“People in public health hate H3N2 flu seasons, like the one gripping most of North America right now. So do folks who work in hospitals and in the care facilities that look after the elderly.
To put it flatly, H3N2 is the problem child of seasonal flu.
It causes more deaths than the other influenza A virus, H1N1, as well as flu B viruses. It’s a quirky virus that seems, at every turn, to misbehave and make life miserable for the people who contract it, the scientists trying to keep an eye on it, and the drug companies struggling to produce an effective vaccine against it.
“H3 viruses dwarf the contribution of H1 to overall epidemic burden [of influenza] in terms of hospitalizations, care facility outbreaks, deaths. I think uniformly in public health we dread H3N2 epidemics over and above those due to H1N1,” said flu expert Dr. Danuta Skowronski, an epidemiologist with the British Columbia Center for Disease Control.
Dr. Daniel Jernigan, head of the influenza division at the Centers for Disease Control and Prevention, concurred. “We just know, over the last several years, when we have an H3 season, it’s unfortunately causing worse disease. But also the vaccine’s effectiveness [targeting it] is not as high as the other components. And so for that reason, even though you’ve been vaccinated, you still can get infected,” ….. “People born before 1968 were not imprinted with an H3N2 virus. So they may have increased susceptibility [to it] as well as, by virtue of their age, have greater vulnerability, just through complications. So that could be totally independent of whether the virus itself is more virulent or not,”…(A)
“Influenza activity increased sharply again in this week’s FluView report. The number of jurisdictions experiencing high activity went from 21 states to 26 states and New York City and the number of states reporting widespread activity went from 36 to 46.” (B)
“We are arguably as vulnerable—or more vulnerable—to another pandemic as we were in 1918. Today top public health experts routinely rank influenza as potentially the most dangerous “emerging” health threat we face. Earlier this year, upon leaving his post as head of the Centers for Disease Control and Prevention, Tom Frieden was asked what scared him the most, what kept him up at night. “The biggest concern is always for an influenza pandemic…[It] really is the worst-case scenario.” So the tragic events of 100 years ago have a surprising urgency—especially since the most crucial lessons to be learned from the disaster have yet to be absorbed.” (C)
“This is just the seasonal flu we’re talking about. It’s not that big of a deal, right?
It is, actually. Seasonal flu epidemics cause three to five million cases of severe disease each year worldwide, leaving 300,000 to 500,000 dead, according to the World Health Organization. In the US, flu forces 140,000 to 710,000 people into hospitals and causes 12,000 to 56,000 deaths annually. The hardest hit are children, the elderly, and people with compromised immune systems.” (D)
“California is reeling from a particularly severe surge in cases of the flu—with pharmacies running out of medicine, packed emergency rooms and a rising death toll.
State health officials say that 27 people younger than 65 have died of the flu in California since October. That’s compared to three the same time last year, The Los Angeles Times reports.
According to health officials, there’s no region of the state where people were being spared from the flu.
At UCLA Medical Center in Santa Monica, the emergency room saw more than 200 patients on at least one day, mostly because of the flu…
Though the flu killed three Californians by this time last year, 68 people had died from it by the end of February, according to state data.
Still, many doctors say the recent surge in flu cases have been unusually severe…
National health officials predict the flu vaccine may only be about 32 percent effective this year. But most people in California and the rest of the country are catching a particularly dangerous strain of influenza that the vaccine typically doesn’t work well against.” (E)
“Methodist Dallas Medical Center announced Sunday night that all non-emergency patients were being diverted to other hospitals due to an influx of patients with the flu. (Published Monday, Jan. 8, 2018)
Methodist Dallas Medical Center says they at “critical capacity” and that all non-emergency patients are being re-routed to urgent care facilities or other hospitals so that they can continue to handle emergencies.
The increase in patient load is largely due to an influx of patients with the flu, the hospital said. Methodist Dallas Medical Center said they are still accepting trauma patients and that anyone who arrives at the hospital needing emergency treatment will receive treatment.
“Consistent with federal and state laws, Methodist Dallas Medical Center is currently re-routing non-emergency patients due to high volumes of patients with flu-like symptoms. This measure is so we can still take care of emergency patients such as trauma, stroke, and those transferred by ambulance. We take this very seriously because we want to be able to treat anyone in need anytime.
During the period while Methodist Dallas is re-routing patients, we encourage anyone having non-emergent symptoms to seek care at an urgent care facility or through their primary care physician.” (F)
Clean Hands Prevent Cold & Flu
Click to access Clean-Hands-Prevent-Cold-Flu-slide-deck.pdf
Vaccination: Who Should Do It, Who Should Not and Who Should Take Precautions
https://www.cdc.gov/flu/protect/whoshouldvax.htm
Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.
(A) ‘The problem child of seasonal flu’: Beware this winter’s virus, by HELEN BRANSWELL, https://www.statnews.com/2018/01/08/flu-virus-h3n2/?utm_source=STAT+Newsletters&utm_campaign=0db0193a7b-MR&utm_medium=email&utm_term=0_8cab1d7961-0db0193a7b-150519373
(B) Situation Update: Summary of Weekly FluView Report, https://www.cdc.gov/flu/weekly/summary.htm
(C) How the Horrific 1918 Flu Spread Across America, by John M. Barry, https://www.smithsonianmag.com/history/journal-plague-year-180965222/
(D) Looks like a rough flu season ahead. Here are answers to ALL your flu questions, by Beth Mole, https://arstechnica.com/science/2017/12/this-years-flu-season-is-upon-us-and-it-looks-bad-heres-what-you-should-know/
(E) Severe flu in California brings medicine shortages, kills 27, by Christopher Carbone, http://www.foxnews.com/health/2018/01/07/severe-flu-in-california-brings-medicine-shortages-kills-27.html
(F) Dallas Methodist Hospital at ‘Critical Capacity,’ Re-Route Non-Emergency Flu Patients, https://www.nbcdfw.com/news/local/Dallas-Hospital-Turns-Away-Non-Emergency-Patients-Due-to-Flu-Activity-468264083.html
“We wonder what it will take to shake the faith of Trump’s fans. His subservience to Russia’s ongoing cyber-invasion? Nope. His relentless assaults on the integrity of our law enforcement and intelligence agencies? Nope. Shooting someone in broad daylight on Fifth Avenue? Probably nope.
But his failure to tackle the opioid epidemic — his big talk and dearth of meaningful action — might conceivably dampen their ardor.
This prescription drug plague has hit their world hard. More than 100 people die each day from opioid ODs; the victims are disproportionately young and middle-aged working-class men in small towns and rural communities — the heart of Trump’s constituency. The worst epidemic state is West Virginia, which Trump won by 43 points. He spoke to their despair when he promised to alleviate it. During the campaign he repeatedly referenced the opioid scourge: “If I win, I’m going to stop it …. We’re gonna spend the money. We’re gonna get that habit broken.”
And not long ago, as president, he vowed to cure the “worst drug crisis in American history” by declaring “a national emergency,” a legal designation that automatically frees up massive federal funds. He promised action that would be “really tough, really big, really great.”
He hasn’t done squat.” (A)
“The average American life expectancy ticked downward for the second straight year in 2016, on the back of surging drug overdose deaths, according to data released Thursday by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention. And while the nation hasn’t experienced a back-to-back drop in life expectancy since the 1960s, the CDC says the opioid crisis is shaping up to extend this decline for a third consecutive year, a milestone that hasn’t been seen since the Spanish flu pandemic in 1918.
U.S. life expectancy fell to an average of 78.6 years in 2016, dropping 0.1 for the second year in a row, according to the CDC report. The slide was driven by higher death rates among young and middle-aged Americans, with those aged 25-34 experiencing the largest increase. The death rate among Americans aged 65 and older actually inched downward between 2015 and 2016.
The overall decline in longevity came as drug overdose deaths exploded in 2016 to a total of 63,600, around 42,000 of which involved opioids, according to CDC data. Although these numbers have been rising steadily since 1999, the 21 percent jump in deaths over 2015 was the largest annual increase so far. Drug overdose deaths involving synthetic opioids like fentanyl and fentanyl analogs have increased an average of 88 percent each year from 2013 to 2016, helping to drive the surge.” (B)
“Over the past few years, economists have struggled to explain why so many people appear to be dropping out of the workforce. The most telling measure of that is the labor-force participation rate—which measures the percentage of the population that is employed or actively looking for work—which now sits around 62.7 percent. That’s low by historical standards. For example, between 1986 and 2001, labor-force participation grew fairly steadily, to between 65 and 67 percent….
The economist Alan Krueger’s work has shown that there’s a striking relationship between these missing workers and increasing opioid addiction. According to an analysis done by Krueger, over the past 15 years, labor-force participation among prime-age workers has declined the most in U.S. counties where opioids prescriptions are the most plentiful. He is sure to mention that cause and effect aren’t clear: It’s hard to say whether addiction breeds joblessness, or vice versa. “Regardless of the direction of causality, the opioid crisis and depressed labor force participation are now intertwined in many parts of the U.S.,” Krueger writes.” (C)
The U.S. foster care system is overwhelmed, in part because America’s opioid crisis is overwhelming. Thousands of children have had to be taken out of the care of parents or a parent who is addicted.
Indiana is among the states that have seen the largest one-year increase in the number of children who need foster care. Judge Marilyn Moores, who heads the juvenile court in Marion County, which includes Indianapolis, says the health crisis is straining resources in Indiana.
“We’ve gone from having 2,500 children in care, three years ago, to having 5,500 kids in care. It has just exploded our systems,” Moores says.
While laws in all U.S. states require that child welfare agencies make “reasonable efforts” to reunify parents with their children, Moores says that process can be especially traumatic for children whose parents often relapse.
She says that more legal consideration should be paid to the child’s rights and safety and that “right now, that balance does not tip legally in favor of the child.”
Earlier this year, President Trump declared the opioid epidemic a public health emergency. But that designation “didn’t come with money,” Moores says. “And that is sadly what the necessity is.” She says reform is needed, and it should focus on “how much in the way of resources should be devoted to trying to reunify children with parents who cannot conquer their addiction.”” (D) (E)
“In “Communities in Crisis: Local Responses to Behavioral Health Challenges,” a report from Manatt Health, we highlight how cities and counties are responding to the opioid crisis and untreated mental illness by developing community-driven programs that connect individuals to treatment and social support services. Successful initiatives are creating systems of care that bridge multiple programs to provide coordinated services to individuals with SUD.
Here are five elements of successful local programs: 1.Collaboration and alignment of local resources. 2.Establishment of a holistic system of care. 3.Navigation across care settings. 4.Community engagement and advocacy. SUD that combines traditional drug court services with behavioral health counseling and treatment. 5.Leveraging both public and private financing.” (F)
“UPMC Hamot’s new Pregnancy Recovery Center looks a lot like the orthopedic office it is replacing on the third floor of 300 State St.
The walls of the office’s waiting room remain covered with nautical drawings and pictures, while the exam rooms still look the same. But starting Jan. 2, the office will see expectant women who are addicted to opioids instead of people with broken bones and damaged joints.
“Our goal is to get these women into treatment as early in their pregnancy as possible and reduce the number of babies born who require neonatal withdrawal,” said Emma Mack, R.N., the center’s outreach coordinator.
Erie County’s opioid epidemic has spurred local hospitals to increase their efforts to help pregnant women who are addicted to these drugs. Saint Vincent Hospital opened its Growing Hope program in September 2016 and now Hamot is creating its program, which is based on a similar one Magee Women’s Hospital of UPMC started in 2014.
