In a blow to Americans relying on Medicaid — the state-federal partnership public health insurance program that covers disabled and low-income Americans — the federal government on Tuesday reaffirmed to a California federal appellate court that, in the Obama Administration’s opinion, “states could cut Medicaid payments to many doctors and other health care providers to hold down costs in the program,” paving the way for massive state health care cuts that will further discourage doctors from treating low-income patients enrolled in the program.

Doctors, health care providers, and patient advocacy groups sued California in response to state health officials’ decision to cut already-low reimbursement rates for providers that treat patients on Medi-Cal — California’s Medicaid program — by an extra 10 percent. State leaders led by Gov. Jerry Brown (D) argue that the payment cuts are necessary for California’s fiscal security, especially as the state expands Medi-Cal to an addition 1.8 million Californians under Obamacare. But critics assert that the drastic payment cuts will make treating current and prospective Medi-Cal beneficiaries anathema to California care providers:

Medicaid is one of the fastest-growing items in state budgets. Cutting payment rates saves money for states and for the federal government, which will pay most of the costs for people who become eligible for Medicaid under the new law.

Health care providers said California’s payment rates were inadequate even before the cuts. They pointed to a federal study that said, “California stands out because of its very low Medicaid payment levels.”

In an interview, Dr. Paul R. Phinney, president of the California Medical Association, a plaintiff in one of the court cases, said: “Two-thirds of doctors in California cannot afford to participate in Medicaid because the rates are so low. The problem will only get worse if rates are cut as we move more and more people into Medicaid.”

The Administration’s endorsement of the Medicaid payment cuts underscores just how badly federal officials want states to take part in Obamacare’s Medicaid expansion. Formally blessing states’ abilities to “reasonably” lower their Medicaid physician payment rates is likely a concession aimed at luring reticent governors into accepting the expansion, since it will save both states and the federal government money. But while expanding Medicaid under Obamacare is crucial for the health and financial security for millions of low-income Americans, drastically lowering hospitals’ and physicians’ Medicaid reimbursements — which are already far less generous than Medicare reimbursements — is rife with risks.

Certainly, provider cuts are preferable to cutting special Medicaid benefits for the poor and disabled that are not available on lower-tier private insurance plans, especially in a state like California that has had its fair share of problems with providing adequate services to Medi-Cal beneficiaries. But California already has 6.8 million residents on Medi-Cal, including one in three Californian children and the majority of HIV-positive Californians. Payment cuts that discourage providers from treating these Medi-Cal beneficiaries will leave millions of Americans with few facilities to go to for their care, making them dependent on either free clinics, costly emergency room care, or forcing them to travel massive distances to find an accepting provider.

Reporting on a 2012 study finding that one in three American doctors won’t take new Medicaid patients, Wonkblog’s Sarah Kliff presciently wrote that that could spell trouble for states with historically low Medicaid reimbursement rates — such as California — that also wanted to expand Medicaid, since “fewer than 60 percent of providers accept new patients in the [Medi-Cal] program.” With Brown’s new Administration-endorsed payment cuts set to hit California’s safety net providers, that number has nowhere to go but down.

As promised, Arkansas Governor Mike Beebe on Tuesday vetoed an anti-abortion “fetal pain” bill. The measure will likely be pushed through without his consent, however, since the Republican-controlled legislature is able to override vetoes through a simple majority vote.

If overridden, the law will be among the most restrictive abortion bans in the nation. It would outlaw abortions after merely 20 weeks of pregnancy, based on the junk science that a fetus can feel pain after that point. Seven other states have similar 20-week restrictions in place, although two of them are currently being challenged in court.

As state legislatures begin their 2013 sessions, a flurry of new “ag gag” bills to protect factory farms from potential undercover whistleblowers have been introduced in 5 states. This week, the Indiana Senate is debating a proposal to criminalize taking photographs or videos inside an agricultural or industrial operation without permission.

Senate Bill 373 is the first of two ag gag bills introduced during Indiana’s 2013 session. New Hampshire, Nebraska, Wyoming and Arkansas are also considering them.

