Kaiser Health News: Increase in health insurance exchange enrollment mirrors some state programs, including Massachusetts

Phil Galewitz of Kaiser Health News reports that enrollment increases for federal exchanges  mirror “activity on several state-run Obamacare exchanges, according to figures obtained from states independently by Kaiser Health News. Minnesota, with more than 54,000 enrollees as of Monday, capturedoubled the number of sign-ups it had at the same time last year. Colorado, Massachusetts and Washington had enrollment growth of at least 13 percent compared to a year ago.

“Because of the new administration and the high likelihood of changes coming to the ACA, it is creating a sense of urgency” for people to enroll, said Michael March and, director of communications for the Washington Health Benefit Exchange. Enrollment exceeded 170,000 customers on the Washington exchange as of this week, up 13 percent compared to same time a year ago.

Other state exchanges saw moderate increases: Connecticut, 3 percent; Idaho, 4 percent; Maryland, 1 percent. California’s enrollment is about same as a year ago. Rhode Island’s enrollment dropped to 27,555 from 31,900 for the same period last year. State exchange officials cited a drop in customers who were automatically renewed because UnitedHealthcare dropped out.

About 12.7 million people enrolled in the state and federal exchanges for 2016 coverage at the end of the previous enrollment season. HHS predicted in October that an additional 1.1 million people would sign up for 2017 coverage. Burwell said Wednesday that her department is sticking with that projection, even though “the headwinds have increased” since the election.

Obamacare, now in its fourth open enrollment season, took some heavy blows this year after several big insurers — including UnitedHealthcare, Humana and Aetna — withdrew from many marketplaces for 2017 because of heavy financial losses. At the same time, remaining insurers increased premiums by 25 percent on average.

All of that, plus a changed political climate in Washington, was expected to dampen enrollment. While the surprise presidential election outcome may have been the primary force for changing those expectations, other factors also have fueled enrollment growth this fall, state officials pointed out in interviews.

More people who don’t qualify for government subsidies are buying health plans on the exchanges because it’s an easier way to compare available plans in one place. Noting that trend, Premera Blue Cross in Washington recently stopped selling individual coverage off the exchange.

In Minnesota, higher government subsidies — which reduce premiums for people with lower incomes — is the main reason why more people have signed up, according to Allison O’Toole, CEO of MNsure, the state-run exchange. The subsidy amount is tied to the cost of the second-lowest silver plan on the exchange, so as premiums rise for that plan, the subsidy rises too. Premiums soared by an average 50 percent in Minnesota for second-lowest silver.

Another factor driving earlier enrollment in that state was caps set by several Minnesota insurers on the number of new enrollees they would accept. People signed up earlier to make sure they could get the plan they wanted, according to O’Toole.

Minnesota’s growth is surprising because one of its biggest carriers, Blue Cross and Blue Shield of Minnesota, stopped selling its most popular health plan on the exchange. That forced about 20,000 people to change insurers or switch from Blue Cross’ PPO, which has a broad provider network, to its HMO plan with a narrower network.

In Colorado, the 18 percent increase in enrollment so far has exceeded officials’ expectations, said Luke Clarke, the spokesman for Connect for Health Colorado, the state exchange. “We had an office pool and no one picked a number that high,” he said. “It was a healthy surprise,” particularly because premiums increased in the state by about 20 percent on average.

Conservatives warn it’s still too early for Obamacare supporters to celebrate.

“I suspect that some states saw big increases because local advocacy groups were able to tell their constituents that they should enroll before Trump is sworn in and Republicans take over Congress — thereby pretty much guaranteeing that they get a full year’s coverage regardless of what Republicans might do on repeal,” said Joe Antos, a health economist with the American Enterprise Institute, a conservative think tank.

Under that scenario, large enrollment increases this fall might be followed by a dropoff in January over the 2016 numbers and the final enrollment tally could end up similar this year’s, he said. Antos noted the true enrollment figures will be known once people pay for their coverage and stay enrolled for the full year.

“As with everything related to ACA,” Antos said, “it’s easy to find a happy story if you squint hard enough and don’t wait for the enrollment process to complete — or the plan year to end.”