Pregnant women with addictions are referred to these programs by their obstetrician-gynecologist, an emergency department physician or a drug-treatment facility. An initial appointment is scheduled and an effort is made to switch the patient to the treatment drug Subutex to wean the woman off opioids and control her withdrawal symptoms.” (G)
“Rochester Regional Health expects by April to open a crisis center at the St. Mary’s Campus in the city. The crisis center will evaluate and treat people coping with an acute behavioral or chemical dependency problem, and arrange follow-up care.
The urgent care model is appropriate for someone who is not a danger to themselves or others, or in the midst of an overdose, said Kathy McGuire, senior vice president of behavioral health and home and community services for Rochester Regional.
“Somebody having an anxiety attack would have gone to the emergency room,” she said. “People go to the emergency room when they’re intoxicated. People who haven’t taken their medication in a bunch of days, they need to talk to somebody and get back on their meds.”
Planning started in 2014, and the idea originally was to treat just mental health episodes. But increasing opioid abuse forced a second look.
“The more the opioid crisis came into full view, the more we said there’s such a tie between chemical dependency and mental health,” McGuire said. “We should be thinking about how we should be using this urgent care center to deal with this crisis as well.” (H)
“The paramedics find them everywhere – slumped over car steering wheels, barely breathing in doughnut shop bathrooms or dead in derelict apartments and expensive mansions.
For the Cataldo Ambulance Service crews outside Boston on the front lines of the U.S. opioid epidemic, the flood of overdose calls is a grim daily reality, despite expanded access to overdose reversal drugs.
“When I started, this was a rare thing. You did one or two here and there. Now, we do quite a few,” said Dave Franklin, 44, a supervisor at the private service that contracts with cities who has worked in the field for more than 20 years.
In Massachusetts, EMS opioid overdose calls hit 20,978 in 2016, up from 8,389 in 2013, according to a state report.
Amid wider use by bystanders and police of naloxone, a drug that reverses overdose symptoms, state figures showed a small drop in opioid deaths in the first nine months of 2017 compared with 2016. But Franklin does not yet see a turning point….
At the ambulance, he checks to make sure there is enough naloxone. They carry more than double the amount they once did because stronger opioids mean that multiple doses of naloxone are often required for someone who is barely breathing.” (I)
“The Chicago Urban League recently issued a paper titled “Whitewahed: The African-American Opioid Epidemic,” outlining the drug’s toll on that community: African-Americans make up 15 percent of the state’s population but account for 24 percent of opioid-related deaths.
At the same time, the researchers said, African-Americans are less likely to get help because Cook County, home to about 2 out of 3 black Illinoisans, has a relative scarcity of clinics providing buprenorphine — the medication many experts believe is among the most effective treatments.
Stephanie Schmitz Bechteler, a co-author of the report, said those grim facts have been missing from the public deliberation over heroin, which often focuses on white users in suburban and rural areas.
“On the one hand, the change in narrative has brought a broader awareness to the issue, but it has come at the expense of the comprehensive set of people who are affected by this,” she said.” (J)
“Based on his latest study, Dartmouth-Hitchcock’s Chief of Surgery Dr. Richard Barth is offering surgeons specific guidelines for post-surgery prescriptions for pain-relieving opioids.
Barth said as a surgeon he wanted to see if there was something he could do to curb the opioid crisis.
Many states, including New Hampshire, have adopted laws that prohibit doctors from prescribing more than a seven-day supply of opioids — but a seven-day supply can range from 20 pills to 80 pills, Barth said.
“I know I prescribe opioids for patients that I operate on I was just wondering if I could do that better and optimize that and help to diminish this epidemic,” Barth said. “The Surgeon General has said if doctors keep prescribing more pills than are actually needed, then this crisis is going to go on unabated.”
The study was published in the Journal of the American College of Surgeons on Dec. 15 and is based on a series of studies Barth conducted at Dartmouth-Hitchcock.
According to the peer-reviewed Journal article, this is the first time specific guidelines have been proposed for prescribing opioids after surgery patients are discharged from the hospital.
The studies took a look at patients who did not have issues with chronic pain, and so were not on opioid medications on a regular basis.” (K)
“New Jersey Gov. Chris Christie says the U.S. finally addressed the HIV/AIDS crisis in the 1980s because affected Americans paraded down the streets of Washington and other major cities, saying it was time for power brokers to take the epidemic seriously.
It’s time to start marching again, he recently told Congress — this time to erase widespread stigma that is holding back the fight against an opioids epidemic that kills about 100 people per day in the U.S.
“We will have seen that we’ve begun to remove the stigma of this disease when the people who are impacted are willing to show their face and march and demand, from their government, a response,” said Mr. Christie, a Republican who led President Trump’s commission on opioids addiction. “They don’t march today because they are ashamed to march, because they don’t want to be identified.”
As federal and state leaders try to catch up with the opioids crisis, analysts say too many people still treat drug addiction as a personal failing instead of a disease and that it’s keeping too many Americans from getting the help they need.
Only 1 in 10 people who need treatment for a substance use disorder are getting it — a ratio that would be unfathomable for conditions such as diabetes or kidney cancer…
Mr. Christie’s commission called for a nationwide awareness campaign to focus on the dangers of opioid use and to remove stigma attached to addiction.
Congress is still debating how much funding to devote to the campaign and overall fight, but in the meantime, it is investigating what role opioid manufacturers may have played in aggressively marketing pain pills or downplaying their addictive qualities in the late 1990s and early 2000s.” (L)
“That should be a wake-up call for the Trump administration, which has talked a fine game about the opioid epidemic but done too little to address it. A far greater sense of urgency is needed to address what has become one of the gravest public-health threats to the United States in living memory…
It would be a mistake to see the fall in life expectancy as part of a broad decline in American public health. Infant mortality continues to drop, and death rates from heart disease, cancer, flu, diabetes, kidney disease and other causes are mainly flat or falling. Rather, the main culprits are known as “diseases of despair” — especially drug overdoses and suicide. And the main victims are men, especially working-class young and middle-aged men, for whom the overdose death rate is twice that of women.
Mindful of the soaring toll, President Trump appointed a presidential commission on combating drug addiction and the opioid crisis, which recommended last summer that the president declare a national emergency, as he has pledged to do. That would have freed up funding from the national Disaster Relief Fund. Instead, in October he declared a public-health emergency, a lesser designation and one that has not unlocked game-changing amounts of federal dollars.
At the highest levels, the administration’s response to the crisis has been sluggish, characterized by boastful rhetoric but stagnant funding. Mr. Trump has spoken of the government producing “really tough, really big, really great advertising,” as if a Nancy Reagan just-say-no approach were adequate to the task of tackling a complex public-health scourge. He said the administration would crack down on the synthetic opioid fentanyl, manufactured in China, and endeavor to develop nonaddictive painkillers as an alternative to opioids. But where is the funding?” (M)
“Democrats, especially in the Senate, have called for including some opioid funding in any major government funding package. Some Republicans whose states have been hit hardest by the crisis, like Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia, have also called for more spending.
There are already small signs that Congress might sign off on more spending in 2018. Kellyanne Conway, the White House adviser who has been leading a kind of “opioids cabinet,” told STAT she is working with the Office of Management and Budget on a request for more funds. Outside groups have also said there may be more motivation to pass funding to address the opioid crisis in an election year.
House Energy and Commerce Committee Greg Walden of Oregon told STAT he is hoping to work on an opioids measure in the new year. And Rep. Tom MacArthur (R-N.J.), who is co-chair of the Bipartisan Task Force to Combat the Heroin Epidemic, said the group delivered a host of new policy proposals to Republican leadership that are aimed at addressing the crisis. He said that effort should also be paired with new funding.” (N)
“In the wake of the opioid crisis, hospitals in the Nashville area are now warning patients that they may have to deal with some pain following surgery or other procedures.
David Alfery, M.D, a Nashville anesthesiologist and part of the working group at the regional consulting firm Health Trust, told Nashville Public Radio that patients have developed unrealistic expectations about post-surgical pain management. As a result, the Hospital Corporation of America-owned TriStar Centennial Medical Center has implemented a new protocol that requires surgeons to have difficult conversations with their patients about opioid addiction.
Mike Schlosser, M.D., chief medical officer for HCA National Group, told the publication that he explains to patients that he will treat their pain but they should expect some level of discomfort because narcotics that eliminate all pain will put them at risk for addiction.
It’s not easy for physicians to strike a balance between meeting the pain management needs of patients and preventing addiction. Many doctors have not had training on effective pain management, and may be confused by guidelines to reduce prescriptions for powerful painkillers. Another wrinkle is that patient satisfaction surveys, like the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), include pain management questions.” (O)
“There are a series of actions that need to be taken if we are going to affect the opioid crisis.
Educate physicians, nurses, pharmacists, medical students, residents and the public on the treatment of acute and chronic pain.
Pharmaceutical companies need to recognize their role in creating this crisis and work with the medical profession to address it.
Educate patients regarding treatment approaches to both acute and chronic pain.
Implement a group model for patients who present to primary pain clinics with complaints of chronic pain. This model is well suited to educate patients regarding the clinic’s approach to the use of opioid analgesics, central and peripheral mechanisms involved in pain, non-medication approaches to pain and empowerment to support each other in dealing with chronic medical conditions involving pain.
Encourage physicians to take the online training in the use of buprenorphine, an often lifesaving medication.” (P)
“The Justice Department has awarded over $70 million during 2017 to help fight the opioid crisis nationwide and set up drug courts. It has directed U.S. Attorneys to aggressively prosecute drug dealers, and just last week established a new office to help oversee the implementation of Justice Department initiatives and coordinate with state and local law enforcement.
Violent drug dealers are not the only ones being prosecuted. As the number of drug-related deaths escalates, law enforcement officials are under growing pressure to prosecute and lock up not only criminal drug dealers, but also doctors, pharmaceutical company officials, and even friends and family of the victims if they’ve aided in an overdose death….
It is unlikely that the opioid crisis will be brought under control in the near future. Prevention and compassionate treatment are important, but even more crucial is for law enforcement to use the proven tools it has at its disposal to prosecute those responsible for the deaths of thousands of Americans. (Q)
“While some insurers have become part of the solution, many continue to contribute to the epidemic. Four out of five heroin users start with prescription painkillers, and our commonwealth and country have been flooded with unnecessary, highly addictive prescription opioids.
Despite no change in reported pain levels, sales of prescription opioids quadrupled form 1999 to 2014 and continue at a staggering pace. In 2015, U.S. doctors wrote 300 million pain prescriptions — and insurance companies approved nearly every single one of them, typically without questioning the need or offering meaningful coverage for alternatives.
Insurers decide which treatments and medications we can afford and which will remain out of reach due to high prices. Aetna is helping by eliminating its copay for Narcan and by limiting the amount of opioid medication approved for short-term pain. Independence Blue Cross also has acted to limit opioid prescriptions. More insurers should take similar steps.
It’s long past time to change the corporate cultures of pharmaceutical and insurance companies so that they value the health and safety of their customers as much as their bottom lines.” (R)
“Gov. Chris Christie still hopes to make tackling opioid addiction his signature accomplishment as he prepares to leave office on Jan. 16.
