WeeklyFinancingNewsPulseNationalEditionfinal20100409.pdf (PDF | 196.00 kb)
SAMHSA222s Weekly Financing News Pulse: National Edition April 9 , 2010 4/ 9 /10 1 SAMHSA222s Weekly Financing News Pulse: National Edition National News HHS Secretary and States Take Steps to Implement National Health Care Reform; More States Join Lawsuit to Combat Individual Mandate CMS Freezes MA Payments for 2011 to Comply with Health Care Reform Obama Administration Delays Trustees Report on Social Security and Medicare to Reflect Reform Senator Grassley Alleges HHS Ignored Medicare Fraud Polls Find More Americans Sti ll Oppose Reform, Retirees Worry about Medicare Studies Released Study Projects Health Care Reform Will Increase Demand for Health Care Among Youth IMS Health Report Finds Prescription Drug Sales Up, Anti-Psychotics Top Sell ers Researchers Find Informed Employees Make More Cost -Efficient Health Care Choices KFF Releases Summary of Health Care Reform, Outlines Mental Health Changes RAND Researchers Suggest Working Longer Could Improve Solvency of Medicare and Social Security Health Affairs Study Finds VA222s VISTA Potentially Saved $3.09 Billion Around the Hill: Hearings on Health Financing To Subscribe to SAMHSA222s Weekly Financing News Pulse, please go to the following link and choose 223Health Care Financing224: https://service.govdelivery.com/service/multi_subscribe.html?code=USSAMHSA&origin=http://www.samhsa.go v/enetwo rk/success.aspx For questions or comments, please contact Kevin Hennessy ( kevin.hennessy@samhsa.hhs.gov ). SAMHSA222s Weekly Financing News Pulse: National Edition April 9 , 2010 4/ 9 /10 2 National News HHS Secretary and States Take Steps to Implement National Health Care Reform; More States Join Lawsuit to Combat Individual Mandate: On April 2, U.S. Department of Health and Human Services (HHS) Secretary Kat hleen Sebelius sent letters to state governors and insurance commissioners to determine their desired level of participation in a national network of high -risk insurance pools. The pools must begin 90 days from March 23, when President Barack Obama signed the health care reform bill. Using $5 billion in federal funding, the pools will provide immediate coverage to uninsured individuals with pre-existing conditions until state - based health insurance exchanges become operational in 2014. Secretary Sebelius222 letters outline five options for states to setup pools. States without pools may create them while the 35 states that already have high-risk pools may add a new pool to cover the target market, build on existing programs, or contract with a carrier of last resort to provide subsidized coverage. In addition, states may elect not to participate in the new pools, in which case HHS will establish a pool within the state. Secretary Sebelius222 letter requested state decisions by April 30 ( Kaiser Health news, 4/3 ; Insurance & Financial A dvisor, 4/5 ; Chicago Sun Times, 4/4 ). In other news, Arizona, Indiana, Minnesota, Mississippi, Nevada, and North Dakota will join a ttorneys general from 13 other states (AL, CO, FL, ID, LA, MI, NE, PA, SC, SD, TX, UT, and WA) in a lawsuit claiming that health care reform222s individual mandate violates the U.S. Constitution ( Kaiser Health News, 3/7 ; The Hill, 4/6 ; Bloomberg via Business Week, 4/7 ; Kaiser Health News, 4/8 ). CMS Freezes MA Payments for 2011 to Comply with Health Care Reform : On April 5, the Centers for Medicare & Medicaid Services (CMS) announced a rule freezing Medicare Advantage (MA) payments in 2011 to comply with federal health care reform , the Patient Protection and Affordable Care Act . The same CMS notice will also implement the law222s $250 Medicare Prescription Drug Benefit Program (Part D) rebate for seniors in the 223doughnut hole224 coverage gap, effective June 15. I n February, CMS officials proposed raising MA payments 1.28 percent ; however , h ealth c are reform will cut $130 billion from MA over the next decade. MA insur es n early one quarter of Medicare beneficiaries ( Kaiser Health News, 4/6 ; Bloomberg via BusinessWeek, 4/6 ; MedPage Today, 4/7 ). Obama Administration Delays Trustees Report on Social Security and Medicare to Reflect Health Care Reform: President Obama222s Administration announced that it will delay the annual trustees report on the Social Security and Medicare trust funds until June 30 to ensure that it reflects health care reform222s impact. The report is typically released April 1. The 2009 report projected that the Medicare trust fund would be depleted by 2019 ; however, reform advocates contend that the new national health care reform law will increase the longevity of the fund ( Kaiser Health News, 4/6 ; Associated Press, 4/6 ). Senator Grassley Alleges HHS Ignored Medicare Fraud: On April 5, Senator Charles Grassley (R - IA) wrote a letter to HHS Secretary Kathleen Sebelius alleging that HHS has ignored reports of Medicare fraud perpetrated by 223phantom pharmacies224 that fraudulently bill Medicare for large sums of prescription drugs . In his letter, Senator Grassley listed several examples of th ese criminal operations , mostly based in California and Florida , that close down after receipt of Medicare reimbur sements . HHS officials said that they will investigate the allegations and take appropriate action ( Kaiser Health News, 4/6 ; ABC News, 4/5 ) . Polls Find More Americans Still Oppose Reform, Retirees Worr y A bout Medicare: A CBS News poll released April 2 found that 53 percent of Americans oppose the new health care reform legislation SAMHSA222s Weekly Financing News Pulse: National Edition April 9 , 2010 4/ 9 /10 3 while 39 percent support it . The CBS poll also found that 20 percent of respondents believe the reforms will benefit