Since trespassing is already illegal, ag gag laws can only have one clear motive: to punish whistleblowers, advocates, and investigative reporters who use undercover recordings to reveal the abysmal conditions in which our food is produced. Undercover investigations have captured factory farms all over the country abusing livestock, passing off sick cattle as healthy, and discharging unregulated amounts of animal manure, which the US Geological Survey identified as the largest source of nitrogen pollution in the country.

The bill’s author, Sen. Travis Holdman (R), added a provision exempting anyone who turns over their video or photos to law enforcement within 48 hours — as long as they do not also share the footage with non-law enforcement, such as media or an animal rights group. But, as the Indy Star points out, many exposés are “undertaken precisely because the authorities failed to do their job. Sometimes, they have spotlighted conditions that were not illegal but were disturbing enough to inspire new laws.”

Indeed, factory farms have largely escaped regulatory and legal scrutiny. Last year, the Environmental Protection Agency abandoned an effort to require these operations to report even basic information like location, number of animals, and amount of manure discharged. Meanwhile, the meat lobby’s grip on lawmakers is so powerful that the USDA was pressured into apologizing for an internal “Meatless Monday” last year by Sen. Chuck Grassley (R-IA) and Rep. Steve King (R-IA), who claimed the optional vegetarian day was a full-scale attack on agriculture.

One USDA inspector even had his job threatened after he tried to report egregious violations at a California slaughterhouse. He then tipped off the Humane Society, which released an infamous video of employees torturing and slaughtering downer cows (sick cows deemed “unfit for human food” by the USDA). The video triggered the largest beef recall in U.S. history and resulted in an unprecedented $500 million penalty.
Read more

New Jersey Gov. Chris Christie (R) has accepted Obamacare’s optional expansion of the Medicaid program, which will extend insurance coverage to an additional 300,000 low-income people in the state. As Republican opposition to the health care reform law finally begins to wane, Christie is the eighth GOP leader to agree to expand the Medicaid program under Obamacare — and the first potential 2016 presidential contender to embrace that provision.

The governor announced his decision at a state budget address on Tuesday. Although Christie remains a staunch Obamacare opponent — and has refused to set up a health insurance marketplace, the law’s other major state-level provision — he explained that expanding Medicaid represents a smart financial decision for his state. Thanks to the increased federal funding allocated for the states that choose to add more low-income residents to their Medicaid rolls, New Jersey will reap up to $300 million in the upcoming budget year.

“It’s simple. We are putting people first,” Christie explained in his address. “We have an opportunity to ensure that an even greater number of New Jerseyans who are at or near the poverty line will have access to critical health services beginning in January 2014.” The governor added that the federal government’s funding toward the public insurance program will mean that “expanding Medicaid will ensure New Jersey taxpayers will see their dollars maximized.”

That position is resonating with a growing number of deeply conservative Republicans. Just last week, Florida Gov. Rick Scott — who has been one of the health reform law’s most vehement critics — also announced his support for Obamacare’s Medicaid expansion. GOP governors in Arizona, Michigan, New Mexico, North Dakota, Ohio, and Nevada have also come out in favor of expanding Medicaid, which leaves nine Republican leaders who are still making up their minds about whether to increase the eligibility levels for their programs.

But the larger Republican establishment, which has increasingly moved further to the right, may not be particularly receptive to Christie’s decision. The governor has not been invited to speak at this year’s Conservative Political Action Conference because he is “simply not a conservative in the eyes of organizers” — largely, as the National Review suggests, because of his positions on Medicaid and gun violence prevention.

President Obama’s health care reform law takes big strides to eliminate the gender disparity in health costs, particularly by prohibiting most insurance companies from “gender rating” — the practice of charging women more for their coverage simply based on their gender. But that provision doesn’t apply to long-term care insurance, an area in which women may soon be charged higher premiums than their male counterparts for the exact same type of coverage.

Even though Obamacare will put an end to gender discrimination in the vast majority of insurance plans, the long-term care insurance industry isn’t required to cease the practice. And the industry is beginning to take advantage of that. Kaiser Health News reports that the nation’s largest long-term care provider has announced it will begin setting its prices by gender as early as this spring, a move that move may encourage the rest of the long-term insurance industry — which has already been hiking up its premiums over the past several years — to do the same:

Women’s premiums may increase by 20 to 40 percent under the new pricing policy, said Jesse Slome, executive director of the American Association for Long-Term Care Insurance. The average annual premium for a 55-year-old who qualified for preferred health discounts and bought between $165,000 and $200,000 of coverage was $1,720 last year, according to the association.