Christie announced grants in excess of $35 million Tuesday for qualified health care providers to care for patients with severe opioid use disorders, pregnant and postpartum mothers, and older adults with opioid dependencies…
“To ensure treatment is successful, it is essential that systems of care join seamlessly to treat the whole individual,” Christie said in a press release. “This funding supports the type of integration of behavioral and primary health care I envisioned when transferring the Division of Mental Health and Addiction Services from the Department of Human Services to the Department of Health.”” (S)
“Attorney General Jeff Sessions on Thursday rescinded a trio of memos from the Obama administration that had adopted a policy of non-interference with marijuana-friendly state laws.
The move essentially shifts federal policy from the hands-off approach adopted under the previous administration to unleashing federal prosecutors across the country to decide individually how to prioritize resources to crack down on pot possession, distribution and cultivation of the drug in states where it is legal.
While many states have decriminalized or legalized marijuana use, the drug is still illegal under federal law, creating a conflict between federal and state law. Thursday’s announcement is a major decision for an attorney general who has regularly decried marijuana use as dangerous.” (T)
“The remaining members of the Presidential Advisory Council on HIV/AIDS were fired en masse this week.
Months after a half-dozen members resigned in protest of the Trump administration’s position on health policies, the White House dismissed the rest through a form letter.
The notice “thanked me for my past service and said that my appointment was terminated, effective immediately,” said Patrick Sullivan, an epidemiologist at Emory University who works on HIV testing programs. He was appointed to a four-year term in May 2016.
The council, known by the acronym PACHA, has advised the White House on HIV/AIDS policies since its founding in 1995. Members, who are not paid, offer recommendations on the National HIV/AIDS Strategy, a five-year plan responding to the epidemic.
The group is designed to include “doctors, members of industry, members of the community and, very importantly, people living with HIV,” said Scott Schoettes, a lawyer with the LGBT rights organization Lambda Legal. “Without it, you lose the community voice in policymaking.”” (U)
(A) Trump on the opioid crisis: Big talk, little action (big surprise), by Dick Polman, https://whyy.org/articles/trump-opioid-crisis-big-talk-little-action-big-surprise/
(B) Opioid Crisis Could Be Biggest Hit To U.S. Life Expectancy In A Century, CDC Says, by Nick Wing, https://www.huffingtonpost.com/entry/opioid-deaths-life-expectancy_us_5a3bfdeee4b0b0e5a7a09e0b
(C) The Opioid Crisis Comes to the Workplace, by GILLIAN B. WHITE, https://www.theatlantic.com/business/archive/2017/12/workers-dying-overdoses/549008/
(D) The Foster Care System Is Flooded With Children Of The Opioid Epidemic, by SCOTT SIMON, https://www.npr.org/2017/12/23/573021632/the-foster-care-system-is-flooded-with-children-of-the-opioid-epidemic
(E) Ohio Child Advocates: Opioid Crisis Straining Foster Care, https://www.usnews.com/news/best-states/ohio/articles/2017-12-21/ohio-child-advocates-opioid-crisis-straining-foster-care
(F) Five key elements of successful local initiatives to combat the opioid crisis, byJonah Frohlich, Chris Cantrell, http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/five-key-elements-successful-local-initiatives-combat-opioid-crisis
(G) Opioid crisis spurs Erie hospitals to help addicted pregnant women, by David Bruce, http://www.goerie.com/news/20171225/opioid-crisis-spurs-erie-hospitals-to-help-addicted-pregnant-women
(H) Rochester Regional opening crisis center to apply urgent care model to mental health, Patti Singer, http://www.democratandchronicle.com/story/news/2017/12/23/rochester-regional-mental-health-crisis-opioid/978831001/
(I) Boston-Area Paramedics on Front Lines of U.S. Opioid Crisis, https://www.usnews.com/news/us/articles/2017-12-22/boston-area-paramedics-on-front-lines-of-us-opioid-crisis
(J) Black victims of heroin, opioid crisis ‘whitewashed’ out of picture, report finds, http://www.chicagotribune.com/news/local/breaking/ct-met-heroin-crisis-african-american-impact-20171220-story.html
(K) NH surgeon offers opioid-prescription guidelines to try to help curb opioid crisis, By MEGHAN PIERCE, http://www.unionleader.com/health/nh-surgeon-offers-opioid-prescription-guidelines-to-try-to-help-curb-opioid-crisis-20171226
(L) Chris Christie calls for campaign to take opioid epidemic seriously and break stigma of addiction, https://www.washingtontimes.com/news/2017/dec/25/opioid-epidemic-fighters-aim-break-addiction-stigm/
(M) America’s opioid epidemic saps life expectancy while the White House sleepwalks, https://www.washingtonpost.com/opinions/americas-opioid-epidemic-saps-life-expectancy-while-the-white-house-sleepwalks/2017/12/26/ac997b2c-e697-11e7-a65d-1ac0fd7f097e_story.html?utm_term=.74284d88bd2a
(N) 3 legislative battles to watch in 2018, by Erin Mershon, https://www.statnews.com/2018/01/02/legislative-battles-2018/
(O) Nashville hospitals take aim at opioid crisis by adjusting approach to pain management, by Paige Minemyer, https://www.fiercehealthcare.com/healthcare/opioid-crisis-drug-addiction-hospital-corporation-american-lifepoint-health?mkt_tok=eyJpIjoiTkdNeE9HVTJPV1V4Wm1SaSIsInQiOiJoZlg5SXN6dzJPc2lHa3FFckV3UElIT0dVREtRR3Fid3hwSmhjQjVyZzdMZ2VIMkcxc1YrYVRPYVNyTUtxaVNBQzlVcjVtdDZ5RFo5Y1wvQStTV1dYZ1k0UTlSam1EY2VQeCtocXM4YUkyQVkrSFZmZm4yNmZ4WittY25rWGRUdjAifQ%3D%3D&mrkid=654508
(P) The U.S. Opioid Crisis: How Can We Remedy?, by Walker Ray, MD and Tim Norbeck , https://www.forbes.com/sites/physiciansfoundation/2018/01/03/the-u-s-opioid-crisis-how-can-we-remedy/#140cd2803768
(Q) The opioid crisis, by Alfred S. Regnery, https://www.washingtontimes.com/news/2018/jan/4/opioid-crisis-is-public-health-emergency-but-its-a/
(R) Opioid crisis: Drug companies, health insurers must step up, by JOSH SHAPIRO, https://www.newsitem.com/articles/opioid-crisis-drug-companies-health-insurers-must-step-up/
(S) Christie grants $35M toward opioid treatment, by Vince Calio, http://www.njbiz.com/article/20180103/NJBIZ01/180109968/christie-grants-35m-toward-opioid-treatment
(T) Sessions nixes Obama-era rules leaving states alone that legalize pot, by Laura Jarrett, https://www.fiercehealthcare.com/healthcare/antibiotic-resistance-research-superbugs-alternative-therapies?mkt_tok=eyJpIjoiTVRFMU4ySTROemM0WWpVNSIsInQiOiJPYWdRdHZEaUZWSXZrVEluUWE5OTRuZVVoMTJGdmhaMVdJbFFUVUtYZjFHUzJmRFI0ZWlyWkVBeWdkUmJCQ2NOVmY3OTlyZTdZUzl0eEc5Zk12N2U5VW1ld0tseFF4YVJsRjFHenI4R25VZ0ZQUG1hNjdOamdjY2crSTZDYmNmTiJ9&mrkid=654508
(U) Trump administration fires all members of HIV/AIDS advisory council, by Ben Guarino, https://www.washingtonpost.com/news/to-your-health/wp/2017/12/29/trump-administration-fires-all-members-of-hivaids-advisory-council/?utm_term=.fcc415cc633c
“The health care industry is consolidating rapidly — hospitals are merging with each other and with insurers; pharmacies are buying insurance companies; and drug companies are snapping up other drug companies.
The big question: Are these deals good for consumers? What happens to networks of hospitals, doctors and pharmacies? Those options will likely narrow as different types of health care businesses end up under the same roof. Regulators ultimately will have to consider whether merged companies are gaining too much negotiating power, and whether these deals will lead to lower health care costs.
What’s next: Regulatory reviews of all these mega-mergers will fall to the Federal Trade Commission — which already has limited resources — and the Department of Justice. Many current deals, including CVS-Aetna, don’t present the same antitrust issues that sunk previous health care mergers. The end of 2017 was among the busiest seasons of mega-mergers in a long time. Expect the trend to continue, while the deals announced last year move closer to reality.” (A)
“There’s an interesting article over at Spectator that details how two of the big mergers initiated in 2017 – CVS-Aetna and Amazon-Whole Foods – may be the start of the re-privatization of healthcare. Both mergers seem to be betting on a future with something different from Obamacare, though it’s very unlikely the national government will get out of the healthcare industry altogether.
That’s okay, at least as far as CVS and Amazon are concerned. If things continue heading along the trajectory of Obamacare lite or an adjusted Obamacare without an individual mandate, the two giant companies are poised to do well. If the government gets mostly out of the health insurance industry through a clean repeal of Obamacare, CVS and Amazon will hit the jackpot. Even if nothing changes, the trends towards big dollars going into healthcare means they’re worst-case-scenario is still highly profitable.” (B)
“Disruption got real. After years of speculation about who or what would become the “Uber of healthcare,” the tectonic plates of the industry shifted substantially in the past year — and there’s reason to believe this will only continue in 2018. A number of mergers illustrate the blurring line between healthcare and other industries, such as retail and insurance. Consider the combinations of CVS and Aetna or Optum and DaVita and Surgical Care Affiliates. As for what’s to come, Apple and Amazon have both shown interest in expanding their healthcare footprint. In fact, just last month, we reported Amazon was in talks to move into the EHR space.
Executive’s takeaway: Executives grew skeptical of the term ‘disruptor’ when it was used as generously as it was circa 2011-2016. But now disruption is actually unfolding at a rapid clip, and executives are paying close attention to who/what poses the greatest threat to their business models.” (C)
“Apple, Google, Microsoft and other tech giants have transformed the way billions of us communicate, shop, socialize and work. Now, as consumers, medical centers and insurers increasingly embrace health-tracking apps, tech companies want a bigger share of the more than $3 trillion spent annually on health care in the United States, too…
The companies are accelerating their efforts to remake health care by developing or collaborating on new tools for consumers, patients, doctors, insurers and medical researchers. And they are increasingly investing in health start-ups…
Each tech company is taking its own approach, betting that its core business strengths could ultimately improve people’s health — or at least make health care more efficient. Apple, for example, has focused on its consumer products, Microsoft on online storage and analytics services, and Alphabet, Google’s parent company, on data…
And Alphabet, perhaps the most active American consumer tech giant in health and biotech, acquired Senosis Health, a developer of apps that use smartphone sensors to monitor certain health signals, also for an undisclosed amount…
Apple is taking a different approach — using its popular iPhone and Apple Watch to help consumers better track and manage their health…
Microsoft, already a major supplier of software and cloud services to medical centers, is also ramping up its health business…
Facebook, too, has been expanding its business and research efforts in the health sector. Last year, Facebook made it more appealing for pharmaceutical companies to advertise their medicines on the platform by introducing a rolling scroll feature where drug makers can list their drug’s side effects in an ad. Such risk disclosures are required by federal drug marketing rules…
Amazon has been less public about its plans in health. But industry analysts have speculated that Amazon could enter the pharmacy business….(D)
“Here are seven key takeaways about major considerations for hospitals in the new tax law, from an interview with KPMG’s Coakley.
