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Daily Archives: December 6, 2013

Who's patenting whose genome?

An international project has developed a free and open public resource that will bring much-needed transparency to the murky and contentious world of gene patenting.In a paper from Cambia and Queensland University of Technology (QUT) published in this week’s Nature Biotechnology journal, researchers revealed that overworked patent offices are struggling to keep up with the rapid explosion in information and technology that genetic sequences represent.

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Judge's Medicare Advantage Order Could Have National Impact

In a decision that could have national implications, a Connecticut federal judge blocked UnitedHealthcare late Thursday from dropping an estimated 2,200 physicians from its Medicare Advantage plan in that state.

The preliminary injunction issued by U.S. District Court Judge Stefan Underhill comes less than 48 hours before a deadline at midnight tomorrow for seniors to choose a Medicare Advantage or drug plan for next year. Medicare officials said they don’t plan to extend the deadline for beneficiaries affected by the terminations, but will continue to monitor the situation. After the deadline, Medicare Advantage members are allowed to make one change from Jan. 1 through Feb. 14 — they can leave their plan and rejoin traditional Medicare.

While the judge’s decision affects only the physicians in Fairfield and Hartford Counties who brought suit, several other medical groups are considering filing similar actions.

“This is very good news from Connecticut,” said Dr. Sam L. Unterricht, president of the Medical Society of the State of New York.  “We will definitely seriously consider filing a suit in New York as well.”

The Ohio State Medical Association is also reviewing the decision, said Todd Baker, a spokesman for the Ohio State Medical Association.

UnitedHealthcare is the largest Medicare Advantage insurer in the country, with nearly 3 million members and is reducing its network of physicians in at least nine other states  More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, a managed care version of Medicare. Generally, it is an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan’s providers.  

“We disagree with the ruling and intend to appeal it immediately,” said UnitedHealthcare spokesman Terry O’Hara.  However, the company will comply with the order, while the appeal is underway.  

The judge criticized the strategy to terminate the doctors: unilaterally amending the doctors’ contracts with a provision that canceled them.  “United’s argument that it has a unilateral right to terminate participating physicians from participation in the Medicare Advantage plan by amendment of that plan is not supported by the language of the contract or the parties’ experience under it,” Underhill wrote.

The U. S. Centers for Medicare and Medicaid Services, which oversees the Medicare Advantage program, is reviewing the provider changes by UnitedHealthcare to determine whether its plans have sufficient doctors to meet federal requirements.

Neither the agency nor the insurer would discuss that review, but the Connecticut doctors argued in court that the changes would harm patients.  

“We won’t let UnitedHealthcare get away with interfering with the doctor-patient relationship,” said Dr. Robin Oshman, president of the Fairfield County Medical Association in a written statement.  The lawsuit was brought by that and the Hartford County Medical Association.

Seniors advocates welcomed the ruling.

 “Judge Underhill’s decision, at a minimum, shows private Medicare plans that they do not have unfettered license,” said Judith Stein, executive director of the Connecticut-based Center for Medicare Advocacy. “Federal courts have jurisdiction over Medicare Advantage actions to ensure the beneficiary rights are protected.”

Unterricht said he hopes UnitedHealthcare will reconsider the doctors’ terminations.

“This patient population is very fragile and requires stable medical care from physicians who know them and whom they know,” he said.

Jaffe.KHN@gmail.com

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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Protein in prostate tissue 'indicates increased cancer risk'

Researchers have discovered that men who have a specific protein present in prostate tissue biopsies may be at increased risk of developing prostate cancer. This is according to a study published in the Journal of Clinical Oncology.The American Cancer Society estimates that around 238,590 new cases of prostate cancer will have been diagnosed in the US throughout 2013.Current methods for diagnosing the cancer include blood tests for the protein prostate-specific antigen (PSA) and biopsies.

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Compression stockings viable as treatment for leg ulcers

New research from the UK has shown that compression stockings are just as effective at treating venous leg ulcers as four-layer traditional bandages, promising cost savings for the National Health Service. The research, published in The Lancet, shows that sufferers treated using compression stockings also reported less recurrence and needed fewer nurse visits, making their use more economically viable.

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CDC report: measles 'eliminated' in US but still poses threat

The measles vaccine was introduced in the US 50 years ago, and now a panel from the Centers for Disease Control and Prevention has said the elimination of measles, rubella and congenital rubella syndrome has endured through 2011. However, the organization warns that measles still poses a threat, citing a 2013 spike in cases.The conclusions from the Centers for Disease Control and Prevention (CDC) report were published in JAMA Pediatrics.

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Healthcare.gov Is On The Mend, What's Next?

News outlets report on the key tasks ahead — enrolling enough people to stabilize the insurance market and covering people whose policies were canceled. 

The Associated Press: Obama’s Fixer-Upper Website Races To Catch Up
It looks like President Barack Obama’s fickle health insurance website is finally starting to put up some respectable sign-up numbers, but its job only seems to have gotten harder. Two months in and out of the repair shop have left significantly less time to fulfill the White House goal of enrolling 7 million people by the end of open enrollment on March 31 (Alonso-Zaldivar, 12/6).

