As Aetna-Humana trial begins, a look at what’s driving health insurance mergers Monday, Dec 5 2016 

aetna-doj-humana

Regardless of how Aetna and Humana fare in their trial against the U.S. Department of Justice, they will continue to face industry pressures toward consolidation, a University of Louisville professor said. The antitrust trial between the insurance giants and the U.S. government begins today in Washington, D.C. Aetna wants to buy Humana for $37 billion, […]

Only 26 Percent Of Americans Support Full Repeal Of Obamacare, Poll Finds Friday, Dec 2 2016 

Americans continue to be divided along partisan lines over Obamacare, with an overwhelming percentage of Democrats favoring it and an equal share of Republicans having unfavorable views, according to a newly released Kaiser Family Foundation poll.

But when it comes to an actual gutting of Obamacare, there’s doesn’t appear to be a lot of support.

One-fourth, or 26 percent, of Americans favor a full repeal of the health care law, while 17 percent say scale it back, according to the Kaiser poll. On the other hand, 30 percent favor expanding the law and another 19 percent want lawmakers to move forward with the law as it is.

The poll was conducted one week after the 2016 presidential election. In its aftermath, President-elect Donald Trump and Republican lawmakers have signaled their intention to follow through on their campaign promise to repeal President Obama’s landmark health care legislation. Republican lawmakers have voted to repeal Obamacare dozens of times.

But the Kaiser survey indicates that there’s been a decline in the percentage of Republicans who want to see the law repealed just since October. In that month, 69 percent of GOPers said they favored repealing the entire law. A month later, once it was clear that the GOP would be in control of the health care debate, just 52 percent of Republicans said the law should be repealed.

Similarly, in October, just 11 percent of Republicans said they wanted the law scaled back but not eliminated. In November, that percentage increased to 24 percent.

The poll also indicates that among those who want to see Obamacare repealed, only a third don’t want a replacement. Two-thirds want to see it replaced by a Republican alternative. There are reports that the GOP may seek an immediate repeal of the law and wait years before settling on a replacement.

Overall, the survey finds that some key provisions of Obamacare are very popular among Democrats and Republicans. For example, 85 percent favor keeping young adults on their parents’ insurance plan until age 26. Sixty-nine percent like the prohibitions on insurance companies denying coverage based on pre-existing conditions.

The most unpopular feature of Obamacare? Only 35 percent favor the individual mandate requiring all people to sign up for health insurance or pay a fine.

Copyright 2016 NPR. To see more, visit http://www.npr.org/.

Women Could Pay More Than Men For Health Care Under Trump Tuesday, Nov 29 2016 

Some women have been worried that they will lose insurance coverage for contraception under the Trump administration, but coverage for other women’s health benefits could also be at risk.

At or near the top of the list is guaranteed coverage of maternity services on the individual insurance market. Before the health law, it was unusual for plans purchased by individuals to cover prenatal care and childbirth. But the Affordable Care Act requires that maternity care be included as one of 10 essential health benefits.

In 2009, the year before the health law passed, just 13 percent of individual plans available to a 30-year-old woman living in a state capital offered maternity benefits, according to an analysis by the National Women’s Law Center.

Some plans offered maternity services as an add-on through a special rider that paid a fixed amount, sometimes just a few thousand dollars, the study found. But even with a rider, a woman’s financial exposure could be significant: the total payment for a vaginal birth was $18,329 in 2010, according to a study by Truven Health Analytics.

Before Obamacare, women were also generally charged higher rates for health insurance than men on the individual market. According to the law center’s analysis, 60 percent of best-selling individual plans in 2009 charged a 40-year-old nonsmoking woman more than a 40-year-old man who smoked, even in plans that didn’t include any type of maternity coverage.

That inequity disappeared under the health law, which prohibited insurers from charging women higher rates than men for the same services.

“Our concern is going back to a world where insurance companies are writing their own rules again, and returning women to those bad old days in health care and losing all the progress we’ve made,” says Gretchen Borchelt, vice president for reproductive rights and health at the National Women’s Law Center.

And preventive health services for women could be on the line if the health law is repealed or changed. Some may be easier to get rid of than others, say women’s health policy analysts.