Tax-exempt hospitals no longer will be able to offset income from unrelated business activities such as cafeteria earnings with losses from other unrelated business activities….
Tax-exempt hospital systems will be liable for a new 21% excise tax on compensation exceeding $1 million paid to its five highest-paid employees….
The new excise tax on high-earning employees does not apply to compensation for the direct provision of medical services. Some physicians receiving compensation over $1 million are paid for both management and medical provider roles…
All hospital systems now have more limited ability to deduct False Claims Act settlements, which are common in healthcare. For a portion to be deductible, hospital attorneys have to write that specification into any settlements or court orders….
For-profit healthcare corporations’ ability to deduct interest payments would be capped at 30% of adjusted taxable income starting in 2018….
Publicly traded hospital companies will have to take the tax law changes into account for their 2017 financial statements for changes such as a reduced value of deferred tax assets…
Hospitals may want to consider tightening their financial assistance policies to limit or exclude assistance for patients who qualify for subsidized Affordable Care Act, Medicaid or other coverage but choose to forgo it….” (E)
“This year’s environmental scan examines trends in the key focus areas of access, value, partnerships, well-being, coordination, and innovation. More specifically, healthcare executives will find insights in the following:
Coverage (ACA, Healthcare insurance, Medicaid, Cost-sharing payments)
Workforce (Nursing vacancies, Physician shortage)
Affordability (Drug prices, Healthcare spending, Health disparities, High deductibles and HSAs, Health expenditures, Cost controls)
Behavioral Health (Drug and opioid crisis, Mental health, workforce shortage)
Value-based Care Models (Analytics and quality, Bundled payments, Quality improvement)
Consumerism (Patient engagement, Telemedicine, Cybersecurity, Diversity)
Community Partnerships (Chronic diseases, Outpatient facilities, Social determinants, Rural health)
Care Coordination (Data and clinical decision-making, Physician practice consolidation, Hospital mergers)
Technology (Electronic health records, Interoperability, Smartphone and tablet usage)
Disruptive Innovation (Investment, Innovation centers, 3-D Printing, Retail health)” (F)
“Many (hospital) CEOs say they are focusing on developing new revenue streams, lobbying and influencing policy, investing in the future (e.g., technology, growth, talent), and developing alternative payment methods. Strategies vary based on the populations each hospital serves.
While no single strategy will work for every hospital, ideas that CEOs are considering include: Diversifying and identifying alternative revenue streams; Developing more primary care locations and alternative sites of care, including urgent care and retail clinics; Reducing inefficiency and rethinking how care is delivered; Investing in strategies to prepare for value-based care, including shifting funding from hospitalists to primary care practitioners and chronic-disease management; Meeting consumer demands—ultimately, the players with the most ‘members’ are going to do the best.” (G)
“The year healthcare became very, extremely, incredibly difficult. Was any component of healthcare ever easy? Those who have spent years in the industry would say no. Yet 2017 was the year in which officials and lawmakers reminded the American public that healthcare is complicated. While true, this narrative functioned as a sound bite to normalize Congressional dysfunction.
Executive’s takeaway: What’s concerning here is whether this throwaway statement will make its way from Capitol Hill to hospital board rooms, executive offices, clinician lounges and medical school lecture halls and, over time, nurture a climate that fosters and condones inaction. It is unproductive to constantly point out the complicated nature of healthcare and/or bask in this acknowledgement. To do so is not the behavior of an effective leader. It goes without saying that healthcare is complicated. Healthcare is also necessary, expensive, life-saving, honorable, slow, inaccessible, urgent, flawed, and never going away. What are you doing to make it better?” (C)
“Kaufman Hall reported that 87 hospital mergers had been recorded through the third quarter of 2017, compared to 102 overall in 2016. By that point, eight transactions had included hospitals with $1 billion or more in revenue, twice as many big-ticket mergers as in all 2016.
“These transactions are driven primarily by strategic imperative and less so by financial drivers,” said Anu Singh, managing director of Kaufman Hall.
M&A activity wasn’t restricted to hospitals and health systems, as a number of deals in the payer sphere could also significantly impact the industry.” (H)
“Hackensack Meridian Health Wednesday announced it now owns JFK Medical Center in Edison, a deal that creates the largest hospital chain in New Jersey.
In what has become a race to amass the most sprawling health care network in the state, Hackensack Meridian now owns 12 acute care hospitals from Bergen to Ocean counties. It employs a staff of 33,000 and 6,500 doctors, and maintains 4,520 in-patient beds, which include children’s and specialty hospitals.
The deal dethrones RWJ Barnabas Health, owner of 11 full-service hospitals valued at $5.4 billion, as the largest hospital and health care provider in the state. Robert Wood Johnson University Health and Barnabas Health merged in 2016.” (I)
“The basketball rivalry between Duke University and the University of North Carolina battle is legendary, but a federal lawsuit says the two elite institutions have agreed not to compete in another prestigious area: the market for highly skilled medical workers.
The anti-trust complaint by a former Duke radiologist accuses the schools just 10 miles apart of secretly conspiring to avoid poaching each other’s professors. If her lawyers succeed in persuading a judge to make it a class action, thousands of faculty, physicians, nurses and other professionals could be affected.
“The intended and actual effect of this agreement is to suppress employee compensation, and to impose unlawful restrictions on employee mobility,” Dr. Danielle Seaman’s lawyers wrote.” (J)
(A) How your health care will be reshaped in 2018, by Sam Baker Bob Herman, https://www.axios.com/how-your-health-care-will-be-reshaped-in-2018-2521747274.html
(B) Should CVS and Amazon replace Obamacare as the healthcare gatekeepers? by Lorie Wimble, https://noqreport.com/2017/12/29/cvs-amazon-replace-obamacare-healthcare-gatekeepers/
(C) 2017, the year that was: 10 things for healthcare executives to note as they head into 2018, by by Molly Gamble, https://www.beckershospitalreview.com/hospital-management-administration/2017-the-year-that-was-10-things-for-healthcare-executives-to-note-as-they-head-into-2018.html
(D) How Big Tech Is Going After Your Health Care, by NATASHA SINGER, https://www.nytimes.com/2017/12/26/technology/big-tech-health-care.html?_r=0
(E) Seven key changes the new tax law will force hospitals to consider, by Harris Meyer, http://www.modernhealthcare.com/article/20180102/NEWS/180109995?utm_source=modernhealthcare&utm_campaign=am&utm_medium=email&utm_content=20180102-NEWS-1801099952018
(F) Environmental Scan, by B.E. Smith Team, https://www.besmith.com/trends-and-insights/articles/2018-aha-environmental-scan/
(G) “Deloitte 2017 survey of US health system CEOs: Moving forward in an uncertain environment”, http://www.modernhealthcare.com/article/20171221/SPONSORED/171229981
(H) 13 healthcare M&A deals that made headlines in 2017, by Paige Minemyer, https://www.fiercehealthcare.com/finance/healthcare-mergers-and-acquisitions-hospitals-payers-year-review?mkt_tok=eyJpIjoiTkdNeE9HVTJPV1V4Wm1SaSIsInQiOiJoZlg5SXN6dzJPc2lHa3FFckV3UElIT0dVREtRR3Fid3hwSmhjQjVyZzdMZ2VIMkcxc1YrYVRPYVNyTUtxaVNBQzlVcjVtdDZ5RFo5Y1wvQStTV1dYZ1k0UTlSam1EY2VQeCtocXM4YUkyQVkrSFZmZm4yNmZ4WittY25rWGRUdjAifQ%3D%3D&mrkid=654508
(I) Hackensack Meridian acquires another hospital and is now N.J.’s largest chain, by Susan K. Livio, http://www.nj.com/healthfit/index.ssf/2018/01/hackensack_meridian_is_njs_largest_hospital_chain.html
(J) Lawsuit: Duke, UNC agreed to not hire each other’s doctors, http://www.modernhealthcare.com/article/20180102/NEWS/180109993?utm_source=modernhealthcare&utm_campaign=am&utm_medium=email&utm_content=20180102-NEWS-180109993
2017’s headline is the rapid transformation of the American health care system with disruptive hybrid private sector mergers, mega-hospital system mergers creating horizontally and vertically super-sized systems, and major capital expansion investment by academic medical centers to retain national and regional “anchor” supremacy.
And the explanation by pundits of the various competing trajectories.
My approach is to curate an annotated synopsis and let the readers reach their own conclusions.
So get started! (And Happy New Year!)
JMM
“The U.S. health care system is begging for disruption. It costs way too much ($3.3 trillion last year) and delivers too little value. Hundreds of millions of Germans, French, English, Scandinavians, Dutch, Danish, Swiss, Canadians, New Zealanders, and Australians get comparable or better health services for half of what we pay. For most Americans, care is not only expensive but is also fragmented, inconvenient, and physically inaccessible, especially to the sickest and frailest among us.
It should come as no surprise, then, that when titans of our private, for-profit health care sector — like Aetna, CVS, UnitedHealth Group (UHG), and DaVita — strike out in new directions, stakeholders react with fascination and excitement. Could this be it? Is free-market magic finally bringing Amazon-style convenience, quality, and efficiency to health care? Are old-guard institutions, like hospitals and nursing homes, on the verge of extinction?” (A)
“CVS Health said on Sunday that it had agreed to buy Aetna for about $69 billion in a deal that would combine the drugstore giant with one of the biggest health insurers in the United States and has the potential to reshape the nation’s health care industry…
The merger comes at a time of turbulent transformation in health care. Insurers, hospitals and pharmacy companies are bracing for a possible disruption in government programs like Medicare as a result of the Republicans’ plan to cut taxes. Congress remains at an impasse over the future of the Affordable Care Act, while employers and consumers are struggling under the weight of rising medical costs, including the soaring price of prescription drugs. And rapid changes in technology have raised the specter of new competitors — most notably Amazon.
A combined CVS-Aetna could position itself as a formidable figure in this changing landscape. Together, the companies touch most of the basic health services that people regularly use, providing an opportunity to benefit consumers. CVS operates a chain of pharmacies and retail clinics that could be used by Aetna to provide care directly to patients, while the merged company could be better able to offer employers one-stop shopping for health insurance for their workers.
But critics worry that customers could also find their choices sharply limited. The deal risks leaving patients with less choice of where to get care or fill a prescription if those with Aetna insurance are forced to go to CVS for much of their care.” (B)
“Ana Gupte, PhD, a senior healthcare services analyst at Leerink Partners, told CNBC she could see Walmart and health insurer Humana joining forces to compete in the shifting healthcare landscape.
“Humana and Walmart have been in a very tight relationship for six, seven years,” she said, and Humana members already receive deals on prescription copays at Walmart pharmacies. Increasing competition and the threats posed by CVS’ deal with Aetna may be enough to push Walmart to consider buying Humana, according to the report.
Anthem, Cigna and Walgreens may also be among the healthcare companies interested in striking a deal, according to Dr. Gupte.” (C)
“In another example of the blurring boundaries in the health care industry, UnitedHealth Group, one of the nation’s largest insurers, said on Wednesday that it is buying a large physician group to add to its existing roster of 30,000 doctors.
UnitedHealth’s Optum unit will acquire the physician group from DaVita, a large for-profit chain of dialysis centers, for about $4.9 billion in cash, subject to regulatory approval. DaVita operates nearly 300 clinics across a half-dozen states, including California and Florida.
