31 October 2013


Story first appeared on ArcaMax.com.

WASHINGTON -- Private contractors working on the troubled federal health insurance marketplace told a congressional committee Thursday that they needed several months, but had only two weeks, before its Oct. 1 launch date to fully test the Healthcare.gov website.

The task was further complicated by the Obama administration's late decision to require users to create personal accounts before they could browse and compare health plans on the website.

User bottlenecks created by the required accounts, along with the abbreviated test period, appear to be the main causes of the marketplace crash that disabled the website shortly after its launch on Oct. 1, the contractors testified. The crash occurred when just 2,000 users across 36 states tried to access the system.

Thursday's hearing before the House Energy and Commerce Committee gave lawmakers their first opportunity to question several key marketplace architects about the rampant problems that have plagued the system and created a political firestorm for President Barack Obama and Health and Human Services Secretary Kathleen Sebelius.

Congressional Republicans want the administration to waive the health-care law's fines for people who don't obtain coverage until the marketplace problems are ironed out. Had it done so previously, said Rep. Brett Guthrie, R-Ky., House Republicans wouldn't have moved to shut down the government during the debt-ceiling standoff earlier this month.

Democrats remain largely supportive of the Affordable Care Act and often used the phrase "fix it, don't nix it," during the hearing to describe their feelings about the problematic website. But some have begun to publicly express anger over the marketplace controversy.

Sen. Jeanne Shaheen, D-N.H., has called for extending the six-month open enrollment period, and others, like Sen. Bill Nelson, D-Fla., said administration officials should fire someone over the problems.

Both sentiments were on display during the four-hour hearing, which at times veered from confrontational to comical.

Committee Chairman Fred Upton, R-Mich., expressed the feelings of most Republicans when he described the website as "not ready for prime time."

After Rep. Joe Barton, R-Texas, repeatedly questioned a witness on whether an obscure website disclaimer would violate a federal privacy law regarding personal health information, Rep. Frank Pallone, D-N.J., angrily called the hearing a "monkey court," noting that the health privacy law wasn't at issue because the website doesn't seek any personal health information from applicants.

The federal marketplace -- a one-stop, online shopping center to purchase health insurance required under the Affordable Care Act --is not a standard consumer website. Databases for numerous federal agencies, more than 170 insurance companies and information on more than 4,500 health plans in 36 states are integrated into the system. It also determines consumers' eligibility for government health plans and federal subsidies that help pay for private insurance.

Government reports indicated that testing for the complex system was months behind schedule, due in part to delays by the administration in drafting guidelines for marketplace operation. But in numerous appearances before the committee, HHS officials and contractors indicated the project was proceeding on schedule with no problems.

"This is on us," White House Press Secretary Jay Carney said during his Thursday briefing. "And that goes from the president on down. This website needs to work effectively for the American people. And we need to get the product that they so clearly desire to them as efficiently and effectively as possible."

At the hearing, Cheryl Campbell, senior vice president of CGI Federal, the contractor that designed and developed the federal marketplace, testified that the system passed eight technical reviews before going live on Oct. 1. She said her team never suggested delaying the site launch because that decision was up to HHS, which served as the site development manager.

"Our portion of the application worked as designed," Campbell told Upton during direct questioning.

But in earlier testimony, she said, "We acknowledge that issues arising in the federal exchange made the enrollment process difficult for too many Americans."

Those problems, Campbell said, stemmed from issues with the "front door" to the marketplace, where people register and create personal accounts. That application, designed by Quality Software Services Inc., "created a bottleneck preventing the vast majority of consumers from accessing" the marketplace, she testified.

Andrew Slavitt, executive vice president of Optum, which owns Quality Software, explained the front door bottleneck to lawmakers: "It appears that one of the reasons for the high concurrent volume at the registration system was a late decision requiring consumers to register for an account before they could browse for insurance products. This may have driven higher simultaneous usage of the registration system that wouldn't have otherwise occurred if consumers could 'window shop' anonymously."

Campbell testified that she believed the window-shopping feature was ordered disabled in August by Henry Chao, deputy director of the Office of Information Services in the Centers for Medicare and Medicaid Services.

Julie Bataille, communications director at the center, known as CMS, called the move a "business decision" to make sure that users understood their eligibility for a tax credit before enrolling in a plan.

Slavitt said he raised concerns with CMS about the risks associated with the lack of system testing on several occasions during the site construction. He said he was told they "understood the concerns "

But Bataille acknowledged that the fully integrated system -- not just its individual parts -- wasn't tested properly. "Due to a compressed time frame, the system just wasn't tested enough," she said in a telephone briefing Wednesday.

While testing of the fully integrated system didn't occur until two weeks before the Oct. 1 launch, both Campbell and Slavitt said that several months of testing would have been optimal for a project this complex.

Rep. John Shimkus, R-Ill., said he believes "political appointees manipulated the system to hide (test) data they didn't want the public to know. And we're going to find out who that is because that's the crux of this problem."