Under Obamacare, preventive services recommended by the U.S. Preventive Services Task Force have to be covered without copays or deductibles. The task force, an independent panel of medical experts, evaluates the scientific evidence for screenings, medications and services. That currently includes recommendations on screening for breast and cervical cancer and testing for the BRCA 1 and 2 genetic mutations that increase women’s risk of breast cancer.

“Coverage of those services can’t be changed without a change to the statute” that created the health law, says Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms. If the law is repealed, then that could happen.

Coverage for contraception and other services endorsed by the Health Resources and Services Administration could be easier to eliminate. In 2011, the Institute of Medicine proposed a list of eight preventive services that should be covered without cost sharing, and HRSA adopted them. That includes all contraceptives approved by the Food and Drug Administration, which most insurers must cover without charging women anything out of pocket.

Also included are requirements to cover well-woman visits at least once a year; screening for gestational diabetes; counseling and screening for sexually transmitted infections; breast-feeding support, counseling and supplies; and screening and counseling for domestic violence.

Changes to that list were proposed earlier this year by a committee led by the American College of Obstetricians and Gynecologists. The addictions include coverage without copays for mammograms starting at age 40 and for follow-up tests after mammograms such as biopsies. That update is under review by federal officials.

“We expect action will be taken before the end of this administration,” says Palanker.

But the Trump administration may not have the same ideas about which preventive benefits for women insurers should be required to cover.

Rep. Tom Price, R-Ga., whom President-elect Donald Trump chose Tuesday for secretary of Health and Human Services, in the past has introduced legislation to repeal and replace the ACA.

“What they can endorse they can also unendorse,” says Adam Sonfield, a senior policy manager at the Guttmacher Institute, a research and advocacy organization for reproductive health based in Washington, D.C.

Finally, many of the details about what’s required by the ACA have been spelled out in thousands of pages of regulations and guidance. The new administration could write different rules or just not enforce the ones that are on the books.

Take coverage for birth control. Some health plans initially interpreted the requirement to cover FDA-approved contraceptives to mean that if they covered birth control pills, for example, they didn’t have to cover other hormonal methods of contraception such as the vaginal ring or patch. Federal officials under Obama have declared that insurers couldn’t pick and choose; they had to cover all 18 FDA-approved methods of birth control.

“A lot of the pieces of the preventive services benefits that clarify and make the coverage real and strong have been through [federal officials’] guidance, and there is fear that could be changed,” Palanker says.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter: @mandrews110.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.

Trumped: Coal’s Collapse, Economic Anxiety Motivated Ohio Valley Voters Sunday, Nov 20 2016 

The electoral map of Kentucky, Ohio and West Virginia is a sea of red with a few islands of blue. Of the 263 counties in the three states, only nine went for Hillary Clinton, most of them around the region’s cities.

The Ohio Valley ReSource looked to voters and voting data to learn more about what motivated Donald Trump’s supporters and what they hope he will do as president.

“More than Obama did!” Judy Collier said from a grocery story parking lot in Whitesburg, Kentucky. “We need jobs.”

“I don’t think Trump is some savior,” Athens County, Ohio, native Rebecca Keller said. “But he is somebody with a different perspective.”

“I will keep my fingers crossed that he can effect some real change in this country,” Jack Rose said in Wheeling, West Virginia.

The county-by-county vote results also tell a story when matched against some of the region’s key economic and social indicators. Some insights and some questions arise about what Trump voters want.

Coal’s Collapse

ovr-state-breakdowns-coal-v2Alexandra Kanik | Ohio Valley ReSource

One obvious factor was the anxiety over the collapse of the region’s coal industry.

“Our coal jobs are gone here in Eastern Kentucky,” Collier said. She lives in Eolia in Letcher County, which has seen a sharp drop in mine production and employment.

David Boggs of nearby Cumberland echoed the hope that Trump will reverse the decline. “He’ll put the coal business back together and straighten this country up a little bit, maybe.”

Resource data reporter Alexandra Kanik looked at the votes for Clinton and Trump in the counties in the three-state region that produce the most coal. (Her results can be seen in the accompanying maps.)

David Boggs of Cumberland, Kentucky: “He’ll put the coal business back together." Benny Becker | Ohio Valley ReSource

David Boggs of Cumberland, Kentucky: “He’ll put the coal business back together.”