With the purchase, UnitedHealth is increasingly moving into the direct delivery of medical care…
The potential threat of new competitors like Amazon entering the pharmacy business and technology companies delivering medical care through cellphones has led former adversaries to become partners, driving insurers to team up with hospitals and doctors’ groups. They are seeking to deliver care in novel ways, outside the expensive setting of a hospital…
Even if insurers succeed in lowering medical costs as a result of the new ventures, economists and other experts warn that shareholders, not consumers, could benefit unless the lower costs yield lower prices for coverage. There must be sufficient competition among insurers for consumers to benefit, Professor Garthwaite said. (D)
“Health care Goliaths are cutting out the middleman. The American health care system is full of intermediaries chasing after a share of the industry’s profit, often by gaming one another. UnitedHealth’s $4.9 billion purchase of a physicians group from DaVita is the latest example of trying to cut costs by eliminating such links in the chain.
The health care system in the United States is akin to one of Rube Goldberg’s zany cartoon contraptions. America spends far more than other countries on treating or preventing ailments, yet with mediocre outcomes. It also ranks worst among 11 industrialized countries in the percentage allocated to administration, the time doctors need to receive insurer approval for treatments, and how long patients spend disputing costs, according to a 2014 Commonwealth Fund study.
The multiplicity of players — drugmakers, doctors, pharmacies, pharmacy benefit managers, insurers, wholesalers and hospitals — means lots of hands trying to grab money from other participants. (E)
“U.S. health insurer Humana and two private-equity firms agreed to buy home health-care and long-term care operator Kindred Healthcare on Tuesday for about $4 billion, the latest expansion by a U.S. health insurer into patient care….
Humana, the fourth-largest U.S. health insurer, will pay $800 million for a 40 percent stake in Kindred at Home, which will contain Kindred’s 40,000 caregivers that serve about 130,000 patients daily.” (F)
“Catholic Health Initiatives (CHI) and Dignity Health have signed a definitive agreement to combine ministries and create a new, nonprofit Catholic health system. The combination brings together two leading health systems, allowing the organizations to expand their mission of service and create a healthier future for people and communities across 28 states….
The new health system will include more than 700 care sites and 139 hospitals, offering people and communities access to quality care delivered by approximately 159,000 employees and more than 25,000 physicians and other advanced practice clinicians. The organizations are geographically complementary with no overlap across hospital service areas.” (G)
“Two major hospital systems are in talks about a possible merger that would create the largest U.S. owner of hospitals, as a series of deals shape up to further consolidate control of the health-care landscape.
Ascension and Providence St. Joseph Health, both nonprofits, are talking about combining, according to people familiar with the discussions. A deal would create an entity of unprecedented reach, with 191 hospitals in 27 states and annual revenue of $44.8 billion… (H)
“Looking to grow their brands and health services, several Catholic-owned hospital operators have announced or are reportedly involved in merger talks….
The more than 300 Catholic hospitals involved in these deals mean fewer acquisition targets for HCA, Tenet, Community and other for-profits. These investor-owned giants are already seeing their hospital admissions deteriorate in the move to value-based care that emphasizes payments to outpatient providers and doctor’s offices to make sure more care is given upfront before it reaches an inpatient facility. In Tenet’s third quarter, for example, “same hospital patient revenue decreased 2.3%” which “reflects a 2.2% decrease in adjusted admissions,” the company said last month.
Tenet is evaluating options for the entire chain of 77 hospitals and 460 outpatient centers including possible sale. “We have and we will continue to review, analyze and pursue all options to enhance shareholder value,” Tenet’s Ronald Rittenmeyer, executive chairman and CEO said in November. (I)
“Franklin, Tenn.-based Community Health Systems completed its 30-hospital divestiture plan Nov. 1. Now, the company expects to sell another group of its hospitals with combined revenue of $2 billion, Chairman and CEO Wayne Smith said during a third quarter earnings call.
To improve its finances and reduce its heavy debt load, CHS put a turnaround plan into place last year. As part of the initiative, the company announced in early 2017 that it intended to sell off 30 hospitals. In August, CHS extended its divestiture plan. The company said it would sell a group of hospitals with combined revenue of $1.5 billion in addition to the 30 hospitals already announced….
“Our goal is to emerge from this process with a sustainable group of hospitals that are positioned for long-term success and growth,” he said.” (J)
“Carolinas HealthCare System, the Charlotte region’s dominant hospital chain, will partner with UNC Health Care of Chapel Hill to form a medical giant – one that leaders of the two systems predict will expand access to care, improve quality and boost the state’s economy…
It marks a major development for Carolinas HealthCare, Charlotte’s largest employer. The new system would run more than 50 hospitals and employ more than 90,000 people, making it one of the nation’s largest hospital chains.
But experts in hospital consolidation cautioned Thursday that deals like these tend to drive up health care costs. That’s because larger systems have more leverage to negotiate higher payments from insurance companies, which then pass on the higher costs to patients.” (K)
“The University of Pittsburgh Medical Center plans to invest $2 billion to build three “specialty hospitals” that include top-of-the-line technologies, the health system announced.
The $2 billion is in addition to $1 billion already set aside by UPMC for capital improvements, the organization said.
The three new facilities will be built near existing UPMC hospitals in Pittsburgh: UPMC Vision and Rehabilitation Hospital at UPMC Mercy; UPMC Hillman Cancer Hospital at UPMC Shadyside Hospital; UPMC Heart and Transplant Hospital at UPMC Presbyterian. (L)
San Diego-based Scripps Health is planning a $2.6 billion expansion — the largest construction project in the organization’s 125-year history.
The expansion will include constructing a $1.3 billion replacement hospital for Scripps Mercy Hospital San Diego; a new seven-story patient tower for San Diego-based Scripps Memorial Hospital La Jolla; and a three-story acute care structure at Scripps Memorial Hospital Encinitas (Calif.). In addition, seismic retrofitting construction is planned for Scripps Mercy Chula Vista (Calif.) and Scripps Green Hospital in San Diego. (M)
“Ohio State University intends to build a new hospital tower, which the university calls “the largest single facilities project ever undertaken at Ohio State.”
The university announced requests for qualifications Wednesday, seeking design professionals for two Wexner Medical Center projects anticipated to cost more than $2 billion: the tower and a new ambulatory center.
The envisioned hospital tower will have up to 840 beds in private rooms to elevate patient-centered care, safety and training for future physicians, the university said…
“This is an important moment in time,” said Wexner Medical Center board member Robert H. Schottenstein in a statement. “We are positioned to take a bold step forward by aligning all the operations of the medical center for the delivery of care, research and innovation that will have life-changing, long-term benefits for central Ohio, the State and beyond…. (N)
“Virtua Health can proceed with its plans to build a $1 billion hospital complex in Westampton, Burlington County, as long as it meets 13 conditions, the New Jersey Health Planning Board decided Thursday after reviewing the proposal…
The new hospital, which would have 339 beds and private rooms for all patients, would replace the Virtua Memorial Hospital in Mount Holly, three miles away…
The 399-bed Voorhees hospital, which opened in 2011, also was part of a $1 billion medical complex. A third Virtua hospital is in Marlton. (O)
“Moody’s Investors Service has issued a negative outlook on the nonprofit healthcare and hospital sector. The outlook reflects Moody’s expectation that operating cash flow in this sector will decline by 2 to 4 percent over the next 12 to 18 months.
The outlook revision comes amid uncertainty regarding federal healthcare policy for nonprofit hospitals and after the sector experienced a larger-than-expected drop in cash flow this year….
This marks the first time in several years Moody’s has issued a negative outlook on the nonprofit healthcare and hospital sector. The debt rating agency has maintained a stable outlook on the sector since August 2015. “(P)
Fitch Ratings’ outlook on the nonprofit healthcare sector is negative for 2018, as the sector faces regulatory, political and competitive challenges.
“..Fitch expects nonprofit hospitals and health systems’ profitability to continue to weaken over the next year. “Growth in Medicare and Medicaid volumes are weakening provider payer mixes at a time when providers are moving from volume-based reimbursement in greater numbers,” said Fitch Senior Director Kevin Holloran.” (Q)
“Dr. Peter Pronovost, one of the nation’s top patient safety experts and advocates, is leaving Johns Hopkins Health System for a job at insurance giant UnitedHealthcare, he announced Thursday on Twitter.
In a statement welcoming Pronovost to UnitedHealthcare, the insurer said he “has distinguished himself nationally and internationally with his ground-breaking work around saving lives, improving patient safety, and improving both the quality and value of health care…
“Dr. Pronovost’s patient-centered approach to care and deep clinical expertise will help bring a provider point-of-view deeper into UnitedHealthcare and improve how payers and care providers work together to share best practices, build appropriate value-based incentives, and effectively use data to improve the patient experience.”” (R)
“Rapid changes in the larger health care field are leading hospitals and health systems to explore new ways to enhance quality, reduce costs, and provide more convenient access to care to meet patients’ needs on their terms…hospital mergers can lead to substantial savings and provide needed funds to finance innovations that will enhance quality and convenience.
Benefits apply whether the hospitals involved are nearby, across the state or even across the country. A larger system allows hospitals to share infrastructure costs for expensive IT and reduce overlapping overhead costs.
It also expands the types of services available to patients and communities, and provides a stable foundation on which to deliver more comprehensive, coordinated and convenient care.”
America’s hospitals and health systems continue to build a high-performing, patient-centered system that benefits us all.
In some communities, mergers might be the only practical way to preserve services and enhance quality. In every case, the changes in the hospital field are in the service of providing a strong foundation upon which to build the health care system of the future and to continue to provide communities with the care they need in the consumer-friendly ways they expect.” (S)
“In theory, insurance companies hold down costs by driving hard bargains with providers. In reality, they find it difficult to do so.
UnitedHealth Group is the largest private health insurer, with about 11% of the overall market. Everyone else is less than 10% (though in local and regional markets there is more concentration).
That makes these insurers plenty big enough to beat up on consumers, but too small to take on powerful providers.
The result: In the USA, 18 cents of every dollar spent goes to health care each year. In other developed countries, health care expenditures are much less, in the range of 10 to 12 cents per dollar.
Which makes recent trends in the hospital industry all the more troubling. Two major hospital chains, Ascension and Providence St. Joseph Health, are in talks to merge, a move that would create a 191-hospital colossus operating in 27 states…
These massive businesses run much as their for-profit brethren — and will put pressure on for-profits to merge as well. That won’t be good for consumers, or the ridiculously high premium the American economy pays for a health care system that lacks effective cost controls.
Not all mergers in health care are problematic. The proposed combination of CVS, the owner of drug stores and walk-in clinics, with Aetna, a major insurer, holds intriguing possibilities for efficiencies and more comprehensive tracking of health care decisions.
It could also be argued that there should be more consolidation among insurance companies. This might not be a hugely popular concept, but it would give them more leverage to say no to costly increases demanded by hospitals and other potent health care providers.
At the very least, it’s time to take a critical eye to the mega hospital empires being erected. They could be very hazardous to your health.” (T)
“The CVS-Aetna deal did not come as a surprise to industry leaders who have been keeping their ears to the ground and have paid attention to recent trends. But nevertheless, this merger is a major shake-up that cannot be ignored. Google, Amazon and IBM Watson are all looking to stake out a piece of the healthcare field, and deals such as Optum’s purchase of DaVita Medical Group underscore the ever-evolving nature of the ways people access and pay for care and services. Providers should not view this movement as a threat that must be stopped. Instead, we should spur innovation on our end. We can’t sit still. That’s why, in Northwell Health’s case, we have been forging new partnerships and pursuing ventures that will enable the organization to compete more effectively in this rapidly changing environment.