At the White House, Carney dismissed a question of whether the administration was so wedded to the Oct. 1 rollout that it didn't allow adequate testing. He called the question "Monday morning quarterbacking."

"The fact that some critics of the Affordable Care Act, who have worked assiduously for years to try to do away with it, repeal it, defund it, sabotage it, are now expressing grave concern about the fact that the website isn't functioning properly, I think should be taken with a grain of salt," he said.

Meanwhile, at the hearing, Slavitt said Quality Software fixed the registration application to meet the site's "unexpected demand." By Oct. 8, he said, the system was processing personal accounts "at error rates close to zero."

But Rep. Anna Eshoo, D-Calif., said the complaints about "unexpected demand" were bogus and that other websites routinely handle similar, if not greater, volumes. "That really sticks in my craw," she told Campbell and Slavitt. "I think that's really kind of a lame excuse. Amazon and eBay don't crash the week before Christmas and ProFlowers doesn't crash on Valentine's Day."

Campbell said she believes the website will be functioning properly in time for people to purchase coverage by Dec. 15, the cutoff date to enroll in coverage that begins on Jan. 1, 2014. The Obama administration is preparing regulations that allow coverage under the health law for 2014 to be purchased until March 31, 2014, the end of the open enrollment period.

To date, 700,000 people have completed applications and gotten determinations on their eligibility for government coverage and federal subsidies to buy private coverage. The administration has said that in November it would provide the number of people who have so far signed up for coverage on the federal website.

22 October 2013


Story first appeared in The Detroit News.

Last week I got news that my health insurance costs are going up. A lot. In 2014 my monthly premium for a family of four will increase 15 percent to $575, my deductible will double to $3,000 and I will lose my drug coverage, adding another $100 a month to my expenses. My story is typical for employees of Gannett, the Detroit News' parent company, and other businesses across the country.

Obamacare is not just creating havoc in state exchanges, it is roiling the larger private health insurance market. Costs are skyrocketing thanks to the expensive mandates, regulations and taxes buried in the Affordable Car Act.

Call it the Unaffordable Care Act.

Billed by President Barack Obama as a historic reform that would reduce heath insurance costs by $2,500 a year and cover 40 million uninsured, the program is dictating terms to every health insurer while offering employees a grim choice of rising costs with their company plan or seeking refuge in unworkable, expensive government-run state exchanges.

While many small employers have welcomed a delay in the ACA's employer mandate until 2015, businesses that already provide insurance are facing Obamacare's new reality. The bad news has come in waves as companies like Home Depot and Trader Joe's announced they are dropping coverage for part-time employees. Hundreds of thousands of consumers are losing their "mini-med plans" because they don't meet Washington's minimum requirements. Now come the premium increases for self-insured businesses that an analysis by Duke University's Center for Health Policy estimates will cost an average family $800 a year. In Michigan, for example, insurance costs for the Extreme Chrysler dealership in Jackson are going up 70 percent and Michigan Group Benefits insurance says its clients' average increase is 23 percent.

The $2,100 cost jump in my Gannett plan, administered by United Health, is actually worse than it appears, as my premiums have already swelled by 45 percent since 2011 as insurers anticipated federal regs forcing, for example, coverage of dependents up to 26 years old. Gannett must also swallow a $63 tax for each individual in its group plan and another $2.13 fee per head to "study heath care outcomes." Similar costs threaten private, union-negotiated health plans, leading Teamsters President Jimmy Hoffa to say Obamacare will "destroy the very health and well being of our members."

"Health care costs historically have been going up 7 percent a year, so anything above that is probably due to provisions in Obamacare," concludes Drew Gonshorowski, a policy analyst for the Heritage Foundation's Center for Analysis, who says the ACA's over-regulation is upsetting important insurance calculations like "age-brand compression" that balances risk pools.

"Insurance pricing is one of the most complicated, difficult-to-price markets," he says. "The ACA doesn't allow insurers to price freely."

Obamacare promises that its state exchanges offer insurance options, but the government-run system is dysfunctional. Three weeks after its launch, the federally run Michigan Health Care Exchange is still a nightmare. In the first two weeks I couldn't sign up because the three security questions wouldn't load. Last week, the security questions were finally there, but then I stalled at the next page. After waiting in a chat room, an Obamacare assistant finally responded: "Unfortunately, (high volume) is causing some glitches for some people trying to create accounts, log in, and complete their application. Keep trying and thanks for your patience."

But if/when if I do get in, more sticker shock awaits.

An analysis of the feds' own data by Heritage's Gonshorowski finds Michigan consumers (as in most states) will experience cost increases across the board. For a family of four, the state exchange will increase costs from $771 to $864 per month. Even for a 27-year old, the youth demographic on which exchanges depend to subsidize older applicants, the exchange increase costs from $117 to $255 per month, a 118 percent hike.

"The essence of the law is working," said the president at his Monday news conference. "The prices are lower than we expected, the choice is greater than we expected." Do you believe him or your lying eyes?

