pile said. “You’ve got to find the hospital to handle the unique needs of the patients you want to transfer.”

Evacuation numbers continued to climb on Tuesday. But Pile said numerous hospitals also scaled back or suspended plans for evacuations. One such facility was Ben Taub, one of Houston’s major safety-net hospitals, which only evacuated three patients after originally seeking to move all 350 patients after flooding occurred inside the hospital basement.

“In the case of Ben Taub, as the waters went down, and additional staff were able to arrive, they whittled down their list,” Pile said, speaking Wednesday. “They may even open back up to full service later today.”

Bryan McLeod, director of external and online communications at Harris Health System, said in a statement Tuesday afternoon that Ben Taub, the system’s largest hospital, is now seeking to “offload some of the patients that we currently have” in anticipation of a “surge of patients” expected as roads clear.

“I can only imagine the burden is going to increase,” said Vivian Ho, a health care economist with Rice University. “It’s going to get tough on them.”

Coordinated response

Pile praised the coordination of hospitals, first responders, and civic leaders. In other major storms elsewhere, he said, some hospitals have failed to communicate effectively; ambulances would bring patients to their doors even though the facilities might be unable to meet their needs.

By contrast, Pile said, roughly 25 hospitals affected by Harvey declared an “internal disaster” — a status that reflects a hospital facing problems in carrying out normal daily operations — that allowed SETRAC to pass along timely information along to first responders who could, in turn, divert patients toward care at hospitals capable of treating them.

“The majority of our hospitals stayed open,” Pile said. “The teamwork of hospitals and EMS agencies through our coalition kept it from becoming an even a bigger disaster.”

Pile hasn’t heard of any hospitals in the Houston area devastated to the point of shuttering — something that’s also occurred in other storm-ravaged cities. It’s because of that he believes nearly all Houston-area hospitals will be fully up and running by the end of September.

“This storm was paralyzing,” Pile said. “Within a month, [I expect] 90 to 95 percent of hospitals will be back in full service. That’s a first.”