It will be especially intriguing to see what market segments CVS and Aetna pursue after the merger is finalized. Undoubtedly, they will offer prescriptions, preventive care and other primary services to supplement CVS’ “Minute Clinics,” but it remains to be seen what other health services will be provided as part of this new collaboration. Regardless of what new competitors enter the healthcare market, the seriously ill, elderly patients with chronic conditions and those who have suffered traumatic injuries will still be relying on hospitals to take care of them. It’s highly unlikely that any of the new players will be providing inpatient care. As we all know, the bulk of healthcare funding is spent on long-term care for people at the end of life. The Amazons and Googles of the world are not targeting that population.” (U)
“It’s all about the patient.
Or at least about keeping patients and the revenue generated for their medical care.
As health care is rocked by deals aimed at shattering traditional boundaries between businesses, some of the nation’s biggest hospital groups are doubling down on mergers that seem much more conventional. Skeptics say some of these hospital deals are more of the same: systems seeking to increase their leverage with insurance companies and charge more for care…
But the frenzy of mergers and other alliances taking place also reveals a frantic attempt to court and capture patients as people have more choices about where to go for care. Patients are increasingly relying on walk-in clinics, urgent care centers or an app on their cellphone to check out a nasty rash or monitor their diabetes, and they are looking for places that are both less expensive and more convenient than a hospital emergency room or doctor’s office…
The fundamental question is whether hospital groups have what it takes to use their increased scale to radically change,…
But the challenge cannot be underestimated in asking these massive institutions to come together and change into something radically different. “You’re taking a zebra and a zebra,” Mr. Cassels said. “What they want to become is a unicorn.” (V)
“The $69 billion merger between CVS and Aetna is a powerful example of the “attacker’s advantage,” according to Ram Charan in an op-ed for strategy + business.
Mr. Charan is a business adviser and teacher who has spent 40 years consulting CEOs and executive boards. He defines the attacker’s advantage as “the competitive edge generated by leaders who can detect subtle shifts in consumer behavior, markets, and economic and social systems; who can spot an opportunity before others do; and who can lead their enterprises decisively to execute on that opportunity.” (W)
“….. no one should underestimate the challenge of growing the UnitedHealth acquisition of dispersed physician groups into a national system capable of disrupting our floundering health system. Health care is a very local affair, and the organizations providing it tend to be creatures of their localities and histories. It can take generations for a provider-insurer partnership to develop a culture of trust, collaboration, and value orientation that has made existing examples of these combinations so uniquely effective. If the new entity seeks to grow, it will find that recruiting and training physicians who can leave the fee-for-service mentality behind is a challenge, as is finding leadership that can gain and keep health professionals’ trust. Kaiser has failed in several attempts to spread to new locations. And though UnitedHealth’s Optum division, which will run the partnership, has some limited experience managing selected specialty health services, making this new enterprise work could prove daunting.” (A)
“Many Mayo Clinic doctors, nurses and other employees will be free to roll up their sleeves and show their ink in 2018 with a new policy allowing tattoos to be visible.
Mayo Clinic is loosening up its “Dress and Decorum Policy.” Currently, employees with tattoos are supposed to keep them covered at work or face discipline.” (X)
“New Hyde Park, N.Y.-based Northwell Health named Michelin Star chef Bruno Tison assistant vice president for food services and the corporate executive chef.
In his new role, Mr. Tison will oversee food quality, culinary training, menu and recipe development for the entire health system. His responsibilities will include teaching the health system’s cooks to make healthier and tastier food.” (Y)
(A) Is M&A the Cure for a Failing Health Care System?, David Blumenthal, https://hbr.org/2017/12/is-ma-the-cure-for-a-failing-health-care-system
(B) CVS to Buy Aetna for $69 Billion in a Deal That May Reshape the Health Industry, By MICHAEL J. de la MERCED and REED ABELSON, https://www.nytimes.com/2017/12/03/business/dealbook/cvs-is-said-to-agree-to-buy-aetna-reshaping-health-care-industry.html
(C) Why the CVS-Aetna deal could push Walmart to buy Humana, by Ayla Ellison, https://www.beckershospitalreview.com/payer-issues/why-the-cvs-aetna-deal-could-push-walmart-to-buy-humana.html
(D) UnitedHealth Buys Large Doctors Group as Lines Blur in Health Care, by REED ABELSON, https://www.nytimes.com/2017/12/06/health/unitedhealth-doctors-insurance.html?_r=0
(E) UnitedHealth’s Deal May Point to Health Care’s Future, by ROBERT CYRAN, https://www.nytimes.com/2017/12/06/business/dealbook/unitedhealth-davita.html
(F) Humana, private-equity firms buy Kindred Healthcare for $4 billion, by Ty Wright, https://www.cnbc.com/2017/12/19/humana-private-equity-firms-buy-kindred-healthcare-for-4-billion.html
(G) Dignity Health and Catholic Health Initiatives to Combine to Form New Catholic Health System Focused on Creating Healthier Communities, https://www.dignityhealth.org/about-us/press-center/press-releases/dignity-health-and-catholic-health-initiatives-announcement
(H) Hospital Giants in Talks to Merge to Create Nation’s Largest Operator, by Melanie Evans and Anna Wilde Mathews, https://www.wsj.com/articles/hospital-giants-in-talks-to-merge-to-create-nations-largest-operator-1512921420
(I) Catholic Hospital Mega-Deals Pressure For-Profits Like Tenet And HCA, Bruce Japsen, https://www.forbes.com/sites/brucejapsen/2017/12/12/catholic-hospital-mega-deals-pressure-for-profits-like-tenet-and-hca/#41a1d7844c08
(J) CHS to sell additional hospitals worth $2B in revenue, by Ayla Ellison, https://www.beckershospitalreview.com/hospital-transactions-and-valuation/chs-to-sell-additional-hospitals-worth-2b-in-revenue.html
(K) CEOs describe health care partnership as a ‘marriage’, by Ames Alexander, Deon Roberts and Ann Doss Helms, http://www.charlotteobserver.com/news/business/article170440017.html
(L) UPMC will invest $2B to build 3 specialty hospitals, by Paige Minemyer, https://www.fiercehealthcare.com/finance/upmc-capital-investment-allegheny-health-network-hospital-expansion
(M) Scripps Health to launch $2.6B expansion, by Alia Paavola, https://www.beckershospitalreview.com/facilities-management/scripps-health-to-launch-2-6b-expansion.html
(N) New hospital tower would be Ohio State’s largest single project, by Jennifer Smola, http://www.dispatch.com/news/20171129/new-hospital-tower-would-be-ohio-states-largest-single-project
(O) Virtua wins health planning board OK to build a $1 billion medical campus in Westampton, by Jan Hefler, http://www.philly.com/philly/news/new_jersey/Virtua-Health-Westampton-hospital-Mount-Holly-medical-project.html
(P) Moody’s: Outlook is negative for nonprofit hospital sector, by Ayla Ellison, https://www.beckershospitalreview.com/finance/moody-s-outlook-is-negative-for-nonprofit-hospital-sector.html
(Q) Fitch issues negative outlook for nonprofit hospitals: 4 things to know, by Ayla Ellison, https://www.beckershospitalreview.com/finance/fitch-issues-negative-outlook-for-nonprofit-hospitals-4-things-to-know.html
(R) Top patient safety expert, innovator of checklists, departs Johns Hopkins, by Meredith Cohn, http://www.baltimoresun.com/health/bs-hs-peter-pronovost-leaves-hopkins-20171214-story.html
(S) Health care mergers benefit patients, by Rick Pollack, https://www.usatoday.com/story/opinion/2017/12/17/health-care-mergers-benefit-patients-editorials-debates/108704794/
(T) When hospitals merge, you pay the bill, https://www.usatoday.com/story/opinion/2017/12/17/when-hospitals-merge-you-pay-editorials-debates/953998001/
(U) Michael Dowling: 4 most important healthcare trends in 2018, by Written by Michael J. Dowling, https://www.beckershospitalreview.com/hospital-management-administration/michael-dowling-4-most-important-healthcare-trends-in-2018.html
(V) Hospital Giants Vie for Patients in Effort to Fend Off New Rivals, by REED ABELSON, https://www.nytimes.com/2017/12/18/health/hospitals-mergers-patients.html?_r=0
(W) Why the Aetna–CVS Deal Is a Lesson for Leaders, by Leo Vartorella, https://www.strategy-business.com/blog/Why-the-Aetna-CVS-Deal-Is-a-Lesson-for-Leaders
(X) Mayo to allow visible body art, with some exceptions, by Jeff Kiger, http://www.postbulletin.com/news/local/mayo-to-allow-visible-body-art-with-some-exceptions/article_4b0c7713-633b-5230-86d7-5468901bcf3c.html
(Y) Northwell first health system in nation to hire Michelin Star chef, by Anuja Vaidya, https://www.beckershospitalreview.com/hospital-executive-moves/northwell-health-appoints-assistant-vp-of-food-services-corporate-executive-chef-3-takeaways.html
“About 8.8 million Americans enrolled in health coverage through Healthcare.gov, the Trump administration announced Thursday, a slight dip from last year after the Trump administration cut spending and outreach but far from a dramatic drop.
Last year, about 9.2 million people signed up through Healthcare.gov, which serves more than 30 states. A dozen states run their own marketplaces and several of those states have not yet closed their open enrollment.
Seema Verma, the head of the Centers for Medicare and Medicaid Services, which oversees the federal marketplace, tweeted next year’s Obamacare enrollment numbers a week after the open enrollment period for 2018 coverage ended.
There are two ways to look at the numbers: On the one hand, in a thriving marketplace, you would expect enrollment to grow every year. On the other hand, given the deep cuts that the Trump administration made to Obamacare advertising and the decision to have the sign-up window, the law has proven pretty resilient.” (A)
“The numbers essentially defied President Trump’s assertion that “Obamacare is imploding.” They suggested that consumers want and need the coverage and subsidies available under the Affordable Care Act, even though political battles over the law, President Barack Obama’s signature domestic achievement, are sure to continue in Congress and in next year’s midterm election campaigns.
Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services, reported the total in a Twitter post on Thursday. She said her agency had done a great job to “make this the smoothest experience for consumers to date.”
Republican efforts to dismantle the Affordable Care Act this year had an unintended effect: They heightened public awareness of the law and, according to opinion polls, galvanized support for it among consumers who feared that it might be taken away….
Ms. Verma tried over the summer to persuade Congress to repeal the Affordable Care Act, but on Thursday, she boasted about how well the law’s insurance marketplace — under new management — was meeting the needs of consumers.” (B)
“After Trump signs the tax bill into law, enrollment could drop precipitously now that people are not financially pressured to buy health insurance. Health policy experts predict a sizable number of healthy people likely won’t enroll.
That could two do things, say health-care experts: Drive enrollment down further and raise premiums even higher, since insurance companies will be spending more money on sick people without balancing it with healthy people.
That means that in places where there aren’t wide swaths of insured Americans — such as rural areas in Iowa or New Hampshire — insurance companies could have incentive to pull out of Obamacare exchanges, further weakening the law. In a sense, Republicans are creating a self-fulfilling prophecy.