Henry Payne's column runs every Tuesday online. Payne is a Detroit News editorial writer and editorial cartoonist. He also is editor of The Detroit News Politics forum.

21 October 2013


Story first appeared in the Miami Herald. 
Evan Zimmer has been indicted for racketeering, arrested for drunk driving, and busted for soliciting a prostitute, after which he showed up in court while impaired. He’s also a psychiatrist, licensed to this day to practice in South Florida. In Florida, medical professionals hang onto their licenses and continue practicing as the state grapples with a lengthy disciplinary process that can take years, according to the Florida Center for Investigative Reporting (FCIR). This angers one Miami Medical Malpractice Lawyer.  On occasions when doctors do get suspended, as was Zimmer in February. 2012, it can be difficult to locate the disciplinary citation in public records. Between 2010 and 2012, it took the Florida Board of Medicine an average 434 days to resolve charges of misconduct against doctors, nurses and other healthcare workers, according to Florida Department of Health records. Elsewhere, states complete similar investigations in significantly less time. In Texas, it took an average of 282 days to resolve a complaint in the third quarter of this year. In California, the rate was 264 days for its 2012 fiscal year. The Florida Department of Health, which licenses medical professionals in the state, declined to make anyone available for this report. The drawn-out process in Florida is due in part to decreased funding for the state’s health department, which still reels from a $55.6 million budget cut in 2011. The cut, some contend, resulted in overwhelming caseloads for lawyers investigating complaints. Others say low pay at the health department has led to too much turnover. Pay for board of medicine attorneys ranges from $52,000 to the low six-figure range, according to state records. “It’s a revolving door of lawyers there because they are paid so poorly,” said David Spicer, a Palm Beach County attorney who represents medical professionals in licensing and disciplinary disputes. “The public is at risk by this underfunding. It allows doctors to practice while their case is being looked into, when perhaps they shouldn’t be.” Florida disciplinary actions between 2010 and 2012 include 55 suspensions, 30 revocations and 88 cases where a license was voluntarily surrendered, a review by the FCIR found. Among the disciplined doctors was Zimmer, who was arrested in October 2010 for allegedly soliciting a prostitute. In November 2010, Zimmer pleaded no contest to the Miami charge and was sentenced to 60 days in jail. He had already served time, having been jailed by a judge who was irked when he observed the doctor to be impaired in court. The state health department, which licenses doctors and had received “various allegations” of drug use against Zimmer, ordered him to appear on June 30, 2011, for a mental and physical exam. He skipped the appointment. It was rescheduled three weeks later, but he skipped that, too. Zimmer did appear for a third appointment, at which time he submitted a hair sample, which tested positive for cocaine and marijuana. Six month later, on Feb. 17, 2012, his license was suspended until such time as he “demonstrates the ability to practice medicine with reasonable skill and safety.” It has since been restored on a probationary basis. It is the second time his license was pulled. The previous incident, in the 1980s, involved prescribing drugs to patients without proper documentation and, in some cases, without the proper examination. The state has the ability to move quickly when a doctor poses a public hazard. But in nonemergency cases, the majority of complaints to the medical board, often drag on. Media reports in 2011 revealed Florida’s spotty record of policing poorly performing physicians. In response, the state established an Emergency Action Unit to review complaints. Still, the unit has been unable to keep up with new complaints, and some of those emergency actions took over a year to complete. In its first year, the unit issued 287 emergency actions, primarily suspensions and several license removals. Last year, that number jumped to 500, according to the health department. At the same time, the special interests of the medical profession are at play. The accused in Florida are sometimes accompanied to their medical board hearing by someone from the Professionals Resource Network, which in 2010 received a $5.4 million contract with the state Department of Health to assist medical professionals who have emotional health issues, including addiction or mental disorders. The contract was renewed this year for $7.2 million. Professionals Resource Network uses the same address on its tax filing as the Florida Medical Association, a trade group representing 20,000 physicians. The network also “contracts with them for accounting services and management of employee benefits,” PRN’s medical director, Penelope Ziegler, said in an email. She declined to be interviewed. Nationwide, delays in investigations of medical professionals have led to those accused of wrongdoing to hop from state to state. Because of the lengthy hearing process, doctors can move across state lines as charges in one state are neglected or undetected in another. There is no national clearinghouse for sanctioned medical professionals available for the public to check on their own provider. In Florida, patients can research a doctor at the state’s Department of Health website. But a clear record doesn’t mean a clear past. Physicians who lose their license can apply for reinstatement, and doctors who are reinstated receive a new license number, as did Zimmer when he lost