Experts say they expect other long-term-care insurers will soon follow suit.

Long-term-care insurance provides protection for people who need help with basic daily tasks such as bathing and dressing. It typically pays a set amount for a certain number of years — say, $150 daily for three years — for care provided in a nursing home, assisted living facility or at home. Never a very popular product with consumers, many of whom found it unaffordable, in recent years the industry has struggled and many carriers have raised premiums by double digits or left the market.

Women typically live longer than men — and often end up becoming the primary caregivers for their husbands, which reduces those men’s need for long-term insurance care. But when women’s health eventually devolves, they often don’t have a partner who can provide that type of care for them, and they’re stuck relying on insurance coverage. That’s why women typically have much higher claims for long-term care services, and why insurance companies want to be able to charge them more.

But women also tend to have fewer economic resources than men do, since an enduring wage gap accumulates over time to leave older women with significantly less wealth. Over the course of a 40-year working career, the average woman loses out on an estimated $431,000, and the annual wage gap jumps to about $14,352 in the five years before retirement. Requiring women to pay more for health care in the final years of their life could be a significant drain on their resources, particularly for single women, and ultimately prove unaffordable.

And ultimately, charging women more won’t address the fact that the country’s long-term care industry is currently an unsustainable model. The health care reform law originally included a provision to help address the long-term care crisis in the United States — but the Obama Administration decided the Department of Health and Human Services didn’t have enough authority to implement it, and the GOP has simply pushed to repeal it rather than working to craft a better policy. The fiscal cliff deal finally did away with it for good, but lawmakers still haven’t worked out a better system for taking care of Americans’ long-term care needs — in an equitable way that’s affordable for both women and men.

Officials at Oklahoma State University did not go to the police with several reports of rape or sexual assault on campus in 2011, falesly believing that they were following procedures protecting the information of the purported assailant.

According to a report by an OSU Board of Regents task force, university representatives “misinterpreted the Federal Education Rights Privacy Act.” The university believed that purported rapists’ educational records might have been involved in the case, and so, to protect those records, decided sexual assault fell under the purview of the school, not law enforcement:

Friday’s report cites a provision in FERPA that allows institutions to contact campus police to ask them to investigate possible crimes on campus. The report notes that members of the news media brought the provision to university officials’ attention.

According to the report, OSU officials rejected that argument, saying a different provision in FERPA wouldn’t have allowed them to turn over educational records, including those generated in student conduct hearings.

But that provision wouldn’t have applied in this case, according to the report. When officials learned of the incidents, no student conduct hearings were pending, meaning no such records had been created.

“OSU could have notified the police immediately after it became aware that the sexual assaults had been committed,” the report states.

Universities like Oklahoma State are struggling to come up with adequate sexual assault policies. OSU’s Board of Regents’ task force was actually created as a response to the child molestation case at Penn State University. Often, rape (on campus and elsewhere) goes under-reported, both on the part of the victim and the university. Victims often report feeling too ashamed to go to the authorities with what’s happened to them. For obvious reasons, universities have a vested interest in maintaining low numbers of sexual assault reports on their campuses.

During a Budget Committee Hearing on Tuesday, Sen. Jeff Sessions (R-AL) announced that the Affordable Care Act — which had been projected to reduce the deficit by billions over 10 years — would actually increase long-term debt by $6.2 trillion, undermining administration claims that the law would expand coverage to millions of Americans and help reign in federal spending.

“A new government report dramatically proves that the promises made assuring the nation that the largest new entitlement program in history since Medicare — the president’s health care program — would not add a dime to the long or short term debt of America was false,” Sessions said, referring to a recently released study from the Government Accountability Office (GAO).

“The results of this report confirm everything critics and Republicans have been saying about the health care bill and reveal the dramatic falsehoods that were used to push it to passage.” He went on:

SESSIONS: According to the GAO under a realistic set of assumptions the health care law will increase the deficit by 7/10th percent of GDP or roughly $6.2 trillion over the next 75 years. $6.2 trillion unfunded liability of the United States. In other words, the GAO reveals that the big tax increases in the bill come nowhere close to covering the massive spending.