Some health experts warn it could be a prophecy Republicans could come to regret, since residents of less-populated areas and the self-employed, who are also often uninsured, tend to be Republican.” (C)
“Senate Majority Leader Mitch McConnell on Thursday said he wants the Senate to move past Obamacare repeal in 2018 in favor of stabilizing insurance markets and to other issues, prompting a backlash from one of the Senate’s most prominent advocates of repeal and an ally of President Trump….
“Well, we obviously were unable to completely repeal and replace with a 52-48 Senate,” McConnell said referring to the partisan split in the chamber. “We’ll have to take a look at what that looks like with a 51-49 Senate [once Alabama Democratic Sen.-elect Doug Jones is seated]. But I think we’ll probably move on to other issues.”
McConnell’s comment drew a sharp rebuke from Sen. Lindsey Graham (R-S.C.), who is hoping to revive a bill next year repealing Obamacare in favor of block grants to states. He and Sen. Bill Cassidy – who authored the last GOP attempt to repeal the health care law in 2017 – met this week to strategize about how to bring back the effort in the new year.
“I think that’s a huge mistake,” Graham told reporters. “We should do everything we can to replace it, as much as [Democrats] did to pass it. We own it now.”” (D)
“Republican Sen. Lindsey Graham of South Carolina immediately pushed back on McConnell’s comments. “To those who believe — including Senate Republican leadership — that in 2018 there will not be another effort to Repeal and Replace Obamacare — you are sadly mistaken,” Graham said in a statement and on Twitter.
Obamacare is still the law of the land and will continue to crumble which will drive up insurance costs for hard-working Americans and eventually pave the path to single-payer health care.
I’m fully committed to Repealing and Replacing Obamacare in 2018 by block-granting the money back to the states and away from Washington bureaucrats who are completely unaccountable to the patients of America.”” (E)
“With President Donald Trump poised to sign a tax bill that would effectively kill off the mandate requiring most Americans to buy health insurance coverage or pay a fine, calls for federal legislation to stabilize the individual insurance market are intensifying. But some experts doubt that federal help for 2018 is on the way, and wonder if states would be better off taking action on their own to prop up their markets….
States may be better able to keep their individual markets afloat by taking matters into their own hands. States could implement their own individual mandate penalties. Massachusetts has had one for the past 10 years. However, implementing the ACA’s most unpopular provision would be politically tricky. Officials in states including California, Connecticut, Maryland and others are considering their own mandates.
States could also set up state-based reinsurance programs and apply for federal funding under a 1332 waiver. Alaska, Minnesota and Oregon have lowered premiums in their marketplaces by taking that route. Most states don’t have enough money to run a reinsurance program independently… (F)
“In practice, the precise effect of the provision has been unclear. The Obama administration had made the mandate somewhat porous, with a long list of life circumstances that would exempt people from having to pay a penalty. Some economists have argued that the penalties are too small to encourage the truly reluctant to enroll. The C.B.O. said it was re-evaluating its own assumption but thought it had probably overestimated the provision’s impact on premiums and insurance enrollment. Still, some mandate enthusiasts continue to argue that the provision’s disappearance will lead to a death spiral of ever-escalating insurance premiums and eventual market collapses.
Those questions, once largely academic, will get real-life answers in coming months and years. The end of the mandate will establish a sort of natural experiment, in which its influence will become much more clear. Some states may not wait to find out. Policymakers in several blue states are weighing state-level insurance mandates. Those policy descendants may help settle the question of the importance of the mandate to the design of Obamacare, with its market-based system for expanding insurance coverage.” (G)
“While young and healthy individuals may very well rejoice at the repeal of the individual mandate, nobody stays young and healthy forever. Just as Social Security relies upon a younger generation of workers to fund the retirement income of the elderly, so too does ObamaCare rely on the healthy to take care of the sick. We all eventually retire and we all eventually get sick. It is just a basic fact of life that every single one of us will have our time of need.
But now Republicans are appealing to our selfish, short-term instincts to make us lose sight of our long-term future as a nation. Throughout all the ObamaCare repeal attempts, from the skinny repeal to Graham-Cassidy bill to the elimination of cost share reductions, Republicans have tried so hard in so many ways to make America sick again. This time they may have very well succeeded.” (H)
“A new poll by The Associated Press-NORC Center for Public Affairs Research finds that 48 percent named health care as a top problem for the government to focus on in the next year, up 17 points in the past two years.
The poll allows Americans to name up to five priorities and found a wide range of top concerns, including taxes, immigration, and the environment. But aside from health care, no single issue was named by more than 31 percent.
And 7 in 10 of those who named health care as a top problem said they had little to no confidence that government can improve matters. The public was less pessimistic in last year’s edition of the poll, when just over half said they lacked confidence in the problem-solving ability of lawmakers and government institutions.” (I)
“First, the just-passed Republican tax plan eliminates the penalty on people who don’t have ACA-approved health coverage. So people will soon be able to buy short-term insurance without worrying about that penalty….
But short-term plans don’t have to meet standards set by the ACA, so they often come with limitations that can leave people with huge medical bills if they get seriously ill. These plans can be cheap,…“but they also don’t cover very much.”
For example, insurers can exclude coverage or charge extra for everything from maternity care and prescription drugs to mental health care. They also don’t have to cover pre-existing conditions—that is, any condition for which you have experienced symptoms or sought treatment for up to five years before enrolling. And if you get seriously ill after the policy starts, the company can refuse to later renew your plan.
Short-term plans can also have higher deductibles than what’s allowed by the ACA…. By contrast, ACA plans are prevented by law from putting a dollar limit on any of these essential health benefits.” (J)
“Take, for example, the poor Maine Warden Service pilot who landed Wednesday morning on Eagle Lake in northern Maine. While taxiing to the state’s airplane base, he hit a soft spot and, well, all you can see now is the Cessna’s tail poking through a hole in the surface.
Which brings us to Sen. Susan Collins. “I’m not pretending that I’m not disappointed and annoyed,” Maine’s senior senator said in a telephone interview late Wednesday, shortly after her much-ballyhooed bargain with Senate Majority Leader Mitch McConnell sank like a plane on thin ice.
The deal went like this: In exchange for Collins’ vote for the Republicans’ tax giveaway to corporations and the wealthiest among us, McConnell promised – promised – that two bipartisan bills aimed at rescuing the Affordable Care Act, or Obamacare, would pass by the end of the year.
Uh-huh.
Wednesday afternoon, while President Trump and a herd of happy Republicans gathered at the White House to bask in the glow of their newly minted tax “reform,” Collins and Sen. Lamar Alexander, R-Tennessee, announced that, alas, their two Obamacare bills will have to wait until next year.
Deadline? What deadline? Promise? What promise?..
She blamed Senate Minority Leader Chuck Schumer, D-New York, who announced last week that Democrats in the Senate would not support the Obamacare rescue legislation as part of a year-end stopgap spending bill.
If that’s not a warning sign of danger ahead, what is?…
Little wonder that much of Washington, D.C., not to mention Maine, now snickers about how Collins got played. “If I get the bills that I’ve been advocating for passed, but they’re passed six to eight weeks later than I expected, how does that mean I’ve been played?” she asked. “How do you know you’re going to get them in six to eight weeks?” I countered. “How do you know I’m not?” she replied. I don’t.
But like most common-sense Mainers, I know enough to stay off thin ice.” (K)
“In a larger sense, the Republicans’ rhetorical victory of cutting out the individual mandate will make the ACA — which is increasingly popular — even more popular. The individual mandate was the only aspect of the law that didn’t enjoy wide support among the public. The other components of the law — protecting preexisting conditions, ending lifetime caps, ensuring that certain benefits such as chemotherapy and mental health are covered by law — enjoy widespread popularity.
A more popular law will be a more challenging target to repeal. And already Senate Majority Leader Mitch McConnell (R-Ky.), with an even narrower majority after the Alabama Senate race, is signaling that repeal may be a bridge too far.
So where does this leave us? It leaves us with two laws.
Call the first one Obamacare. It provides preexisting condition protections and other safeguards to American families. And for the millions covered under the Medicaid expansion or who have family incomes less than $100,000, it delivers affordable health-care coverage.
Call the second one Trumpcare. It exposes many — especially in rural areas and those who make too much for subsidies — to significantly increasing premiums, driven by the calculated decision from Republicans to get rid of the mandate.” (L)
(A) 8.8 million people signed up for Obamacare coverage despite Trump’s sabotage, by Dylan Scott, https://www.vox.com/policy-and-politics/2017/12/21/16807348/obamacare-enrollment-2018
(B) Obamacare Sign-ups at High Levels Despite Trump Saying It’s ‘Imploding’, by ROBERT PEAR, https://www.nytimes.com/2017/12/21/us/politics/health-obama-care-affordable-care-act.html?_r=0
(C) No, Trump didn’t repeal Obamacare. But he may regret claiming as much, by Amber Phillips, https://www.washingtonpost.com/news/the-fix/wp/2017/12/21/no-trump-didnt-repeal-obamacare-but-he-may-regret-claiming-as-much/?utm_term=.0f6897582a8e
(D) McConnell: ‘We’ll probably move on’ from Obamacare repeal in 2018, by CRISTIANO LIMA and JENNIFER HABERKORN, https://www.politico.com/story/2017/12/21/mcconnell-well-probably-move-on-from-obamacare-312407
(E) McConnell Ready To ‘Move On’ From Obamacare Repeal, Others In GOP Say Not So Fast, by KELSEY SNELL, https://www.npr.org/2017/12/21/572588692/mcconnell-wants-bipartisanship-in-2018-on-entitlements-immigration-and-more
(F) Calls for Obamacare market stabilization intensify as individual mandate penalty is axed, by Shelby Livingston, http://www.modernhealthcare.com/article/20171221/NEWS/171229980
(G) Requiem for the Individual Mandate, by Margot Sanger-Katz, https://www.nytimes.com/2017/12/21/upshot/individual-health-insurance-mandate-end-impact.html
(H) Repeal of the ObamaCare mandate is a selfish and short-term plan, by DR. EUGENE GU, http://thehill.com/opinion/healthcare/366046-repeal-of-the-obamacare-mandate-is-a-selfish-and-short-term-plan
(I) Poll says US citizens worry most about health care, by Emily Swanson and Ricardo Alsonso-Zaldivar, https://www.csmonitor.com/USA/2017/1221/Poll-says-US-citizens-worry-most-about-health-care
(J) Is ‘Short-Term’ Health Insurance a Good Deal?, by Nancy Metcalf, https://www.consumerreports.org/health-insurance/is-short-term-health-insurance-a-good-deal/
(K) With raised ax in plain sight, Collins went out on a limb, by Bill Nemitz, http://www.pressherald.com/2017/12/22/bill-nemitz-with-raised-ax-in-plain-sight-collins-went-out-on-a-limb/
(L) Republicans didn’t repeal Obamacare. They solidified it, by Andy Slavitt, https://www.washingtonpost.com/opinions/republicans-didnt-repeal-obamacare-they-solidified-it/2017/12/22/c2eec7e2-e72d-11e7-a65d-1ac0fd7f097e_story.html?utm_term=.ab60c9066378
“Just like the health care vote, there were a small number of Republican senators who seemed like they might hold out. But unlike last time, Senate leadership managed to successfully cut deals with these senators to secure “yes” votes.