his license in the 1980s, then regained. If a physician gets in trouble again, the Health Department records system makes it difficult to connect the two incidents. The Federation of State Medical Boards, an association representing the 70 U.S. medical boards, used to make available data on the disciplinary actions. But the federation stopped posting the information this year. When the data was available, consumer advocate group Public Citizen compiled it into an annual report to rate serious actions in each state. Florida ranked in the bottom ten of the list four times between 2001 and 2012, making it among the least active U.S. boards. “It’s likely the state medical boards didn’t like how we were using the information,” said Dr. Michael Carome, director of the health research arm of Public Citizen. A representative from federation, Drew Carlson, declined an interview, but said in an email that the data was removed amid “concerns expressed by boards about the FSMB report included that its almost exclusive focus on medical boards’ disciplinary actions was not representative of the broad range of activities medical boards engage in to protect the public. “ Two of every five medical professionals in Florida are licensed in another state or states, according to the Federation of State Medical Boards. The system is a mish-mash of reportage, wherein state health boards and hospital systems report disciplinary actions to large national database, called the National Practitioner’s Data Bank. The names of the sanctioned individuals though, are not available through the data base to the public, allowing suspended doctors to get a license in another state. The system is accessible to hospitals and other qualified health care operations. The lengthy delay in the hearing process, combined with a seriously flawed national system for reporting medical malfeasance, allows physicians like cardiologist Rick Szumlas to continue to hold a license in Florida — in good standing — while being suspended in Texas after complaining to police that “aliens were invading his head.” His defense claimed his mental troubles were a thing of the past. A witness said it was a brief episode. The Texas board issued an order in June 2011, agreeing to allow Szumlas to treat patients in a “group or institutional setting” while receiving psychiatric treatment. His license in Florida notes that Szumlas is “not practicing in Florida,” although his record here has no public complaints and his license status is “clear/active.” Meanwhile, his license in Illinois reflects the action in Texas. “Outside of the state, it goes on a case by case basis,” said Jay Wolfson, director of the Florida Health Information Center at the University of South Florida. “If I am a physician in Wyoming and I lose my license to practice there, that board has to post that action. And if I am practicing in Florida, I am supposed to tell them. And I have to appear before the board.” For states to catch up with actions in another state, “it all starts with that original state,” said Jarrett Schneider, a spokesman for the Texas Medical Board. He said state health officials review news accounts as much as anything else in looking for possible license troubles. “We don’t just rely on the National Practitioner’s Data Bank.” He added that a license revocation in one state may take a while to get into the hands of another, especially when states rely on the sanctioned party to divulge. “There is a timing element here, in which an individual might be caught in a situation in one state and word hasn’t gotten back to the other,” Schneider said. Or sometimes a sanction in one state simply isn’t caught by another, as in the case of Leesburg physician James Lee Allen, who was forced to surrender his license in Florida in 2010, more than four years after voluntarily surrendering his Wyoming license after pleading guilty to felony child pornography charges. Allen held licenses in three other states, as well. Nevada revoked his license in 2007. Louisiana records show Allen’s license there was expired before his arrest. The reason for the revocation in Florida was a failure to inform the board of the Wyoming action four years before. Nine months after Florida removed his license, Allen unsuccessfully petitioned to get his medical license back in Wyoming. While “nearly all physicians are OK, they are human,” noted Wolfson, the health information center director. Complaints against doctors often come from disgruntled family members or former patients looking for some solace. Still, there are misdeeds and failing among the ranks that need to be policed. Florida’s lengthy disciplinary delay and state-funded defense of the accused is the result of a strong political presence of the medical profession. “While there are some lobbying interests for the public, they aren’t as well funded or as targeted as those for physicians. The [American Medical Association] has a laser like ability to focus on legislators and can kill things quickly.” Zimmer, the Miami Beach psychiatrist busted for prostitution and suspended for drug use, declined to discuss his troubles. But he did compliment the state’s Medical Board that had suspended his license. “If you attend a couple of Medical Board meetings, you will find a sincere and devoted group of professionals from various domains, who agonize over the parameters of each and every case, prior to reaching a broad range of deeply considered conclusions, consequences and judgments,” Zimmer wrote. “To paraphrase Sir Winston Churchill, this system may be terrible, but it’s the best we’ve developed, so far.” Zimmer ended his email by noting that “it is not how many skeletons we have in our closets, it is how we make them dance for us that counts.”