Should #STAT take ads from drug industry lobbyists at #PhRMa?

While acknowledging the quality of the reporting at STAT — and the search for new revenue  to support good journalism — Health News Review wonders why The Boston Globe life science spin-off has to take ads from the pharmaceutical industry’s top lobbying group.

Some STAT readers might see PhaRMa as a champion of just another health-related indstat-phrma-sponsorshipustry, like medical software or consulting services.  Others question the industry’s research, pricing and marketing practices as evidence of a commitment to profits over healing and access.

So, HNR argues that the ads allow the “industry to buy juxtaposition to messages that often call their practices into question.”  

Worth noting that my STAT newsletter arrives with different sponsors on different days. Last week’s included J&J, Amgen, a life science software maker, or none at all.

From HNR:

I am sure that STAT allows no editorial influence by this or any other sponsor. Their hard-nosed coverage of pharmaceutical industry news is top notch…

 

But I do not praise their front office decision to accept this sponsorship deal. It startles me and bothers me every time I see that PhRMA logo on the STAT newsletter. And I think it could raise legitimate questions in discerning readers’ minds.  Journalism ethics dictates that one should strive at all costs to avoid even the appearance of a conflict of interest. Was it necessary for STAT to enter into this sponsorship deal?  STAT just introduced a premium subscription plan.  I hope that works for them; maybe it will generate enough income so that they wouldn’t feel compelled to swim in the murky waters of the PhRMA sponsorship deal…

Certainly PhRMA is thrilled with STAT saying “Yes” –  allowing them to buy their way into regular appearances in the STAT newsletter. This is a foot in the door for an industry to buy juxtaposition to messages that often call their practices into question. It would be understandable if any reader’s head was spinning with thoughts of “What’s going on here?”

From Health Leaders: Shame, fear and medical errors

From a recent talk 978-080703330-2at Harvard by Danielle Ofri, MD, author of What Doctors Feel.

Ofri’s talk centered on one emotion, shame, which she said overwhelms many doctors and is a major reason many medical errors go unaddressed.

When errors are not acknowledged, even those without bad outcomes, no one learns from them, she said. And, there is little incentive for doctors to point out their shortfalls. “We want to look like we know what we are doing. When in doubt, pretend. That’s what I learned in my internship. “

Click here for full story from Health Leaders Media 

Video: Harvard School of Public Health: The Chronic #Pain Epidemic

Will 21st Century Cures Act benefit hospitals?

captureFirst: The Globe is getting some attention for its five-part narrative about a family that helped  start a drug company to keep their son on an experimental cancer treatment.

Nicely written narrative with illustrations and audio. We won’t give away the ending. 

Also, here’s what people were saying a year ago about the “21st Century Cure Act.” It’s been amended since then, but much of what they have to say still applies. My take was: What’s in it for hospitals? 

The drug development and approval elements in the proposed legislation are the centerpiece of a gift basket that has something for everyone: engaged patients, drug makers, FitBit fanatics, NIH-funded scientists, those faced with rare diseases, and those fighting antibiotic resistance.

What do hospitals get out of it? Of course, it depends on whom you ask. One side says it will clear out bottlenecks that are delaying access to better drugs and new, effective antibiotics. That’s good news for hospitals struggling to improve patient outcomes and prevent readmissions. The other side says it will lead to unsafe drugs and a flawed approach to dealing with antibiotic resistance. That’s bad news for hospitals struggling to improve patient outcomes and prevent readmissions.

John Powers, MD, is a former head of the FDA’s Antimicrobial Drug Development and Resistance Initiatives. He is now a clinical professor at the George Washington University School of Medicine and one of the bill’s critics. If the bill’s provisions regarding FDA approval become law, hospitals should be worried that they will be held responsible for drugs that are ineffective or worse, he said.

“If you have a new drug and it doesn’t make the patient better, what you actually end up doing is spending more money in the long run because they stay in the hospital longer,” Powers said. “Or you may have to administer additional treatment to deal with the side effects of that medicine — which costs money.”