Politico: Next Up: Obamacare Worst-Case Scenario?
Enrollment surge or no enrollment surge, the next Obamacare challenge is a big one: How will the White House make sure all those people with canceled policies get new coverage by Jan. 1? At the rate the signups are going — even with the speedier, newly functioning Obamacare website — the administration has a vast distance to travel before the estimated 4 to 5 million people with canceled policies get new health coverage (Nather, 12/6).

McClatchy: Obama’s Prescription For Health Care Law Is PR
The White House’s renewed effort to tout the law has two aims — to encourage Americans to sign up for coverage and to reassure nervous Democratic lawmakers and other allies who have watched Obama’s so-far unsuccessful efforts to contain the political damage. … The messaging push is the latest White House attempt to regain control of a debate that since the Oct. 1 debut of HealthCare.gov has been dominated by discussion of website failures, error rates and software fixes (Hennessey and Parsons, 12/5).

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Snags Emerge Even In States Where Exchanges Are Working

Insurers are reporting behind-the-scenes technical glitches that could undermine Jan. 1 coverage. In addition, news outlets offer progress reports from California, Connecticut, North Carolina, Minnesota and Oregon.  

Politico: State Exchanges Hitting Data Snags, Too
Even in states where Obamacare enrollment is booming, insurance companies are running into significant behind-the-scenes technical glitches that could threaten Jan. 1 health coverage. Many of these 14 states and the District of Columbia have been eager to tout the success of their own exchanges compared with the bungled federal portal, but they now appear to be worrying about back-end problems similar to those afflicting healthcare.gov (Cheney and Millman, 12/6).

Los Angeles Times: State Health Exchange Swamped With Enrollees
California’s health exchange is struggling to keep pace with a surge of applicants who are encountering long waits and website problems as they try to meet a Dec. 23 deadline. In response to higher-than-expected demand, the Covered California exchange said it is adding staff and expanding its capacity to answer consumer calls. It received 17,000 calls in less than an hour Wednesday, more than it received in an entire day in recent weeks. The exchange is also trying to dig through a backlog of 25,000 paper applications filed in October and November (Terhune, 12/5).

The Associated Press/Washington Post: Santa’s Big Surprise — A Health Insurance E-Card?
California’s health insurance exchange Thursday urged holiday shoppers to think about giving young people “the gift of health.” Some suggestions from Covered California: Help a young adult pay for coverage, or send an e-card with a personal message and information about the federal health care overhaul. There’s also a website where family members can pledge to help get relatives coverage (12/5).

The CT Mirror: CT’s Obamacare Exchange Applications Surging This Week
Application activity for the state’s health insurance exchange has skyrocketed this week, with close to 1,000 people signing up for coverage each day. That compares to a previous peak of 3,544 enrollees for the entire week before Thanksgiving. “The surge is now,” said Peter Van Loon, chief operating officer for the exchange, known as Access Health CT. He noted that the exchange’s call center has been getting an average of 2,400 calls per day this week (Becker, 12/6).

Los Angeles Times: A Health Care Navigator In Unfriendly Waters
Rascoe is one of thousands of foot soldiers hired nationwide to sign Americans up for coverage under President Obama’s Affordable Care Act. Her task is made all the more challenging because she works in one of the Republican-led states openly hostile to the act. The GOP-controlled Legislature ordered state health officials not to cooperate with the federal program. Many of the people in this rural swath of North Carolina — despite being among the neediest potential beneficiaries of Obamacare — remain skeptical and uninformed (Bennett, 12/6).

MinnPost: MNsure Officials Heartened By Latest Health-Insurance Sign-Up Data
MNsure officials said their latest statistics make them confident that enrollment will keep pace with their health insurance targets for the sign-up period that ends in March. Consumer interest in the state’s health exchange doubled — and in some cases, more than doubled — in most areas tracked since last month, according to data released Wednesday (Nord, 12/5).

In other news related to state health law policies —

The Oregonian: Oregon Violated Laws By Allowing Health Plans To Be Extended, According To Legislative Lawyers
The Oregon Legislature’s lawyers think the state erred when it allowed insurers to extend health plans set to expire this year under the provisions of the Affordable Care Act. More than 140,000 Oregonians faced Dec. 31 cancellations of their health insurance until Oregon Insurance Commissioner Laura Cali announced that insurers could extend those policies until the end of next year (Gaston, 12/5).

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Capitol Hill Workers Have Extra Month To Get Health Insurance

Washington D.C.’s insurance exchange has been having problems.

The Washington Post: House Extends Current Health Plans For Lawmakers, Staffers, If Needed
Acknowledging widespread issues with the process of enrolling for new health-care coverage, House officials reiterated Thursday that lawmakers and their staffs whose current health insurance is set to be terminated at the end of the year will automatically have that coverage extended until the end of January unless they have already enrolled in new coverage. The reminder from House administrative officials is standard operating procedure for anyone set to lose coverage under the health care program for federal employees (O’Keefe, 12/5).