15 October 2013


Story first appeared on Discovery News.
Although prosthetic hands give amputees a way to grasp objects, they do not offer a sense of touch. That means the person has to watch his or her robotic hand as it reaches to push or pick up an item.

Now researchers at the University of Chicago might have found a way to add touch to prosthetic limbs. The research, which appears in the Proceedings of the National Academy of Sciences, is funded in part by the Defense Advanced Research Projects Agency, and it’s not hard to see why the military would be interested. Beyond dreams of cyborg warriors, there’s the more prosaic matter of helping injured veterans.

5 Major Advances in Robotic Prosthetics

The study, led by Sliman Bensmaia, assistant professor in biology and anatomy, identified patterns of neural activity that occur when monkeys manipulate objects and then induced these patterns artificially.

First he and his team connected electrodes to areas of a monkey’s brain that corresponded to each of its finger. The idea was to find out what kind of brain activity occurred when monkeys pick up or touch something.

Next, the researchers touched the animals’ fingers, using a device that applied a specific amount of pressure. The monkeys were rewarded if they correctly identified which finger was touched — the monkey just had to look in the right direction. Next, the researchers repeated the same action, but in reverse, sending an artificial signal through the electrode to the monkey’s brain, which caused the monkey to act the same way it would had it’s fingers been touched by the device — identifying fingers as touched even when they weren’t.

The next step was the sense of pressure. They trained the monkeys to identify whether the pressure on their fingers was smaller or larger. In this case, Bensmaia’s group wrote a computer program to generate the same kind of electrical current that gave rise to pressure sensations.  Once again, the animals reacted the same way as if they had actually touched something.

Finally, the scientists examined the brain signals that occurred when there was a “contact event.” When the monkey’s hand was initially touched or pressure released, their brains showed a spike in activity. This spike is in addition to the signals for pressure and the individual fingers — it’s what tells the brain that there’s something in the hand to begin with before the signal settles down. The scientists duplicated that brain activity spike with artificial signals as well.

That implies that by programming those signals into an artificial limb, it’s possible to duplicate the sensation of touch. Just as natural limbs send signals to the brain, the artificial one would do so, too, except it wold be through electrodes linked to the relevant parts of the brain rather than nerve cells. An amputee would actually feel the object they are touching with such a prosthetic.

First ‘Bionic Dog’ Has Four Prosthetic Limbs

The setup hasn’t been tested in humans yet. But the monkey results are promising, and it could solve not only the problem of touch sense, but that of sensing limb position and possibly even help a person balance on his or her artificial legs.


Story first appeared in the Detroit Free Press.

At least 146,000 Michiganders — and possibly thousands more — with health coverage purchased directly from insurers now are learning their polices will end Dec. 31 because they don’t meet the minimum requirements of the federal health care act.

Under the law, each policy must cover essential benefits in 10 categories. Instead of beefing up these policies, insurers are opting to drop them, advising consumers to consider other policies that are now available either from the insurers directly or though the Michigan Health Insurance Marketplace, also known as the state exchange.

The policies that are ending were often less expensive on the individual market because they provided limited benefits and were sold to healthier consumers.

And that was fine with consumers such as Josh Mulder.

Mulder had landed a plan several years ago that cost his Wixom family offour just $291 a month. That policy will end Dec. 31, according to a letter from his insurer.

The policy didn’t cover things such as maternity care or prescription drugs, but, Mulder said, his family is generally healthy and he was willing to take the risk.

“I had a great rate,” he said.

Rates that meet the required benefits under health reform average $762.06 a month on the Michigan Health Insurance Marketplace for his family of four, according to a cost estimator by the Michigan Department of Insurance and Financial Services.

Blue Cross Blue Shield of Michigan has notified about 140,000 policyholders on the individual market that their plans will end Dec. 31. Health Alliance Plan and its subsidiaries are dropping 6,000 plans.

Both are major players on the state exchange, where 13 insurers, including a HAP subsidiary and another Blues insurer, Blue Care Network, are offering 142 plans.

That Blue Cross and HAP are ending current policies on the individual market isn’t surprising, said Robert Krughoff, founder and president of the Washington-based nonprofit Consumer Checkbook.

The increased costs to provide essential benefits was just one part of the cost equation. Under the health care reform law, insurers also can’t deny anyone insurance, even if they’re very sick. Neither can insurers cut cap coverage at a lifetime limit.

“These plans had to be reconfigured,” Krughoff said.

Customers will pay more, but they also will get more coverage now, noted Gail Jensen Summers, an economics professor at Wayne State University, who specializes in health insurance policy and costs.

The insurers may expect their customers to seek them out on the marketplace, where federal tax credits for some consumers can help shrink the costs of the monthly premiums, according to Checkbook’s Krughoff.

In the first 10 days of business, the exchange logged 14.6 million unique visits, according to the U.S. Department of Health and Human Services.

Anyone whose income is up to 400% of the federal poverty limit — up to $45,960 for an individual and $94,200 for a family of four — is eligible for tax credits.

Health insurance reform supporters have said this puts insurance within reach for an estimated 1.4 million Michiganders who are underinsured or uninsured.

Blue Cross, in fact, is competing aggressively on state marketplaces across the U.S., Krughoff said.

Another insurer on the Michigan exchange, Kentucky-based Humana, indicated that it, too, will end some policies, but it declined to offer specifics. Letters to members are being finalized, according to the insurer.

Grand Rapids-based Priority Health is taking a different tack. It’s allowing its current and new members to lock in 2013 rates that extend through 2014 before they end those plans on Dec. 31, 2014. The plans won’t include all the essential benefits required under the law, but the insurer will be able to extend them for one more year, said spokeswoman Amy Miller.

That extension is possible for some plans. Still, with the exception of catastrophic plans targeted for those younger than 30, all plans on the individual market must carry essential benefits Jan. 1, 2015, said Caleb Buhs, spokesman for the Michigan insurance department.