Watch it:

How is it possible that one report — requested by Sessions — conflicts so starkly with almost all other government assessments to confirm Republican talking points about the law? It’s simple: Sessions designed it that way.

The Alabama senator asked the office to estimate would would happen if the cost containment provisions in the law — the Independent Payment Advisory Board, excise tax on high-cost plans, and reductions in Medicare payments to providers — are “phased out over time” while the coverage provisions remain. Unsurprisingly, the GAO concluded that if the portions of the law that were specifically designed to keep costs under control don’t go into effect, then the law won’t be effective in lowering health care costs. Sessions is touting the government expenditures included in the law — the affordability credits and Medicaid expansion — while ignoring its cost savings. The same report concluded that if “both the expansion of health care coverage and the full implementation and effectiveness of the cost-containment provisions” are sustained, “there was notable improvement in the longer-term outlook.”

To be sure, economists disagree on how best to implement the law’s cost containment provisions. The GAO report notes that the Centers for Medicare & Medicaid Services’ Office of the Actuary has found that providers will not be able to “improve their own productivity to the degree achieved by the economy in large,” proving the savings to be unsustainable. Other economists, however, contend that the actuary doesn’t score savings from preventive care and system modernization and estimate that if those factors are included, the annual growth rate in national health expenditures falls significantly.

The responses of individuals, employers, insurance companies, and Exchange administrators may be hard to predict and Congress may have to adjust the law and its cost containment mechanisms. But for a senator to design a study that purposely underplays the law’s cost controls is not only disingenuous, but also fundamentally misleading and dishonest.

Update

Page 13 of the report shows how the law’s efficiencies can lower spending on major federal health care programs in the out years:

While answering constituents’ phone calls on C-SPAN Tuesday morning, Rep. Reid Ribble (R-WI) — who is a member of the influential House Budget Committee — bucked his party’s usual line on public health care entitlements by praising the idea of allowing Americans aged 55 and older to buy into the public Medicare program for seniors.

When the Wisconsin caller asked Ribble about the reform proposal — commonly referred to as a “Medicare buy-in” — for Americans between the ages of 55 and 64, Ribble complimented the idea and asserted that the U.S. must engage in a robust and similarly innovative debate over lowering health care costs:

CALLER: Good morning. For Medicare, why can’t instead of raising the age, let people buy in at 55, at $450 a month, and then go back to $100 [a month], approximately, at 65, and you would have more money put into Medicare, and it would help the small businesses that are insuring the older people?

RIBBLE: Hey Harold, that’s a great idea. Thank you for calling from Wisconsin, I hope it’s not snowing there today. Those are the types of ideas we need to get on the table and start talking about. We recognize that the Medicare program will continue to grow based on sheer demographics of the country aging. There are fewer workers replacing those that are retiring, and so there’s gonna be pressure put on these critical programs. And ideas like yours should have a hearing and voice in the halls of Congress, and I really appreciate you coming up with suggestions like these, because these are the types of debates that have to happen. Thank you for weighing in this morning.

The $450 per month the caller suggests that individuals between 55 and 64 buying into Medicare should pay is a monthly premium that would go towards funding Medicare Part B, which is the supplemental medical insurance that covers beneficiaries’ doctors’ fees, outpatient hospital visits, and various other non-prescription drug benefits. Under the caller’s plan, that premium would eventually be reduced to the standard Medicare Part B insurance premium for Medicare beneficiaries who are 65 and over, which is about $105 per month in 2013. Medicare Part A covers inpatient hospital stays, as well as hospice services and nursing care, and does not require the vast majority of seniors to pay any premium.

While the proposal is obviously just a rough sketch, it does represent a far more progressive vision for reforming entitlements and lowering health care spending than smokescreen strategies to shift costs onto consumers such as GOP proposals to raise the Medicare eligibility age — and it could substantially lower both older Americans’ premiums and employers’ health care cost obligations to their older workers.

Ribble’s apparent endorsement of the idea comes as a surprise, as he conspicuously states on his congressional website that he voted to repeal Obamacare and obstruct several of its funding measures — although he does admit to supporting certain reform elements in the landmark health law. Nonetheless, Ribble’s comments this morning set him apart from a significant swath of the Republican Party and conservative advocates of more “free-market” approaches to health care reform that curtail, rather than expand, public insurance pools like Medicare.

