Could Trump loss spur ACA deal with Clinton?

http://www.modernhealthcare.com/article/20160806/MAGAZINE/308069967?utm_campaign=KHN:%20Daily%20Health%20Policy%20Report&utm_source=hs_email&utm_medium=email&utm_content=32680906&_hsenc=p2ANqtz-8nP5ZXs-xTx8YLmsU1xy2D7TA9W-YZGGEprO1iMVPktjne-ajvgjdNOgE7EhYYIrcsUGRYbMfLZjXQgfzB6vtOj6qj7w&_hsmi=32680906

With Donald Trump’s presidential campaign faltering, Republican health policy experts are gaming out Plan B for working with a Hillary Clinton administration to achieve conservative healthcare goals.

Their focus is on a possible “grand bargain” that would give conservative states greater flexibility to design market-based approaches to make coverage more affordable and reduce spending in exchange for covering low-income workers in non-Medicaid expansion states. A key element, conservative experts say, would be for a Clinton administration to make it easier for states to obtain Section 1332 waivers under the Affordable Care Act. Those waivers allow states to replace the law’s insurance exchange structure with their own innovative models.

While none are ready to sign on yet, congressional Republicans would have to agree to shore up the ACA’s struggling exchange markets by paying insurers for enrolling sicker populations and continuing to help low-income enrollees’ with cost-sharing responsibilities. House Republicans are challenging the cost-sharing subsidies in court.

Elderly Hospital Patients Arrive Sick, Often Leave Disabled

Elderly Hospital Patients Arrive Sick, Often Leave Disabled

Ron Schwarz, 79, was hospitalized after falling in the shower. Schwarz is a patient in a special ward at the San Francisco General Hospital known as the Acute Care for the Elderly unit, or ACE. (Heidi de Marco/KHN)

Not A Priority

Hospitals can be hazardous places for elderly patients, who are at increased risk of falling, drug-induced injury and confusion.

But as the nation’s senior population grows, many facilities are ill-equipped to address their unique needs.

Kaiser Health News visited hospitals around the country, reviewed data and interviewed dozens of patients, family members and health providers to document the extent of the problem and highlight possible solutions.

How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.

Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.

California Doctors And Hospitals Tussle Over Role Of Nurse-Midwives

http://khn.org/news/california-doctors-and-hospitals-tussle-over-role-of-nurse-midwives/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=32615438&_hsenc=p2ANqtz-8ImMNfbaboVFE98SiaPvCTZ4yTpxm1jcBnGL_CYvqxvYvZwPQNFNecHArS_UOxcmh7DeSB55A1rlnC8y5IjYTjPqcSTg&_hsmi=32615438

mother-baby-hospital_770

A California bill that would allow certified nurse-midwives to practice independently is pitting the state’s doctors against its hospitals, even though both sides support the main goal of the legislation.

The California Hospital Association and the California Medical Association, which represents doctors, agree that nurse-midwives have the training and qualifications to practice without physician supervision.

But they differ sharply over whether hospitals should be able to employ midwives directly — a dispute the certified nurse-midwives fear could derail the proposed law.

The bill would override an existing law that requires certified nurse-midwives to practice under the supervision of medical doctors. California is one of only six states that requires full supervision. Several other states mandate other forms of collaboration, such as in prescribing medications.

The American College of Nurse-Midwives has been chipping away for decades at state laws that require physician supervision, and it has finally passed the tipping point nationally, said Jesse Bushman, director of federal government affairs for the organization. Nurse-midwives aren’t seeking permission to go off and do whatever they want without consulting anyone, Bushman said. “They’re just asking to be able to do what they are trained to do.”

In states where nurse-midwives can practice independently, there is more access to care, he said, citing a recent report published by the George Washington University’s Jacobs Institute of Women’s Health.

There are more than 11,200 nurse-midwives around the nation, including about 1,200 in California. They provide maternity care, family planning services and other primary care for women.

