Hoping to improve the quality of health services offered to Arizonans with serious mental illness, Gov. Jan Brewer (R-AZ) will forego her own reservations about the Affordable Care Act to accept funding from a $500,000 federal health grant that will provide mental-health clinics with traditional doctors:

“The idea is to put one entity in charge of a person’s health care, both medical and mental. Data sharing and on-site coordination between health professionals have been shown to reduce medication costs, identify untreated conditions, improve overall health care and keep people out of the hospital.

A one-stop shop is more comfortable for people with mental illness, who often avoid the typical doctor’s office, let conditions go untreated and wind up in emergency rooms…[D]ata shows that three-fourths of the 12,000 people with serious mental illness don’t have a primary-care doctor. The partnership between Magellan and Maricopa Integrated Health Services is intended to change that.”

By creating a wholistic medical home, the Maricopa County health system and Magellan Health Services will use the money to lower the number of preventable deaths among mentally-ill patients, who face a life expectancy 30 years below that of the average Arizonan.

Despite accepting its funds, Brewer still opposes the federal health care law and has called the individual mandate “a sweeping violation of these fundamental principles established by the founding fathers.” Arizona has also joined 25 other states in challenging the constitutionality of the measure.

Meanwhile, Brewer has worked to reduce access to health coverage in Arizona, eliminating insurance for 310,000 beneficiaries enrolled in Arizona’s Medicaid program and shutting down the state Children’s Health Insurance Program, which effectively robbed 47,000 low-income children of health coverage. In January, Brewer tried to balance the budget by cutting a further 280,000 residents off from their Medicaid funding.

–Sarah Bufkin

Managed Care Matters’ Joe Paduda brings me back down to earth from my ‘maybe they can do delivery system reform in the bipartisan super committee’ heights and offers a more realistic look at what the cuts will look like (if you believe the group will agree on a set of reductions in the first place):

With Medicare and Medicaid accounting for a large and ever-increasing part of the deficit, by necessity the super-committee is going to have to look at provider reimbursement. As Bob Laszewski points out, they don’t have time to fundamentally alter reimbursement methodology, can’t change the eligibility parameters under the terms of the deal, and they are starting from a deficit projection that assumes the pending 29.5% cut in physician reimbursement is actually going to happen.

The 29.5% alone accounts for about $300 billion, so the super-committee has to find another $1.2 trillion on top of that $300 billion.

Where’s it going to come from?

Physician reimbursement under Medicare and Medicaid is going to get hammered.

Hospitals are going to see substantial cuts in reimbursement as well.

Pharma and PBMs participating in Part D are another big target, and one with less political pull in DC.

Insurers heavy in Medicare Advantage have been reporting nice earnings of late; that’s not going to escape the notice of deficit-cutters in Washington.

Expect to see means testing for Medicare as well.

These are all cuts that will have the effect of shifting costs onto beneficiaries and won’t rid the system of waste and inefficiency or encourage providers to deliver better care. It’s so depressing, isn’t it?

Janet Adamy has an article in the Wall Street Journal arguing that the health care cuts in the debt ceiling deal — either from the bipartisan committee or the triggers that kick in should that committee fail to agree on a package of reductions — has the health industry and some seniors worried about the future of Medicare and Medicaid:

To hit the $1.5 trillion in spending cuts, the congressional committee is likely to reconsider major changes to Medicare that the White House and congressional leaders put on the table during this summer’s debt-ceiling negotiations. President Barack Obama in earlier negotiations floated the idea of raising the Medicare-eligibility age to 67 from 65 in an effort to win Republican concessions. He also said he was open to a means test.

“All those type of issues will certainly be looked at by the committee,” said Tom Nickels, a senior vice president at the American Hospital Association.

Should the committee’s recommendations not make it into law, the backup spending-cut mechanism would include cuts to Medicare. The agreement says these cuts would affect health-care providers, not beneficiaries, and would be capped at 2%.

Some health-care-provider groups contend they couldn’t absorb such payment cuts without affecting patients. The hospital industry says the cuts could overload emergency rooms, shut down trauma units and reduce patient access to the latest treatments.

The committee’s recommendations — and Suzy Khimm previews what those may be — will be fairly troubling as far as beneficiaries are concerned. President Obama has previously tentatively agreed to raise the Medicare eligibility age and so (with that door open) one could imagine the proliferation of other similar ideas that would take more people out of the program.

But the committee could also offer proposals to hasten the kind of delivery and payment reforms that are already part of the Affordable Care Act. These changes would not be so much about slashing reimbursement rates as they would be about paying providers differently to encourage them to provide more efficient care. It’s a tricky thing to figure out — particularly since nobody is quite sure how to reform and modernize the health care reimbursement system — but one policy makers should at least consider if they’re truly interested in lowering health care costs over the long haul. What’s a good place to start? All-payer rate setting.

This week, the Obama administration announced that all health insurers will be required to cover birth control and other women’s health services without charging co-pays. This historic move has sent the burgeoning right-wing campaign against birth control into an apoplectic fit. Today, Fox News’ America’s Newsroom decided to feature one such activist in a “fair and balanced debate” on whether ensuring a woman’s access to birth control is a good idea.