Indiana lawmakers sparked controversy last week when they proposed a forced ultrasound bill that would go even further than similar measures in states across the country: it would require women to undergo two potentially invasive ultrasounds, both before and after taking the RU-486 abortion pill. State lawmakers are now walking that back, conceding that the legislation doesn’t need to stipulate a second ultrasound — but the first ultrasound requirement remains in place as the full Senate prepares to vote on the legislation on Tuesday.

Indiana senators approved the revision by a unanimous voice vote. The state lawmakers acknowledged that medical professionals themselves should be able to make the decisions about what type of tests are best for their patients, and requiring doctors to perform a second ultrasound is an unnecessary overreach. But even though the exact same logic also applies to the bill’s first forced ultrasound requirement, Republicans weren’t willing to engage in the political fight to drop the anti-choice provision altogether:

Sen. Ron Alting, R-Lafayette, sponsored the move to drop the second ultrasound and replace it with a requirement that doctors perform “appropriate testing.” Alting said that would give doctors the option of performing blood or urine tests on their patients.

“I think that physicians know a little bit more about that particular area than legislators,” Alting said.

But when asked why his amendment didn’t remove the requirement for a pre-drug administration ultrasound, Alting said: “I just know that I didn’t have the votes for that to happen.”

The full bill’s sponsor, state Sen. Travis Holdman (R), didn’t object to removing the requirement for the second ultrasound. Still, he stood firm in his belief that the same type of political interference into women’s medical decisions is “essential” before the administration of the abortion pill.

Holdman also brushed aside concerns that requiring women to undergo an ultrasound before taking the abortion pill would necessitate an invasive transvaginal probe — according to the GOP state senator, women’s health advocates’ concerns about mandated transvaginal ultrasounds are simply “a lot of hype.” But, even when legislation like Holdman’s doesn’t specifically stipulate a transvaginal ultrasound requirement, that certainly doesn’t mean the issue isn’t relevant.
Read more

The quest to improve patient care, maximize medical efficiency, and curb wasteful spending by digitizing Americans’ patient records, insurers’ claims, and providers’ treatment requests just gained a powerful new ally: “Watson,” IBM’s revolutionary data-mining supercomputer that made national waves when it defeated reigning Jeopardy! champion Ken Jennings at his own game.

American Medical News reports that health insurance giant WellPoint has struck up a deal with IBM and Memorial Sloan-Kettering Cancer Center in New York to use the supercomputer — which has spent its post-Jeopardy days amassing and “learning” massive amounts of data about the American health care, insurance, and public health industries — for two pioneer programs to automatically process, review, and pre-authorize medical claims and treatment requests, as well as a third program dubbed “Interactive Care Insights for Oncology” that will “identify individualized treatment options for cancer patients, starting with lung cancer” in order to advise oncologists on the latest and most effective treatment regimens by incorporating up-to-the minute longitudinal medical studies and cancer data into its suggestions.

In an email to ThinkProgress, Cindy Wakefield, a Regional Director for Public Relations at WellPoint, pointed out that the new technology has the potential to have a big impact on the health care industry. “We believe the IBM Watson technology can improve the efficiency and quality of treatment, potentially eliminating unnecessary testing, enhancing the consistency of actions, and accelerating the time to treatment via expedited decision-making processing,” Wakefield explained. “We are continuing to train Watson, and we are teaching Watson by ‘feeding’ it information such as our medical policies and clinical guidelines.”

Using Watson’s technology to automate claims processes could be a potent catalyst for a more efficient American health care industry — which is often bogged down by poor inter-provider communication, incomplete and non-centralized data, and archaic paper records. The supercomputer could also advise providers on the most efficient and appropriate use of treatments based on each individual medical claim, patients’ specific insurance benefits, and patients’ medical histories by analyzing health care data from across the country.

Interestingly, if Watson concludes that a physician or provider’s treatment request is not the most effective one based on a patient’s history and medical benefits, the computer can register its disagreement — but as Wakefield explained to ThinkProgress, it cannot override the provider’s decision or deny treatment requests. Instead, a human nurse would have to review Watson’s alternative suggestion, and then make a judgment call along with the provider on whether or not to comply with it.

Read more