Americans are Increasingly Turning to Medicaid for Long Term Care Coverage

Currently, about 62% of nursing home beds in the U.S. are paid for by Medicaid. Many elderly individuals cannot afford to pay for such long term care—the average total cost of long term care received from age 65 to death is $91,100 for men and up to double that amount for women, based on the presumption that women live longer. Low income individuals rely on Medicaid to pay for these expenses and other middle-class individuals are forced to spend down their assets to qualify for Medicaid coverage for their long-term care.

Medicaid was created to provide health insurance to low-income individuals, and not to cover long term care for the majority of the elderly population. Yet, it has evolved into a “safety net” for millions of Americans who cannot afford to pay for their long-term care.  As the baby boomer generation continues to age, Medicaid spending on long term care is expected to rise by almost 50% by 2026, putting pressure on a system that was not designed to carry such a burden.

State and federal officials are working to control Medicaid costs. Some states, for example, are contracting with managed care companies to provide long term care services to Medicaid beneficiaries. However, many health advocates are concerned that these managed care companies, which traditionally provided only medical care, will restrict the coordination of care for the elderly.  California most recently announced that it will hold informational hearings to discuss possible resolutions to the increasing cost of long term care.

 Sources: http://www.npr.org/sections/health-shots/2016/08/03/488385286/medicaid-safety-net-stretched-to-pay-for-seniors-long-term-care

Tags: Long Term Care Coverage, Burdened Medicaid System, Lower and Middle Class Americans

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Legalization of Marijuana Reduces Teenage Use

According to the results of a biannual poll conducted by Colorado’s Department of Public Health and Environment, teenage marijuana use has not increased since the state legalized the use of recreational marijuana for adults over the age of 21. The poll surveyed about 17,000 high school students in Colorado, of which 21.2 percent responded that they used marijuana in the preceding thirty days. This is a slight decrease from the 2011 results of 22 percent. The 2015 survey also indicated that the nationwide average for teen marijuana use is slightly higher than Colorado’s at a rate of 21.7 percent. Yet, contrary to the results of Colorado’s survey, a survey by the U.S. Department of Health and Human Services placed Colorado at the top of the list of states which the highest rate of marijuana use in teenagers between the ages 12 to 17.

Advocates for legalization of marijuana believe that the results in Colorado’s survey prove that the “fears of widespread pot use by minors” in states with legalized cannabis are unwarranted. Yet, others are skeptical about the results. SMART Colorado, an organization that lobbies for stricter marijuana regulations, believes it is “‘deeply concerning” that according to the survey, only 48 percent of students in Colorado view regular marijuana use as a risky behavior.

Source: http://www.scientificamerican.com/article/colorado-s-teen-marijuana-usage-dips-after-legalization/

Pharma Cash Cow: Old Medications, Lucrative Opportunities

In August of this year, the rights to the decades old drug Daraprim were purchased by pharmaceutical company Turing Pharmaceuticals.  Daraprim is the standard of care for treating toxoplasmosis and is used as well in treating HIV infections, cancers, and malaria.  Although the drug was previously sold at $13.50 per tablet, upon its purchase by Turing Pharmaceuticals, the drug’s price increased by over 5,000% to $750.00 per tablet, sparking mass outrage across the internet.

The CEO of Turner Pharmaceuticals, Martin Shkreli, a former hedge fund manager, responded to the widespread criticism of the price increase by providing several reasons for the pricing structure change.  In particular, Mr. Shkreli cited the need to keep the company’s manufacturing costs competitive and to raise capital for the development of new medications to treat toxoplasmosis.  However, medical professionals indicate that there is no need to develop new pharmaceuticals to treat toxoplasmosis and that the former price was profitable, albeit at a much smaller margin.

In response to the public outcry against the price hike, which included criticisms from former Secretary of State Hillary Clinton and presidential candidate and Vermont Senator Bernie Sanders, Turing Pharmaceuticals has reversed the price increase. However, Turing Pharmaceuticals is not the only pharmaceutical company to acquire an old medication and subsequently increase its price to boost profits.  Other drugs, such as Sovaldi, used to treat hepatitis C; Harvoni, a follow-on formulation of Sovaldi for hepatitis C; Retrophin, used to reduce kidney stones; and Cycloserine, used to treat drug-resistant tuberculosis, have also been subjected to similar price increases. Congress is poised to inspect the recent trend in drug price increases, but until congressional action is taken, it appears public outcry will be the primary means of keeping more excessive increases at bay.

To read more about, this click on any of the following links:  LA Times, NBC, NBC News, CBS News

A Medicaid Card Does Not Necessarily Mean Access to Healthcare

Since the implementation of the Affordable Care Act (“ACA”), millions of Americans have enrolled in Medicaid. However, the government has not ensured that the new beneficiaries will have access to doctors. In fact, many Medicaid recipients are finding that they have to wait months due to shortages of doctors who accept Medicaid. Daniel R. Levinson, the inspector general of the Department of Health and Human Services, blames the lack of access on variations in standards between states. More specifically, most states rely on private insurance companies to comply with Federal rules in providing Medicaid beneficiaries with “adequate access to all services covered.” However, “adequate” is defined by each state. Some states opt for a “time and distance” standard for access, others set a maximum number of days a patient may have to wait to see a doctor, and some base the standard on a doctor/patient ratio. The result has left many Medicaid patients waiting up to 60 days to see a specialist, while others are forced to travel great distances because their state only requires one primary care provider for every 2,500 beneficiaries.