them personally though 35 percent believe the reforms will improve consumer protection. In addition, a Washington Post survey released March 28 found similar results. The Washington Post found that 50 percent of Americans oppose health care reform222s changes while 46 percent support them. The Post poll also found that 60 percent of seniors believe that reform will weaken Medicare and that 58 percent of seniors oppose the changes in the new law. Finally, a retiree poll conducted in March by Extend Health Inc. found that , while 60 percent of retirees believe Medicare will remain solvent in their lifetime, only 20 percent believe it will be solvent when their children retire ( The Washington Post, 3/28 ; CBS News, 4/2 ; San Francisco Business Times, 4/5 ). Studies Relea sed Study Projects Health Care Reform Will Increase Demand for Health Care Among Youth: A study by three economists from the University of Miami, the University of California Berkeley , and the University of California Santa Barbara projects that demand for health care by previously uninsured young adults will rise dramatically because of national health care reform. Under the Patient Protection and Affordable Care Act , parents may include dependent children on their insurance plans up to age 26. The study found that young adult s222 demand for health care drops significantly when they lose their parents 222 coverage and projects that reform will dramatically increase the quantity of care provided to those currently uninsured individuals . Roughly 45 percent of individuals aged 19 to 29 were uninsured for at least part of 2009, making that age group one of the largest groups of uninsured Americans ( The Wall Street Journal, 4/5 ; Kaiser Health News, 4/5 ). IMS Health Report Finds Prescription Drug Sales Up , Anti - Psychotics Top Sellers : On April 1, IMS Health released a report finding that prescription drug sales grew 5.1 percent from 2008 to 2009, totaling $300.3 billion. By sales , antipsychotic medications were the top selling class of drug for 2009 at $14.6 billion and antidepressants were the fourth highest at $9.9 billion. IMS officials reported that increased use of generic drugs, coupons , and other payment reduction programs offered by drug manufacturers spurred sales figures . In addition, IMS reports that generic drugs accounted for 75 percent of dispensed prescriptions in 2009 ( IMS Health, 4/1 ; Kaiser Health News, 4/2 ; The Wall Street Journal, 4/2 ; AP via Forbes, 4/1 ; Business Week, 4/1 ). Researchers Find Informed Employees Make More Cost- Efficient Health Care Choices: A re cent study conducted by researchers from Tufts University222s School of Medicine and Boston University222s School of Public Health publ ished in the American Journal of Managed Care found that employees who were aware of their copayment or premium costs were more likely to opt for cost- efficient medical treatment. The researchers surveyed government workers in Massachusetts, finding that workers who knew their premiums or their copayments were more likely to seek care in doctors222 offices rather than emergency rooms ( American Journal of Managed Care, 4/7 ; Boston Herald, 4/8 ; Kaiser Health News, 4/8 ). KFF Releases Summary of Health Care Reform, Outlines Mental Health Changes: On March 26, the Kaiser Family Foundation (KFF) released a summary of provisions in the national health care reform legislation, the Patient Protection and Affordable Care Act , and changes made by the Health Care and Education Reconciliation Act of 2010 . The summary explains numerous mental health provisions , SAMHSA222s Weekly Financing News Pulse: National Edition April 9 , 2010 4/ 9 /10 4 including the strengthening of community mental health center standards and support of interdisciplinary behavioral health training through scholarships and loans ( KFF, 3/26 ). RAND Researchers Suggest Working Longer Could Improve Solvency of Medicare and Social Security : A study by RAND Corp. researchers published in the Journal of Economic Perspectives suggests that workers remaining in the labor force past the traditional retirement age of 65 may extend the solvency of both Medicare and Social Security . The researchers suggest that if employees 65 and older obtain insurance through their employers, Medicare would act as a secondary rather than primary payer , saving the system money. The researchers noted that changes in the structure of employer pensions and social security benefits are already encouraging many to remain in the labor market past 65 and suggest that lawmakers pursue policies that encourage those who wish to continue working to do so. The study suggests eliminating pension penalties for those continuing to work past retirement age and educating the public about pensions and retirement. The authors noted that the key challenges to their proposal would likely be declining health of workers as they reach retirement age and employer s222 reluctance to hire older workers ( Health Leaders Media, 4/8 ). Health Affairs Study Finds VA222s VISTA Potentially Saved $3.09 Billion : A study published in Health Affairs estimated that the VA222s Health IT system, the Veterans Health Information Systems Information Architecture (VISTA), may have saved the VA $3.09 billion between 1997 and 2007. The researchers suggest that VISTA has made the provision of health care more efficient, with t he biggest savings coming from its component electronic records infrastructure. However, researchers note that the study only examined potential savings and emphasized the need for empirical studies ( Kaiser Health News, 4/7 ; Kaiser Health News, 4/7 ). Around the Hill: Hearings on Health Financing Cong ress is out of session and reconvenes April 12.