The top coal producing counties in the region had two, three, sometimes six times the support for Trump over Clinton, Kanik found.

Trump seized on coal’s demise and pinned the blame on federal regulations. West Virginia University history professor William Hal Gorby said that fits a long pattern in regional politics.

“Rolling back environmental regulations, what’s called the overreach of EPA, it’s sometimes referred to as the ‘war on coal,’” Gorby said. “That language has had a lot of support, of course, before Trump was running for president.”

The “war on coal” still makes for politically potent rhetoric. However, it does not match well with facts. Executives at electric utilities say their move away from coal has more to do with economics than environmental regulation — natural gas is just cheaper. And since Election Day, some mining industry supporters have walked back their promises of a coal comeback.

Rust Belt Blues

ovr-state-breakdowns-ecodistress-v2Alexandra Kanik | Ohio Valley ReSource

Trump supporters also hope manufacturing jobs might return.

Electrical contractor Jack Rose of Wheeling once worked in the steel industry that sustained the city for decades.

“I saw the industry decimated by the wealthy who wanted to maximize profits,” he said. “You see jobs outsourced to Mexico, Canada, China, everywhere but here.”

Martin Dofka, an airplane mechanic in Wheeling, also worked in the steel mills before they shut down. “I believe there should be tariffs on imports if those companies don’t meet standards they’d face in the U.S.,” he said. “It is unfair labor that’s created the Rust Belt.”

While free trade helped consumers and some companies here, the Ohio Valley’s heavy manufacturing base clearly came out on the losing end of many trade deals. Many manufacturing and mining communities fell into economic distress.

Rebecca Keller (center) of Athens County, Ohio: "He’s not a savior, but he is somebody with a different perspective." Atish Baidya/WOUB

Rebecca Keller (center) of Athens County, Ohio: “He’s not a savior, but he is somebody with a different perspective.”

What a Trump administration might do about that is an open question. On the campaign trail, Trump pledged to take a tougher stance with trading partners and to renegotiate or scrap some free trade deals. One of those deals, the pending Trans-Pacific Partnership, now appears to be dead.

However, a recent incident in the region raises questions about how well Trump’s rhetoric matches reality when it comes to manufacturing and trade. On Nov. 17, the president-elect used his Twitter account to claim credit for preventing Ford from moving a Kentucky plant to Mexico.

“I worked hard with Bill Ford to keep the Lincoln plant in Kentucky,” Trump tweeted.

But Ford made clear that the plant, which makes a Lincoln-branded SUV, was not in consideration for a move to Mexico and that no jobs at the plant were in danger. Rather, the company was considering an assembly line switch to another model of SUV (the Ford Escape).

Poverty and the Polls

ovr-state-breakdowns-poverty-v4Alexandra Kanik | Ohio Valley ReSource

ReSource reporter Kanik’s analysis shows several counties in the region with the worst poverty also had the greatest turnout for Trump.

“Martin County, with some of the highest poverty in Kentucky, had 10 times the vote for Trump,” she said. “In fact, no county in our region with greater than 30 percent poverty went blue.”

The Appalachian Regional Commission classifies 54 counties in the three states as economically distressed. All but one — Athens County, Ohio — went for Trump.

Democratic positions on taxes and government services traditionally favor folks with low incomes, giving rise to the argument that many people in the region are voting against their own economic interests.

But historian Gorby argued that it’s not that simple. Democrats, he said, long ago drifted from the New Deal coalition platform that appealed to many working people and the poor.

“They moved away from core issues of economic security that really matter a lot to ordinary working people and particularly rural voters,” Gorby said. “It’s left a lot of people in the Rust Belt and Appalachia feeling neglected.”

The Healthy Choice?

ovr-state-breakdowns-uninsured-v2Alexandra Kanik | Ohio Valley ReSource

Health care was also an issue for some Trump voters.

“We need medical care,” Judy Collier said. “More than Obamacare — cheaper medicine.”

This is an issue where the vote and the data tell different stories. Kanik noted that as recently as 2013, Kentucky and West Virginia had uninsured rates of 20 percent or higher. Both states made tremendous progress under the Affordable Care Act.

“By 2016, after both states expanded Medicaid under the Affordable Care Act, we saw rates much closer to 5 or 10 percent,” she said.