Politico: House Official Presses OPM On Obamacare
[The House’s chief administrative officer] Dan Strodel wrote in a message sent Thursday evening that he is well aware of the struggles that people have faced with the D.C. exchange, where members of Congress and qualifying aides will enroll for their coverage. … In one of its latest technical problems, the website for D.C. Health Link was down for maintenance earlier Thursday — the same time that staffers for the exchange were in a Senate office building, trying to help aides sign up (Kim, 12/5).

Roll Call: D.C. Health Link Glitch Causes Headaches At House Health Fair
On Thursday, with about five days left until the end of open enrollment, House staffers trickled out of the health benefits fair with packets of new insurance information and knowledge of a new roadblock. … DC Health Link experienced “technical difficulties with their website,” according to a mass email sent to all Senate staff at 11:32 a.m. The glitch meant employees could learn more about the plans being offered by insurance carriers on the site but not enroll (Hess, 12/5).

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Consumers Are Not Insured Until They Pay 1st Premium

CNN cautions that it’s not enough to sign up for a health law policy — you need to make that first payment to your insurer. Elsewhere, ProPublica looks at healthcare.gov’s back-end system to provide your sign-up information to insurers, and the Obama administration awards $55 million in grants to bolster the health care workforce.

CNN: Obamacare: You’re Not Insured Until You Pay
Just because you’ve picked an Obamacare insurance policy doesn’t mean you’ve got coverage. If you want to be insured come Jan. 1, you have to pay your first month’s premium by your insurer’s due date, often Dec. 31. Sounds simple enough, but federal officials and insurers are concerned that many consumers don’t realize they have to take this last step and will remain uninsured (Luhby, 12/5).

ProPublica: Healthcare.gov’s Mysterious New Number: ‘834’ 
Now that the front-end of healthcare.gov appears to be working properly, the media’s focus is quickly shifting to the back-end systems that are supposed to provide insurance companies with accurate information about consumers enrolling in their plans. The issue is an important one because if insurance companies get incorrect data, their future customers may not be enrolled properly and that could lead to headaches — or worse — come January when patients show up at doctors’ offices or hospitals thinking they are insured but really aren’t (Ornstein, 12/5).

The Washington Post: Obama Administration Awards $55 Million To Boost Health Care Workforce
The Department of Health and Human Services has awarded $55.5 million in grants to help bolster a health-care workforce that is stretched thin and possibly due for more strain under the Affordable Care Act. The health legislation, known as Obamacare, requires the uninsured to obtain medical coverage, potentially placing more stress on the nation’s health care network (Hicks, 12/6).

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Refusing Medicaid Expansion To Cost States Billions, Study Says

The decision not to participate will costs states billions over the next decade which will be passed onto taxpayers, according to a study by the pro-reform Commonwealth Fund. Meanwhile, Pennsylvania Gov. Tom Corbett begins the process of seeking federal approval for his proposal to use expansion money to help the poor buy private insurance. And the Wisconsin Assembly votes to give those losing Medicaid three more months to sign up for private plans. 

The Associated Press/Washington Post: Feds’ Site Gives States Incomplete Medicaid Data
People shopping for insurance on the federal marketplace may be informed they’re eligible for Medicaid and that their information is being sent to state officials to sign them up. However, states say they aren’t able to enroll them because they’re receiving incomplete data from the Obama administration (12/5).

The Washington Post: Study: Refusing Medicaid Expansion Will Cost States Billions Of Dollars
When the Supreme Court ruled in 2012 that the federal government could not compel states to expand their Medicaid programs under the Affordable Care Act, it gave Republican opponents of the measure the opportunity to decline to participate in one of the law’s central tenets. But a new study estimates the decision not to participate will cost those states billions of dollars over the next decade — costs that will be passed on to taxpayers. The Affordable Care Act requires the federal government to pay 100 percent of the costs of expanding Medicaid for three years. After that period, the law mandates the federal government pay 90 percent of the costs of expansion (Wilson, 12/5).

The Associated Press: Corbett Seeks Federal OK For Alternative Medicaid Plan
Gov. Tom Corbett will begin the formal process Friday of seeking approval for his plan to bring billions of federal Medicaid expansion dollars to Pennsylvania to extend health insurance to half a million working poor. The process will begin with the online posting of Corbett’s approximately 100-page proposal, which lays out more detail surrounding his plan to use the expansion money to help people buy private insurance, rather than cover them under the traditional Medicaid program (Levy, 12/5).

The Associated Press: Assembly Passes Medicaid Delay Bill
As those in Wisconsin working to get people enrolled for health insurance through the federal online marketplace reported progress in recent days, the state Assembly passed a bill Wednesday that would give those losing their Medicaid coverage three more months to sign up for private plans (Bauer, 12/5).

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