Consumers can still find plans on the exchange and off the exchange that do cover all the essential benefits. It might cost the insurer more to offer the extension at the same premium rates, but it gives members “more time to consider their options going into 2015,” she said.

Gary Plasko of Walled Lake is looking at options like those.

An insurance broker, he knew big changes were coming under health care reform. He wasn’t surprised when he was notified last week that his policy — one that costs the 63-year-old nonsmoker $381 a month and covered about 70% of his medical costs with no deductible — was ending. And he had warned customers to expect similar notices.

Still, he was disappointed with what he found.

Like the Mulders, Plasko won’t get tax credits to help him pay for the new policies.

He said he found a Blue Cross policy for less than $550, but it covers about 60% of his medical costs. Plus, he now faces a $6,350 deductible.

The law? For him, he said, “it’s the un-Affordable Care Act.”


Story first appeared in The Detroit News.
Lansing— Lawmakers must pass corrective legislation that could spark another squabble over Medicaid expansion, the Senate’s appropriations chairman says.

“I would hope that people want it to go reasonably smoothly ... (but) some might say we’re not done fighting,” said Sen. Roger Kahn, R-Saginaw.

Follow-up legislation is needed because the Senate backers didn’t win immediate effect for the Medicaid act Snyder signed into law Sept. 16. It will make more than 400,000 additional state residents, earning 100 to 133 percent of the federal poverty guideline, eligible for government-funded health care.

The legislation can’t take effect until about three months into 2014, so state lawmakers have to come up with $70 million to cover Medicaid mental health services during that period. Had the expansion taken effect immediately, the coverage cost would have transferred to the federal government Jan. 1.

The Senate Fiscal Agency says cleanup legislation also is needed to revise downward by $500 million the amount of federal Medicaid funds received and spent this fiscal year. The bill specifies $1.7 billion, but the three-month delay will reduce the amount to around $1.1 billion or $1.2 billion, according to fiscal agency analysts.

The $70 million outlay and the technical adjustment through what’s termed a “negative supplemental appropriation” of $500 million could be wrapped into a single bill.

Lawmakers probably would take up the legislative proposal in about five weeks, Senate Majority Leader Randy Richardville, R-Monroe, told the press last week. He said Kahn would craft the proposal.

“There’s a fair amount of accounting work to be done,” Kahn said. “I would imagine before it gets ramped up, there will need to be a discussion between Richardville, (House Speaker Jase) Bolger and (Gov. Rick) Snyder.”

A spokeswoman for Sen. Patrick Colbeck, R-Canton, whose staunch opposition nearly prevented passage of the Medicaid expansion, said he wasn’t available for comment Friday.

Spokesman Ari Adler said it had been Bolger’s understanding nothing much more than the $70 million appropriation was needed as a follow-up. The $500 million is “just gone ... (and) we don’t need to take any action on it,” he added.

“Either way, this should not be seen as some sort of proxy on Medicaid reforms,” Adler said. “The policy debate was already held, the votes were cast and the outcome is done.”

04 October 2013


Story first appeared on BBC News.

The report, which followed 73,000 women for 17 years, found walking for at least seven hours a week lowered the risk of the disease.

The American Cancer Society team said this was the first time reduced risk was specifically linked to walking.

UK experts said it was more evidence that lifestyle influenced cancer risk.

A recent poll for the charity Ramblers found a quarter of adults walk for no more than an hour a week - but being active is known to reduce the risk of a number of cancers.
Recreational activity

This study, published in Cancer Epidemiology, Biomarkers & Prevention followed 73,615 women out of 97,785 aged 50-74 who had been recruited by the American Cancer Society between 1992 and 1993 so it could monitor the incidence of cancer in the group.
Continue reading the main story   
“Start Quote

    We know that the best weapon to overcoming breast cancer is the ability to stop it occurring in the first place.”

Baroness Delyth Morgan Breast Cancer Campaign

They were asked to complete questionnaires on their health and on how much time they were active and participating in activities such as walking, swimming and aerobics and how much time they spent sitting watching television or reading.

They completed the same questionnaires at two-year intervals between 1997 and 2009.

Of the women, 47% said walking was their only recreational activity.

Those who walked for at least seven hours per week had a 14% lower risk of breast cancer compared to those who walked three or fewer hours per week.

Dr Alpa Patel, a senior epidemiologist at the American Cancer Society in Atlanta Georgia, who led the study, said: "Given that more than 60% of women report some daily walking, promoting walking as a healthy leisure-time activity could be an effective strategy for increasing physical activity amongst post-menopausal women.

"We were pleased to find that without any other recreational activity, just walking one hour a day was associated with a lower risk of breast cancer in these women.

"More strenuous and longer activities lowered the risk even more."

Baroness Delyth Morgan, chief executive of Breast Cancer Campaign, said: "This study adds further evidence that our lifestyle choices can play a part in influencing the risk of breast cancer and even small changes incorporated into our normal day-to-day activity can make a difference.