 

NIH to begin testing Zika vaccine in humans

https://www.washingtonpost.com/news/to-your-health/wp/2016/08/03/nih-to-begin-testing-zika-vaccine-in-humans/?tid=hybrid_collaborative_3_na

As the Zika virus continues its spread, infecting people in more than 50 countries and threatening fetal development in pregnant women, scientists have been racing to develop an effective vaccine for the disease.

Federal researchers on Wednesday announced a milestone in that effort: their first clinical trial in humans.

The trial will involve at least 80 healthy volunteers between ages 18 and 35 at three locations around the United States, including at the National Institutes of Health Clinical Center in Bethesda. The main goal of the study will be to evaluate the vaccine’s safety and to see whether it generates an immune-system response in patients. If those early results are positive, researchers hope to began a larger-scale trial in Zika-affected countries in early 2017.

“A safe and effective vaccine to prevent Zika virus infection and the devastating birth defects it causes is a public health imperative,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a statement. “NIAID worked expeditiously to ready a vaccine candidate, and results in animal testing have been very encouraging. We are pleased that we are now able to proceed with this initial study in people. Although it will take some time before a vaccine against Zika is commercially available, the launch of this study is an important step forward.”

3 possibilities for the future of the ACA exchanges

http://www.fiercehealthcare.com/payer/3-possibilities-for-future-aca-exchanges?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWldRd1kyUXpNalUwWXpFeCIsInQiOiJaWkJVWkdKWG9DSFJwYytCZmVHV1JKcFhVd1lZbUlHS1JjZTZHZWI2ZDl3dU1XNU5oTWpCY3lSU3BYaWtyZXVyeGZmbDdyTVFHWk5OQUhEQzhlZkdlNm9lTnE3Y2M2elhcLzRrN3F5aXFKXC9RPSJ9

With health insurers struggling to turn a profit on the Affordable Care Act exchanges and premiums likely to rise, many have wondered what the future will hold for this prominent feature of the Obama administration’s healthcare reform law.

This week, Aetna became the latest major insurer to indicate it will re-evaluate its participation in the ACA marketplaces amid climbing financial losses that mirror those experienced by UnitedHealth, Humana and much smaller consumer operated and oriented plans.

What’s more, the cost of the ACA’s “benchmark” silver plan will increase by a weighted average of about 9 percent in 2017, compared to a 2 percent average increase in 2016. And in some areas of the country, insurers have requested steep rate increases–as much as 60 percent–for their exchange plans.

Colorado campaign supporting universal healthcare ballot measure enlists Bernie Sanders

Colorado campaign supporting universal healthcare ballot measure enlists Bernie Sanders

Getty Images/ Jeff Mitchell

Backers of ColoradoCare — the state ballot initiative that would establish universal healthcare in Colorado — think they have the perfect job for former presidential candidate Sen. Bernie Sanders.

With the Democratic National Convention in Philadelphia behind him, Sanders “comes to Colorado and campaigns for single-payer — and we win,” said T.R. Reid, one of the architects of ColoradoCare. The initiative aims to provide every resident of Colorado with affordable health insurance. Sanders made universal coverage one of the cornerstones of his presidential bid.

The proposal comes with a $38 billion annual price tag — to be paid by a tax on workers and businesses. The program would eliminate the need for insurance premiums and deductibles, and proponents claim it would save the state and individuals a lot of money.
Reid said the backers of ColoradoCare have pitched Sanders’ team, hoping he will campaign on behalf of the measure that will come before voters in November.

Sanders has already championed the issue in the state — he pushed for a single-payer system during his Democratic primary campaign in Colorado. It was one of his key healthcare positions, and it got thousands of his supporters cheering at an event in Denver in February.

Long-term care costs force many seniors into Medicaid

Long-term care costs force many seniors into Medicaid

culture change in nursing homes

Donna Nickerson spent her last working years as the activity and social services director at a Turlock, California, nursing home.