Live streaming right now: “How does where you live affect your health.”#BUSPH40 #BUSPHSymposia #environment #public health

Lots of health news in Boston this week, but at the moment, check out the live stream of this event.capture

Can the physical and social aspects of your neighborhood influence your health? The symposium will explore the roles of the built environment and housing and will evaluate the science on how interventions can improve the health of vulnerable populations.

 

Agenda

8:30–9 a.m.
Breakfast and Informal Greetings

9–9:15 a.m.
Welcome and Opening Remarks

Sandro Galea, Dean and Robert A. Knox Professor, Boston University School of Public Health

Jonathan Levy, Professor, Environmental Health, Boston University School of Public Health


BUILT ENVIRONMENT AND HEALTH
9:15–10 a.m.

Howard Frumkin, Professor of Environmental and Occupational Health Sciences, School of Public Health, University of Washington


10–11:30 a.m.

Panel Discussion: Separating Neighborhood-Level from Individual-Level Risk Factors

Mariana Arcaya, Assistant Professor, Urban Studies, Massachusetts Institute of Technology

Yvette Cozier, Assistant Dean for Diversity and Inclusion and Assistant Professor, Epidemiology, Boston University School of Public Health

Theresa Osypuk, Associate Professor, Epidemiology and Community Health, University of Minnesota School of Public Health

Shakira Suglia, Associate Professor, Epidemiology, Emory University Rollins School of Public Health

Monica L. Wang (Moderator), Assistant Professor, Community Health Sciences, Boston University School of Public Health


HOUSING AND HEALTH
11:30 a.m.–12:30 p.m

Ron Sims, Former Deputy Secretary of the United States Department of Housing and Urban Development


12:30–2 p.m.

Panel Discussion:  The Influence of Housing on Health

Carlos Dora, Coordinator, Public Health and the Environment Department, World Health Organization

Patricia Fabian, Research Assistant Professor, Environmental Health, Boston University School of Public Health

David Jacobs, Chief Scientist, National Center for Healthy Housing

Megan Sandel, Associate Professor, Pediatrics, Boston University School of Medicine

John Spengler (Moderator), Akira Yamaguchi Professor of Environmental Health and Human Habitation, Harvard T.H. Chan School of Public Health


2–2:10 p.m.

Break


2:10–3:40 p.m

Panel Discussion: High-Risk Populations and Strategies to Improve Health

Kalila Barnett, Executive Director, Alternatives for Community and Environment

JoHanna Flacks, Legal Director, Medical-Legal Partnership | Boston (MLPB)

Hector Olvera, Associate Professor and Director of Research, University of Texas at El Paso School of Nursing

Madeleine Scammell, Assistant Professor, Environmental Health, Boston University School of Public Health

Carey Goldberg (Moderator),  Health and Science Reporter, WBUR


3:40–3:45 p.m.

Closing Remarks

Jonathan Levy, Professor, Environmental Health, Boston University School of Public Health

Don’t take your #vitamins, says doctor from the Cambridge Health Alliance

fruit-photoEven though it is affiliated with Beth Israel Deaconess Medical Center, the Cambridge Health Alliance is often overlooked in this land of huge, lauded teaching hospitals. But Dr. Pieter A. Cohen’s editorial about supplements in JAMA gets a mention in  a story in this Tuesday’s Well column  in The New York Times.

Americans spend more than $30 billion a year on dietary supplementsvitamins, minerals and herbal products, among others — many of which are unnecessary or of doubtful benefit to those taking them. That comes to about $100 a year for every man, woman and child for substances that are often of questionable value…

In an editorial entitled “The Supplement Paradox: Negligible Benefits, Robust Consumption” accompanying the new report, Dr. Pieter A. Cohen, of Cambridge Health Alliance and Somerville Hospital Primary Care in Massachusetts, pointed out that “supplements are essential to treat vitamin and mineral deficiencies” and that certain combinations of nutrients can help some medical conditions, like age-related macular degeneration. He added, however, “for the majority of adults, supplements likely provide little, if any, benefit.”

Among the changes found in the new study: multivitamin/mineral use declined to 31 percent from 37 percent, “and the rates of vitamin C, vitamin E and selenium use decreased, perhaps in response to research findings showing no benefit,” Dr. Cohen wrote. Sometimes people do act sensibly when faced with solid evidence.

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