Yet only two counties in those two states went blue. Most voted for the candidate who pledged to repeal the law.

Judy Collier of Eolia, Kentucky: "We need jobs and medical care."Benny Becker | Ohio Valley ReSource

Judy Collier of Eolia, Kentucky: “We need jobs and medical care.”

“It’s an interesting phenomenon,” said Simon Haeder, a professor at WVU’s John D. Rockefeller IV School of Policy and Politics, where he focuses on health care.

Haeder said his research shows that many people strongly support most elements of the Affordable Care Act. But when asked about “Obamacare,” that support plummets.

“Most members of the public have little idea of what the Affordable Care Act is or what it does,” he said. He blamed misinformation from the media and the major political parties.

“One of the major parties certainly has every incentive to distort what it does,” Haeder said. “And the other party has done a poor job explaining how people benefit.”

ReSource reporters Benny Becker, Glynis Board, Nicole Erwin and Aaron Payne contributed to this story. 

More ER Patients Now Paying With Medicaid, Report Says Friday, Nov 18 2016 

The number of emergency room visits in Kentucky hasn’t gone up much since Medicaid expanded or people started getting coverage on the individual market. That’s according to a new report from the Foundation for a Healthy Kentucky.

Before the Medicaid expansion, many uninsured Kentuckians were going to the emergency room instead of a primary care doctor for non-emergency treatment because they could not be turned away.

Now, more of them have Medicaid coverage, but they’re using the coverage for the same type of ER visit. The percentage of people in the emergency room with Medicaid coverage did increase quite a bit by 2015, with almost half  covered by Medicaid. That’s up from 30 percent in 2012.

The cost of emergency care that could have been treated in a primary care office is estimated to be around $30.8 billion annually. Private insurance companies often have higher co-pays for an ER visit to deter people that could otherwise go to urgent care or their family doctor.

But with Medicaid, that’s not the case. There are no financial incentives for people not to go. One of the original intentions of the Affordable Care Act was to reduce unnecessary ER visits, though that hasn’t quite panned out as expected in Kentucky or nationwide.

“The Affordable Care Act in its initial sales pitch thought that we would have a fairly substantial decrease in the number of people using the ERs,” said Ben Chandler, CEO of the Foundation for a Healthy Kentucky. “And what we found out instead is that the ER usage has been pretty stable. About as many people are using them now as they were then.”

Chandler said using the ER for primary care is “inefficient.”

More than 400,000 people gained insurance coverage through the expansion of Medicaid to include adults without children and those earning up to around $15,000 a year. Meanwhile, around 100,000 people got insurance through the creation of the state-run exchange, Kynect.

Jim Waters, president of the libertarian-leaning think tank Bluegrass Institute, said the only way to get Medicaid patients away from the ER is to charge co-pays that are higher than for primary care.

“People who have private coverage are not using the ER more, and the reason is because they’re having to think about in terms of, is my condition worthy of an ER visit, or should I go and have a regular doctor’s visit,” Waters said.

A big reason for that is convenience and time, according to a 2013 study from the Robert Wood Johnson Foundation. Primary care physicians often have long wait-times for first visits, and sometimes don’t have same-day appointments. In the ER, patients always get seen eventually.

Some hospitals have implemented programs to target patients that could receive care elsewhere, and either send them to a primary care doctor from the ER for an immediate appointment, or set them up with an appointment post-visit.

Many primary care offices also advise patients to go straight to the ER if they believe they’re having a life-threatening emergency, when the primary care doctor could perhaps treat the patient.

President-elect Donald Trump has vowed to repeal and replace the ACA, which would include the Medicaid program and state exchanges. Instead, he’s proposed to give states big blocks of money to manage Medicaid however they choose.

Because of this, Gov. Matt Bevin will likely get the changes to the program he wants, including co-pays and premiums that could help drive down ER usage.

Kindred shares jump on $700M deal to buy and sell nursing homes Monday, Nov 14 2016 

kindred

Shares of Louisville-based hospital and nursing home operator Kindred Healthcare rose sharply Monday morning after the company announced a $700 million deal to buy and then sell 36 skilled nursing facilities. The company had said last week that it was no longer interested in running such facilities. It announced the news at the same time […]

Local businesses compete in UPS X-PORT Challenge Friday, Nov 11 2016 

Brian Tooley, owner of Bardstown-based Brian Tooley Racing makes his pitch to judges at the 2016 UPS X-PORT Challenge. | Photo by Boris Ladwig.