Mr. Levinson believes that the federal government should be more involved in developing and enforcing state standards of access. However, insurance companies worry that if the federal government forces a larger pool of doctors who accept Medicaid, it will upset the low premiums resulting from insurers limiting access.

Read more here.

Wal-Mart Wants to Be Your Primary Care Doctor

Recently, Wal-Mart has begun promoting itself as a “primary medical provider” in order to sway customers into becoming patients. The retail giant has opened five primary care facility clinics in South Carolina and Texas, with plans to double the number of clinics by the end of the year.   Wal-Mart is using its “vast rural footprint” to bring primary care to areas of the country where people have limited access. CVS and Walgreens already offer some medical services, but unlike Wal-Mart, they are not equipped to treat patients as a primary medical provider.

Wal-Mart relies on physicians to supervise the clinics’ operations rather than actually to treat patients. Medical assistants and nurse practitioners will administer the bulk of the patient care. Wal-Mart’s focus is becoming the first stop for patients, but some experts are concerned that stores like Wal-Mart will be unable to provide care for more complex medical issues.

Read more here.

Federal Rule Blocks Many Rehabilitation Facilities from Treating People Covered Under the Affordable Care Act

The Affordable Care Act (“ACA”) allows states to expand Medicaid to cover more low-income individuals, as well as cover alcohol and substance abuse treatment programs. However, a Federal rule enacted half a century ago prohibits Medicaid coverage for “community based” rehabilitation facilities that have more than 16 beds. As a result, many facilities are unable to provide treatment to the increased number of individuals now eligible for substance abuse treatment under the ACA’s Medicaid expansion. Although some facilities have sacrificed beds to fit within the guidelines and others have simply absorbed the cost of taking in more patients, only Congress has the power to change the rule to provide Medicaid coverage for larger treatment facilities.

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New York City Stabbing Reveals How the Mentally Ill Slip Through Cracks After Released From Prison

A few days after Daniel St. Hubert was released from prison, he allegedly went on a stabbing spree resulting in the death of a 6-year-old boy.   Hubert’s past is checkered with violence. In fact just before his release, he had been incarcerated for five years for choking his mother with an electrical cord. Moreover, Hubert’s time in prison was filled with violence against inmates and correctional workers. The correctional system would seem to have been aware of Hubert’s propensity for violence. Indeed, it took three years before he was deemed psychologically fit to stand trial for the assault on his mother.

While in prison, Hubert underwent years of therapy that resulted in improvement in his behavior including six months without any citations for violence.  On May 23, 2014, after a psychiatric evaluation, Hubert was released without a structure in place to ensure the safety of Hubert and the public.

Currently, the criminal justice system focuses on ensuring that the mentally ill are competent to stand trial, but little has been done to combat mental illness once mentally ill prisoners are released. New York’s “Kendra’s law” gives the state the authority to order outpatient treatment for individuals who have had a violent past and have refused treatment. However, this law does not ensure thatmentally ill people released from prison will receive needed treatment. Hubert’s case forces us to ask whether or not six months without a citation for violence is enough time to deem a prisoner stable enough to re-enter society. Further, is there a better way to keep tabs on released prisoners with mental illnesses?  Whatever the solution, there are civil liberty issues that must be balanced with public safety.

Read more here.

Sex-Reassignment Surgery Will No Longer be Automatically Denied by Medicare

A federal review board has ruled that Medicare will now cover sex-reassignment surgery on a case-by-case basis. The review board decided that coverage for sex-reassignment surgery will no longer be automatically denied by Medicare.

The ruling does not create a right for Medicare recipients to receive payment for their reassignment surgery, but it does allow flexibility for doctors to use clinical evidence to determine if the cost should be covered.

The estimated cost for treatments is anywhere from $25,000 to $75,000 per person.

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1,700 Patients Were Not Put On Official Waiting Lists at the Phoenix V.A.

Richard J. Griffin, the Inspector General for Veterans Affairs, reported that 1,700 veterans were not placed on the Phoenix V.A.’s official waiting lists for doctors’ appointments. In fact, many of these patients may not have received medical care at all, and there are allegations that some veterans may have died while waiting for care.

 Investigators found that out of a sample of 226 patients, the average wait time for an initial primary care appointment was 115 days.  But the Phoenix V.A.’s reported average to the National Veterans Affairs Office was 24 days. (The average wait time is a factor in determining bonuses and salary increases. Moreover, several waiting lists were uncovered during the investigation that were separate from the “official” waiting list suggesting that criminal activity may have been involved in reporting wait times in Phoenix.

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Congress Looks to Revamp Mental Health System

Soon, Congress will hear testimony concerning the Helping Families in Mental Health Crisis Act. Republican representative, Tim Murphy, from Pennsylvania, sponsored the bill, and, though many agree that the mental health care system requires revamping, some provisions in the bill have sparked controversy. Among the more controversial provisions is one that supports the increased use of involuntary outpatient treatment—via court-ordered therapy for “certain mentally ill people with a history of legal or other problems.” Detractors of this provision claim that it will erode trust in doctor-patient relationships, and that it presents a civil rights issue. However, 45 states have compelled treatment programs already, one of which is New York.

New York’s compelled treatment program, Kendra’s Law, was passed in 1999. Since the implementation of Kendra’s Law, studies show that the percentage of patients returning to the hospital or getting arrested has greatly decreased. The statistic is significant, as “about 350,000 Americans with a diagnosis of severe mental illness…are in state jails and prisons” and the availability of psychiatric beds meets only 10 percent of that need. 

Read more here.