…Collins was most concerned about the provision in the tax bill that would kill Obamacare’s individual mandate and cause millions to lose their health insurance, according to the nonpartisan Congressional Budget Office….. Collins got Senate leadership to commit to Obamacare stabilization. This ultimately ensures the federal government keeps paying for cost-sharing subsidies to help lower the cost of health insurance, but it won’t do much to mitigate the loss of the individual mandate….
Collins’s health insurance deal has a rocky path forward…
But there’s a major roadblock to Collins’s health care goals: House Republicans.
Republicans in the House have said that Collins made her negotiations with Senate leadership, not them. And they’re clearly feeling no obligation to play by her rules.” (A)
A major obstacle to passing a short-term spending bill by the end of the week was eliminated Wednesday when two key Republican senators asked GOP leaders not to consider health-care legislation as part of the legislation.
Senate Republican leaders had considered attaching the health-care proposal to the short-term spending bill to keep the government running through mid-January. But that approach ran into resistance from hardline conservatives in the House, who balked at approving what they consider a giveaway to insurance companies.
“Rather than considering a broad year-end funding agreement as we expected, it has become clear that Congress will only be able to pass another short-term extension to prevent a government shutdown and to continue a few essential programs,” Sens. Lamar Alexander of Tennessee and Susan Collins of Maine said in a joint statement.
For that reason, Alexander and Collins said, they asked Senate Majority Leader Mitch McConnell not to offer the health care legislation this week. The senators said they would offer the bill early next year.” (B)
““When the individual mandate is being repealed that means ObamaCare is being repealed,” Trump said during a Cabinet meeting at the White House on Wednesday.
“We have essentially repealed ObamaCare, and we will come up with something much better,” Trump added, saying block grants might be one approach.
During a House floor speech Tuesday, Speaker Paul Ryan (R-Wis.) cast the mandate repeal as “finally restoring the freedom to make your own health-care choices.”
“By repealing the individual mandate at the heart of ObamaCare, we are giving back the freedom and the flexibility to buy the health care that’s right for you and your family,” he said….
Sen. Susan Collins (R-Maine) has aired concerns about repealing the mandate, saying she wished the tax bill left health care alone, while reiterating that she has never actually supported imposing the tax penalty for those going uninsured.
“Repealing the individual mandate without other health-care reforms will almost certainly lead to further increases in the cost of health insurance — premiums that are already too expensive under the [Affordable Care Act],” Collins said in a floor speech Monday where she announced her support for the tax bill.” (C)
“The mandate, which requires most Americans to get health insurance or pay a fine, is repealed in the GOP tax bill. But that does not mean the entire law is being repealed.
The infrastructure for the individual insurance exchanges, such as Healthcare.gov, remain in place.
The expansion of Medicaid under the ACA, which helped cover an additional 15 million people, remains in place in the states that have opted to expand the program.
Other policy changes from the law, such as insurance companies’ inability to reject a patient due to a preexisting condition and mandatory coverage of basic health needs like prescriptions, remain in place.
In fact, according to the Congressional Budget Office, the Obamacare individual insurance markets are likely to remain relatively stable — albeit with a lower enrollment total — even without the mandate.
But the mandate repeal could still bring about adverse affects on the healthcare market.
The CBO estimated that 13 million more people would go without insurance by 2027 without the mandate than if it remained in place. It also estimated that premiums in Obamacare markets would jump 10% over the current baseline.
Most consumers will be shielded from the increase due to subsidies from the federal government, but as many as 2 million Americans could be priced out of insurance, according to the CBO.” (D)
“Ultimately, repealing Obamacare’s individual mandate would cause 13 million fewer Americans to be insured in 2027 compared with current law, according to the nonpartisan Congressional Budget Office (CBO). Healthier and wealthier people may choose to forgo coverage, and even poorer, medically needy people may not sign up for insurance because they don’t know which options are available and there may not be the same sense of urgency to enroll without the mandate. The CBO also predicts that premiums in the markets would spike 10% without Obamacare’s individual mandate as the exchanges are left with a sicker consumer pool. However, for most Obamacare enrollees (those making between 100% and 400% of the Federal Poverty Level), an accompanying increase in federal subsidies will make up for higher premiums. Those making above that income level (about $48,000 for an individual or $98,000 for a family of four) will have to face the brunt of premium increases, though. (E)
(A) Key senators sold their votes on the tax bill for some high-risk deals, by Ella Nilsen, https://www.vox.com/2017/12/20/16796670/gop-tax-bill-flake-collins-immigration-health-care
(B) Alexander-Murray health care proposal delayed, removing obstacle to avoiding government shutdown, by Michael Collins, http://www.tennessean.com/story/news/politics/2017/12/20/alexander-murray-health-care-proposal-delayed-removing-obstacle-avoiding-government-shutdown/970413001/
(C) Congress repeals ObamaCare mandate, fulfilling longtime GOP goal, RACHEL ROUBEIN, http://thehill.com/policy/healthcare/365785-congress-repeals-obamacare-mandate-fulfilling-longtime-gop-goal
(D) Trump applauds ‘Obamacare repeal’ in the tax bill — but there’s a big problem with that claim, by Bob Bryan, http://www.businessinsider.com/trump-obamacare-individual-mandate-repeal-in-tax-reform-bill-2017-12
(E) The GOP Tax Bill Repeals Obamacare’s Individual Mandate. Here’s What That Means for You, by SY MUKHERJEE, http://fortune.com/2017/12/20/tax-bill-individual-mandate-obamacare/
“Some conservative health policy experts don’t think Congress and Trump have gone far enough. They fear scrapping the mandate but leaving many rules intact would prove disastrous, possibly setting in motion an inevitable “bailout” from Congress that would let Obamacare live to see another day. Conservative thinker Chris Jacobs, for instance, wrote in The Federalist recently that lawmakers need to get the rest of the job done. Mandate repeal, he wrote, is like “pruning back the fruit of the poisonous tree” when what’s needed is an attack on its roots.
Yet the end of the individual mandate, combined with these other Trump policies, are likely to make comprehensive health insurance even more expensive. And if fewer people are covered, its constituency may be diluted. Yet if there’s one thing that Obamacare has proven since its enactment in 2010, it is that it is resilient, despite perpetual attack. Its protections for people with pre-existing conditions and the working poor earned it a late-blooming popularity.” (A)
The Individual Mandate is “the aspect of Obamacare that basically makes the rest of the system work — and it does work, regardless of the lies conservative politicians tell to dupe followers into thinking the healthcare reform law is a “disaster” and a “catastrophe.”
A recent report from the Commonwealth Fund found that “the Affordable Care Act has put access to healthcare in reach for millions of Americans.” It said fewer people are putting off doctor visits or struggling with medical bills.
In California alone, the percentage of uninsured working-age adults has plunged to 10% from 24%, according to the report. Nationwide, the uninsured rate fell to a record low 8.8% last year.
After President Trump took office and cast uncertainty over insurance markets, the uninsured rate rose this year to a three-year high. Which means the only disaster for Obamacare has been Trump calling it a disaster.
And now Republicans are all but ensuring failure of the law by eliminating the requirement that most people have health insurance. They say they’re protecting personal freedom, giving people the choice of whether or not to buy coverage.
All they’re really doing is showing they have no clue how insurance works.” (B)
“Of all the reasons the Republican tax bill will be a mugging of the majority of non-wealthy Americans, one reason stands out above all else — the bill will seriously set back everyone who has struggled to pay for health insurance and medical expenses.
Repealing the Obamacare coverage mandate is likely to prompt insurers to raise premiums by an estimated 10 percent annually into the foreseeable future, according to the nonpartisan Congressional Budget Office. Why? Because as up to 13 million people drop their policies — CBO’s estimate — the remaining policy holders will end up paying more. (Those dropping coverage will revert to pre-Obamacare days of postponing treatments and hoping for the best.)
That’s just the start of the dire news affecting health care costs, as anticipated increases will more than offset any tax break. Not that most Americans were going to see tax cuts anyway — the bottom 50 percent of wage earners will see their after-tax incomes shrink by 2 percent; the middle 40 percent’s after-tax incomes will shrink by 0.6 percent; while the top 10 percent will see their incomes grow by 1.5 percent or more, the New York Times noted Monday.
There’s more bad health care news. The tax bill’s $1.5 trillion cost also preys on seniors, triggering spending cuts of 4 percent annually for Medicare, the federal health program for those 65 and older.” (C)
“In a speech on the Senate floor Monday, Collins announced her support of the tax legislation, saying that the bill would create more jobs and allow for higher wages. Collins also said she would have preferred that the bill not include repeal of the Obamacare individual mandate penalties that require Americans buy health insurance or pay a fine.
“I have never supported the individual mandate,” she said. “There is a big difference between fining people who choose people who choose go without health insurance, versus the bills considered last summer and fall that would have taken away insurance coverage from people who have it and want it. Those bills also would have made sweeping cuts in the Medicaid program.”
She also touted the Obamacare bills she negotiated to be brought to the floor for passage, which include funding for cost-sharing reduction subsidies as well as funding for reinsurance.” (D)
“Collins announced Monday that she would vote for the tax bill based on promises from President Trump and Senate Majority Leader Mitch McConnell (R-KY) to support two health care bills aimed at mitigating the expected damage from the tax bill’s provision killing Obamacare’s individual mandate…
Still, many Republicans, including Rep. Tom Cole (R-OK), said there is widespread opposition in the House to these policies, which they see as propping up Obamacare.
“Our guys do not want to be in the position of upholding a system that we all oppose and that we tried to repeal and did repeal in this chamber. That’s a real problem,” Cole said, before taking aim at Collins. “We’re not going to let ourselves be blackmailed by one senator for one vote in the United States Senate. I don’t think so.”
McConnell promised Monday that Collins’ health care bills will be attached to the continuing resolution that must pass before midnight on Friday to avoid a government shutdown, along with a host of other bills including natural disaster aid for hurricane ravaged states and the reauthorization of a lapsed health insurance program that covers millions of children.
But House Republicans say it is likely they will vote to strip out the health care bill and kick the bill back to the Senate, setting up a bicameral showdown….
As she strode through the basement of the Senate on her way to a vote on another matter Tuesday afternoon, reporters swarmed around a stony-faced Susan Collins to ask if she still felt comfortable voting for the tax bill if her health care policies’ prospects in the House are in danger.
“We’re a long ways to the end of this,” she said. “I’m not going to comment on the stories you all are trying to write.” (E)
(A) The stealth repeal of Obamacare, by JOANNE KENEN, https://www.politico.com/story/2017/12/19/obamacare-repeal-tax-bill-trump-243912
(B) GOP tax bill also manages to needlessly screw up the healthcare system, by David Lazarus, http://www.latimes.com/business/lazarus/la-fi-lazarus-republican-tax-bill-individual-mandate-20171219-story.html
(C) The main reason the GOP tax plan is a catastrophe: It will send health care costs through the roof, by STEVEN ROSENFELD, https://www.salon.com/2017/12/19/the-1-reason-the-gop-tax-plan-is-a-catastrophe-it-will-send-health-care-costs-through-the-roof_partner/
(D) Susan Collins accuses media of being sexist in coverage of tax bill, by Kimberly Leonard, http://www.washingtonexaminer.com/susan-collins-accuses-media-of-being-sexist-in-coverage-of-tax-bill/article/2643969
(E) House GOPers Say Susan Collins’ Health Care Demands Are Dead On Arrival, by ALICE OLLSTEIN, http://talkingpointsmemo.com/dc/house-gopers-say-susan-collins-health-care-demands-are-dead-on-arrival