She added: "We know that the best weapon to overcoming breast cancer is the ability to stop it occurring in the first place.

"The challenge now is how we turn these findings into action and identify other sustainable lifestyle changes that will help us prevent breast cancer."

03 October 2013

Patients Of Indicted Oakland Co. Cancer Doctor Meet For Support In Weeks Before Trial

Story first appeared in The Detroit News.

Rochester Hills— Cathy Bastian fears her future.

The Oakland Township woman says she is scared of what 21 rounds of chemotherapy she didn’t need did to her body.

The treatments, administered by indicted oncologist Farid Fata, went on for 18 months after she was told she no longer had any evidence of a deadly form of lung cancer in her body.

“He kept me on chemotherapy for a year and a half,” Bastian said during a meeting with other patients of the embattled oncologist. “I begged for my life. I said ‘Dr. Fata, I don’t think my body can take it anymore.’ ”

Bastian says she received 33 sessions of chemotherapy when medical tests indicated she needed 12 sessions to cure her early form of small-cell lung cancer, which has a low survival rate if not caught early.

Bastian is a member of a group of former patients and family members who say they are seeking justice in the wake of criminal charges filed against Fata for Medicare fraud.

The group plans to protest Wednesday outside U.S. District Court before the start of a bond hearing. Fata is being held on a $9 million bond and his lawyers are asking a judge to lower it so their client can be free pending trial later this month on multiple charges of health care fraud.

The doctor maintains he is innocent, according to his co-counsel, Christopher Andreoff.

The group of his former patients gathers regularly at a hotel near Crittenton Hospital’s Cancer Center in Rochester Hills, where some of them first met Fata. They hug each other and share tears as they recall their time as Fata’s patients.

They wonder aloud if their exposure to unnecessary chemotherapy will make them even sicker in the days, months or years to come.

Last month, they launched a letter-writing campaign to state lawmakers and county prosecutors, hoping officials will review state laws regarding licensing physicians. They want Fata to face state criminal charges along with the federal charges.

Many of them plan to follow the case and attend every court hearing involving the doctor.

Fata, the owner of Michigan Hematology Oncology P.C., which has offices in Rochester Hills and six other locations, including Bloomfield Hills and Oak Park, is charged with submitting false and fraudulent claims for medical treatments that were not medically necessary.

Among the allegations: Fata administered chemotherapy and other cancer treatments to patients who didn’t need them. He also is accused of engaging “in a scheme to unlawfully enrich himself” by soliciting and receiving kickbacks in exchange for referring patients for home health care and hospice services.

The federal charges, filed last month, allege that from August 2007 to July 2013, Fata’s MHO practice billed Medicare around $225 million, of which $109 million was for chemotherapy or other cancer treatments. Of the approximately $225 million, Medicare paid more than $91 million to Fata’s medical practice.

Kevin Brown, a Lake Orion resident, said he was very fond of Fata and credited the doctor with curing him of cancer in 2007. Brown said he was shocked when Fata suggested he have more chemotherapy as part of a “maintenance” plan.

“This guy told me I was going to see him the rest of my life,” said Brown.

Angry and filled with questions, Brown said he believes his recent onset of alopecia (hair loss that occurs when the immune system attacks hair follicles) can be attributed to the cancer drug Fata prescribed for him a year even after scans showed him to be cancer-free.

“I just want to meet him face to face ... man to man and ask him why did he do that to me?”

Fata has been in the Wayne County Jail under federal custody since last month, when he was arrested after federal authorities raided his home and medical offices in Oakland County.

His trial is set for mid-October. If convicted, Fata faces a maximum of 10 years for each count.

01 October 2013

Exchanges open Tuesday: Here's what to do

Story first appeared in USA TODAY.

Don't wait. But don't hurry, either.

That's the best approach to the new health insurance exchanges that are scheduled to open for business Tuesday. Buying insurance is supposed to be easier than ever once several provisions of the Affordable Care Act take effect this fall. That doesn't mean the process is easy or should be done speedily, however, experts say. That's especially true if insurance shopping is new to you.

"Don't be hurried in buying a plan," says Bryce Williams, managing director of global benefits consulting firm Towers Watson Exchange Solutions. "There's no rush."

Williams likens it to buying the first car off an assembly line: It may be best to let the new exchanges — particularly the 31 run by the federal government — iron all the kinks out. Federal exchanges may not be ready, and there may be more and better information and "hand holding" available after a few weeks. Besides, your insurance won't start until Jan. 1, 2014, whether you sign up now or in December.

If you're one of the more than 45 million people who lack health insurance, you can begin the enrollment process Oct. 1, but you certainly don't have to. The deadline to purchase (or face a penalty at tax time in 2015) is March 31, 2014.

Every state has people called navigators who received grants to help guide consumers through the process in an unbiased way. Insurance companies are also increasingly pitching their individual policies online and in stores, where agents are available to help you figure out what plan is right for you — but they obviously have a vested interest in your decision. A key benefit to the new online exchanges is the ability to easily compare different plans — as you might during online car shopping — without a pushy salesperson hovering.