But when she developed Alzheimer’s disease and needed that kind of care herself, she and her husband couldn’t afford it: A bed at a nearby home cost several thousand dollars a month.

“I’m not a wealthy man,” said Nickerson’s husband Mel, a retired California State University-Stanislaus professor. “There’s no way I could pay for that.”

Experts estimate that about half of all people turning 65 today will need daily help as they age, either at home or in nursing homes. Such long-term care will cost an average of about $91,000 for men and double that for women, because they live longer.

In California and across the U.S., many residents can’t afford that, so they turn to Medicaid, the nation’s public health insurance program for low-income people. As a result, Medicaid has become the safety net for millions of people who find themselves unable to pay for nursing home beds or in-home caregivers. This includes middle-class Americans, who often must spend down or transfer their assets to qualify for Medicaid coverage.

Medicaid, known as Medi-Cal in California, was never intended to cover long-term care for everyone. Now it pays for nearly 40 percent of the nation’s long-term care expenses, and the share is growing. As Baby Boomers age, federal Medicaid spending on long-term care is widely expected to rise significantly — by nearly 50 percent by 2026.

Election 2016: Big Pharma’s $70 million tops California campaign contributions

http://www.mercurynews.com/health/ci_30117115/election-2016-big-pharmas-70-million-tops-california

With Californians facing the busiest ballot in more than a decade, big spenders are poised to make it one of the most expensive election battles in state history — already contributing $185 million to fight over everything from sex, drugs and guns to tobacco and taxes.

The money is piling up on behalf of campaigns for 17 statewide ballot measures — the most since March 2000. And when it comes to big backers, Big Pharma is far and away the towering force.

According to figures released Monday by the nonprofit MapLight, drug companies have already poured $70 million into an effort to fight Proposition 61, which would limit the prices state agencies pay for prescription drugs.

That’s 38 percent of all the money so far invested into the various ballot measures through July 7, the Berkeley-based group reported. Some observers are predicting drug company contributions will top $100 million by Election Day.

“This is their bread and butter,” said Barbara O’Connor, director emeritus of Sacramento State’s Institute for the Study of Politics and Media, who expects the industry will invest as much money as its needs to win.

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The beneficiary of that drug company money, Californians Against the Misleading Rx Measure, says they got an early start on raising campaign cash. “As the other campaigns start kicking into high gear, they will start raising more,” said Kathy Fairbanks, the no campaign’s spokeswoman.

The AIDS Healthcare Foundation, the measure’s sponsor, has raised about $10 million, according to president Michael Weinstein.

“Maybe $100 million can convince people to vote against what is in their own best interest,” said Weinstein. “From our point of view, today, tomorrow or 10 years from now, justice will prevail on drug pricing.”

With tens of millions on hand, drug makers fight state efforts to force down prices

With tens of millions on hand, drug makers fight state efforts to force down prices

Drug makers are sick and tired of coming under attack for high prices.

And they’re spending tens of millions to try to make it stop.

“We’re under unprecedented pressure because there really is profound misunderstanding out there,” Acorda Therapeutics CEO Ron Cohen, who chairs the industry trade group Biotechnology Innovation Organization, told a crowd at BIO’s conference here this week.

“Together we’re going to fight back, and we’re going to win,” Jim Greenwood, the CEO of BIO, said in his keynote address.

Bills that would have required drug companies to justify, explain, or even cap their prices have faltered in about a dozen states in recent months. Last week, however, brought two blows to the industry: Vermont Governor Peter Shumlin Drug signed into law a transparency act that requires drug makers to justify price hikes. Similar legislation passed in the California state Senate.

Meanwhile, the industry is girding for another California fight this November over a ballot measure that seeks to cap some drug prices. A similar measure is in the works in Ohio. And the industry fears such ballot measures could pop up elsewhere.

But drug makers aren’t responding by cutting prices  — or even by keeping them stable.