On Thursday, 10 small regional businesses, including four from Louisville, competed in a “Shark Tank”-style competition for the chance to win up to $10,000 in export shipping from UPS. The competition, held at Gheens Foundation Lodge, involved entrepreneurs stepping in front of six judges to explain their business and why they would benefit from higher […]

Pharmacogenetics company tied to UofL Foundation files for bankruptcy Wednesday, Nov 9 2016 

pgxl

A local pharmacogenetics company that has a partnership with the University of Louisville Foundation filed Chapter 11 bankruptcy on Tuesday, citing a recent overpayment demand of $26.3 million from a Medicare contractor. Pharmacogenetics Diagnostic Laboratory, LLC — also known as PGXL Laboratories — was founded in 2004 by Dr. Roland Valdes Jr. and Dr. Mark […]

Kindred shares plunge on $685M Q3 loss Tuesday, Nov 8 2016 

kindred

Kindred shares were getting hammered Tuesday after the hospital and rehab center operator said Monday night that it lost $685 million in the third quarter. Shares were down about 27 percent in late-afternoon trading, after plunging 34 percent with the opening bell. Shares on Monday had climbed 6.41 percent on slightly elevated volume as markets […]

How Would A Trump Or Clinton Presidency Affect Health Care? Tuesday, Nov 8 2016 

The outcome of the 2016 presidential election will determine how much people have to pay for health insurance, and whether they will have coverage in the coming years. Democrat Hillary Clinton and Republican Donald Trump have both released plans addressing the Affordable Care Act, rising premiums, and states that have not expanded Medicaid.

Nonprofit research group RAND Corporation took a deep dive into both candidates’ health care plans. Here’s their analysis.

Clinton’s plan

Clinton, if elected, would continue the Affordable Care Act. She’d add a government-run public insurance plan to compete with private plans in marketplaces, which many insurers are pulling out of.  She’d also open up individual market insurance to immigrants, regardless of their immigration status.

Christine Eibner is senior economist with RAND. Eibner said the biggest change Clinton would bring to the ACA is a cap on how much people spend on health care.

“The cost sharing tax credit would cap spending at five percent of income, and spending over that would be subsidized through a tax credit,” Eibner said.

The tax credit would reimburse single people for $2,500 in health care expenses, and $5,000 for families. This would apply to everyone, including people with insurance through their employer. Because coverage would be more affordable, 9.6 million people would gain health insurance, according to RAND’s analysis. But RAND also estimates the program would add $90 billion to the federal debt.

Clinton is also proposing that people 55 and up could enroll in Medicare – right now the requirement is 65 and older. Sara Collins, vice president of health care coverage at The Commonwealth Fund, said Clinton’s proposals are mainly aimed at improving the ACA and fixing problems. Another goal would be to get more states to expand Medicaid.

“She’s proposing that states that haven’t expanded Medicaid yet could get 100 percent matching funds if they move forward over the next three years, similar to what states that already expanded coverage received,” Collins said.

Trump’s plan

RAND’s analysis of Trump’s plan shows it would cost the government $33 billion. Trump has said he would do away with subsidies and most of the ACA. That would also mean an end to Medicare reforms that were included in the ACA to pay for the subsidies. Trump’s plan would also eliminate the tax on people who don’t buy insurance, and a tax on medical device makers.

Trump’s plan would allow consumers to buy plans across state lines, which would allow for greater competition. His plan would also allow people to get a tax deduction for buying insurance on the individual market.

Average out-of-pocket costs for people buying insurance on the individual market would increase to $4,700 under Trump’s plan because the repeal would take away consumer protections like barring insurers from selling or hiking up prices for people with existing health conditions. Twenty million people would lose coverage, according to RAND’s analysis.

Eibner from RAND said because of the rollback of these consumer regulations, insurers would flock to states where protections are looser.

“Premiums would fall in those states and would rise in other states,” said Eibner. “We’d have a situation where older and sicker people would find it more difficult to purchase a policy, and younger and healthier people would find it easier to find a policy, but it’d be more bare-bones than under the ACA.”

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