Key steps in the process:

•Step one. Check out the options on your state's exchange. Start at HealthCare.gov, the federal government's portal, which will route you to your state or allow you to create an account if the feds are running your state's insurance marketplace. Plug in details about where you live, what you earn and family size. If your income is low enough, you may be alerted that you're eligible for Medicaid and told how to apply for that.

•Step two. Determine if you are eligible for financial help, which can come in the form of subsidies to offset the cost of premiums, co-payments or deductibles.

Anyone under age 65 participating in the new state exchanges can get tax credits if their incomes are between the poverty level and 400% of the poverty level. In 2014, that means families of four that make $24,000 to $94,000 per year could get subsidies. Those who make 250% or less of the poverty level can get even more financial help. The federal poverty level is now $11,490 for an individual and $23,550 for a family of four.

•Step three. Calculate what you've been spending for your uninsured health care, including prescription drugs, doctor visits and any emergency room or other hospital visits. Are there health concerns you've avoided addressing that are likely to get worse, like that sore knee or breathing condition? Medicines you should be taking but aren't? Are there young athletes in the house?

•Step four. Spend time pondering what type of plan is right for you, based on how much you can afford to pay in premiums, co-payments and cost-sharing for procedures, as well as what your medical needs are likely to be next year.

Options are grouped into coverage levels that are coined bronze, silver, gold and platinum based on the percentage of out-of-pocket costs borne by the consumer. Bronze plans cover the lowest percentage of expenses — 60% — and have the lowest premiums. Silver plans cover 70%, gold pay 80% and platinum plans cover 90% of out-of-pocket costs. Even policies that appear affordable may not be if you have high deductibles, co-payments or cost-sharing for procedures.

Could you afford to pay 40% of last year's medical bills — and almost everything out of pocket until a high deductible is met?

You need to consider other factors when deciding among plans. Williams recommends consumers stick with insurers that are "well entrenched" in their area; not one you've never heard of before.

Farzan Bharucha, a health care strategist for consulting firm Kurt Salmon, recommends calling providers you would consider if you had insurance and ask whether they will be accepting patients in the policies you're considering.

"A fair number will say they are full," says Bharucha, who advises physician groups and hospitals.

•Step five. Decide whether it even makes sense financially for you to buy insurance. For some people, paying the annual penalty, which starts at $95 or 1% of income for the first year, may be the cheaper move. (Unless, of course, your health takes a turn for the worse.) By 2016, however, the annual penalty will be $695 or 2.5% of income.

The exchange plans are set up so you will never have to pay more than 9.5% of your salary for insurance. But the new law certainly doesn't mean coverage will be cheap.

"It's still going to be expensive, particularly for low-income people," says Andy Hyman, who directs the health care coverage team at the Robert Wood Johnson Foundation. "There is a financial burden, but it's far less today than what it was."

How the financial help works

Under the Affordable Care Act, there are two main types of subsidies to reduce insurance costs and out-of-pocket costs of medical care: tax credits and cost-sharing reductions. To lower your insurance costs, if eligible, you can get subsidies to help pay for plans obtained in the new state exchanges. You might also qualify to pay less out-of-pocket for co-payments, co-insurance (that share of procedure costs you have to pay) and deductibles.

Tax credits

The subsidy amount is based primarily on income and number of family members. The tax credit is calculated as the cost of a "benchmark" middle-range plan in your area minus your required payment, a set percentage of your family income. These benchmark plans are set as the second-lowest-cost "silver" plans for a person of your age living in your area. Depending on how much you make, you'll be expected to pay between 2% and 9.5% of your income on monthly premiums. The difference between what you're expected to pay and the cost of the premium is what the government will cover.

For example, Kaiser Family Foundation says a 40-year-old who makes $30,000 a year is expected to pay 8.37% of income in insurance, or $2,512 per year. In this person's area, the estimated "benchmark" premium is $3,857 per year. So this person gets a tax credit of $3,857 minus $2,512, or $1,345, the foundation says.

These tax credits are "advanceable," meaning that the savings are included in your monthly premiums. You pay lower costs up front, rather than having to get reimbursed later.

Cost-sharing subsidies

Health Savings Account-qualified health plans define a general maximum amount for out-of-pocket costs. Then, eligible people can get reductions in their own maximum out-of-pocket expenses, which range from one-third to two-thirds of this initial maximum, depending on income. Those with the lowest incomes — at or below 250% of the poverty level — can also get plans that cover a higher proportion of the cost of medical services.

Still murky? You'll see how much you can get in savings after you fill out an application for the state exchanges starting Tuesday. But until then, you can estimate your potential savings with the Kaiser Family Foundation's subsidy calculator. This calculator takes into account information about your income, family and tobacco use and gives you estimates of how much you might receive in subsidies and how much you might have to pay for premiums and out-of-pocket costs.