Former Women’s Media Center president Jehmu Greene offered the facts that support greater access to birth control. Namely, “50 percent of pregnancies in this country are unintended pregnancies” –the leading reason why women seek abortions — which costs the U.S. over $11 billion a year. Noting that contraception not only allows women to space out their pregnancies and commit to parenting, but also reduces the number of abortions, Greene determined the new policy to be a “text-book definition of win-win.”

Fox’s anti-birth control “expert,” Family PAC Federal Vice President Sandy Rios, however, found her own reasons to lambast the policy as “ridiculous.” Telling Greene that she lives in “la la land,” Rios offered the following “arguments” against the new policy and a woman’s right to use birth control, which are so ludicrous they’re worth listing:

– “Is the White House out of their mind? Does the West Wing not know what the left wing is doing? We’re $14 trillion in debt and now we’re going to cover birth control, breast pumps, counseling for abuse? Are we going to do pedicures and manicures as well?”

– “Why in the world would you encourage your daughters, and your granddaughters, and whoever else comes behind you to have unrestricted, unlimited sex anytime, anywhere and that, somehow if you prevent pregnancy, that somehow you’ve helped them. I would submit to you that uncontrolled sexual behavior is what is harming our girls, not our lack of birth control — which by the way they don’t seem interested in taking anyway. Having a baby is not the worst thing. I think having multiple sex partners without any kind of restraint or responsibility is much more damning, why would you support that?”

– “In Red China, they have this down to a science. The local health care centers make women come in every month to be examined to see if they’ve had their cycle to make sure they are taking their medication and if they have a baby they are roundly punished, if they have an extra baby that baby is aborted. That is the control we’re moving toward.”

– “I’d like to say that the morning-after pill has other detrimental affects. In Great Britain where it was legalized first, there was an outbreak of older men taking young girls in for the morning-after pill so they wouldn’t get caught and so there are no consequences.”

Watch the segment:

Surveying all of Rios’s “arguments,” Greene stated that Rios’s ultimate goal “is she wants to put ideology over public health.” To which Rios replied, “Yes, I suppose I do.” Rios then offered these parting words to Greene: “You all make science a laughing stock. You present science and facts just to present your viewpoint.”

Two more Democrats, Reps. Loretta Sanchez (D-CA) and Tim Bishop (D-NY) have signed on to Rep. Phil Roe’s (R-TN) bill to repeal the Independent Payment Advisory Board (IPAB) — a 15-member cost-cutting commission established by the Affordable Care Act. The Board is tasked with making binding recommendations to Congress for lowering health care spending if costs increase beyond a certain point.

“IPAB shifts health-care decision-making power away from the patient; it will operate without transparency or accountability, bypassing all congressional oversight; and it places the focus on slashing Medicare costs, rather than on improving the quality of care,” Roe said earlier this month. “I am pleased there is growing bipartisan support to repeal the IPAB because it will lead to rationing of care by government bureaucrats.” But a ThinkProgress analysis of the 198 Democratic and Republican lawmakers who are co-sponsoring the measure shows that 138 members also voted in favor of yesterday’s debt ceiling bill, a measure which could have a far more substantial effect on “slashing Medicare” than the ACA’s IPAB board:

– 138 co-sponsors of Roe’s IPAB repeal bill voted for the debt ceiling deal; 6 Democrats and 132 Republicans.

– 60 co-sponsors of Roe’s IPAB repeal bill voted against the debt ceiling deal; 3 Democrats and 57 Republicans.

The deal reached yesterday would raise the debt ceiling through 2012 by immediately cutting $917 billion from mostly discretionary spending and establishing a joint congressional committee to recommend $1.2 trillion to $1.5 trillion in additional cuts. And while Medicare is protected from the first round of reductions, it will likely be targeted in the second. In fact, the committee is free for slash provider reimbursements or make a wide array of benefit cuts from raising the eligibility age to offering premium support to means testing the program.

If the committee’s recommendations are not enacted by December 23, 2011, across the board spending cuts are triggered, affecting up to 2 percent of Medicare’s total spending, but excluding Medicare benefits. Still, the committee’s cuts or the triggered reductions would do far more to “slash” Medicare expenditures and potentially undermine seniors’ access to Medicare than the IPAB. Here is why (after the jump):
Read more

A new survey of nearly 900 employers from Mercer finds that more than 90 percent businesses are committed to offering medical coverage, even as they anticipate small cost increases from the provisions in the Affordable Care Act. The results are in line with the vast majority of other business surveys and economic reports and contradict critics’ claims that health reform will force employers to drop coverage.

“Employers have spent the past year studying the new law and developing strategies to deal with the increased costs and administrative burdens,” said Beth Umland, director of research for health and benefits for Mercer. “But they don’t seem to have changed their minds about the value of continuing to offer their employees health coverage”:

Employers — who have already seen enrollment increases as a result of the ACA’s requirement to extend coverage to young adults — anticipate that compliance with some of ACA’s provisions (extending coverage to all employees working on average 30 or more hours per week, auto-enrolling new full-time employees and ensuring that plans pay for at least 60% of covered services) will add “at least another 3 percent to their projected 2014 plan costs, with 15 percent expecting an additional 5 percent or more”:

Read more about the survey here.