By Carrie Winans

The Disruptive Women in Health Care blog continually aims to encourage discussion and debate among readers about emerging issues and topics in the health care world. Historically, one of the ways that we have done that is through our weekly round-ups – that is, posts containing summaries and links to some of the big stories in health care news for the given week, with some original commentary and content sprinkled in as well. The way we see it, there is just too much happening in this burgeoning industry; it’s hard to keep up, especially when you’re busy disrupting and making headlines in the health care world yourselves. We know the weekly round-ups have been on hiatus for a while, but are happy to report that they’re finally making a comeback. Each week, we’ll be gathering some of the biggest health care news you can use from at home and abroad for posting on Wednesdays. Feel free to comment on what’s included and send us some links to articles to be considered for next week!

Has your week been too disruptive for you to keep up with the news?  Disruptive Women are on the case!  Here is this week’s round up of some of the most pressing issues here in America and around the world.

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By Hope Ditto. Hopefully it is no secret to our blog readership that above all, the editorial team here strives to be Disruptive – in more than one sense of the word. As a news outlet in this century’s ever-changing media landscape, the niche we pride ourselves on filling is just that – disruptive, at least in the sense that we will have the conversations no one else is having, raise the questions no one else is asking and explore the angle no one else is pursuing. We don’t shy away from controversy, nor do we balk at intimacy – as long as topics are well-researched, provide substantiated arguments and at least acknowledge there is an opposing viewpoint, there are almost no topics we consider off-limits.

There is, however, one area we don’t touch (in fact, we avoid it at all costs): partisan support for a candidate. While certainly all of our individual bloggers have opinions and perspectives, points of view and inherent biases, we will never run posts that are blatantly promoting one candidate for elected office over another.

I say this as a caveat to this post, the purpose of which is to announce a new series we’ll be running this year on the Disruptive Women in Health Care blog in which we explore the presidential candidates’ positions on health care and health policy, where they stand on particular aspect or aspects, what they envision to be an ideal health care system for this country and what role they envision the federal government playing in it.

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CMS Administrator Marilyn Tavenner addressing Care Innovations Summit attendees. Image courtesy of Kaiser Health News.

“I think we would all agree that these are not ordinary times, that this is not an ordinary conference, nor is it an ordinary time in health care,” commented Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner, in her address at the first ever Care Innovations Summit Thursday. In saying so, Tavenner captured not only the essence of the problems facing our nation’s health care system and the reason that over a thousand national thought leaders, senior government officials and industry experts had gathered, but also inspiring attendees with the idea that, by being there, they had the opportunity to be a part of the solution.

Driving the day at the Care Innovations Summit, which was hosted by the Center for Medicare and Medicaid Innovation (CMMI), Health Affairs and the West Wireless Health Institute, was the notion that American innovation could solve any problem, and the thousand-plus attendees were the innovators to solve this one. Emphasizing CMMI’s founding mission of better health, better care and lower costs, speakers across sectors, industries and areas of expertise continued to echo each other’s cries that it was all possible, if people began collaborating and innovating across fields.

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By Hope Ditto

If you chose to partake in what HuffPo referred to yesterday as “ your country’s empty displays of patriotic kitsch” — aka a State of the Union Drinking Game — last night, I certainly hope health care wasn’t one of your buzzwords.

President Obama delivered his 4^th State of the Union (SOTU) address to Congress last night, outlining his goals and his priorities for the nation in the coming year, and – as Sarah Kliff from the Washington Post’s WonkBlog put it  – “For health policy wonks, Tuesday night’s State of the Union speech wasn’t a thriller.”

In fact, in his nearly 70-minute, 7,000 word address, “President Obama mentioned Medicare and Medicaid… once. ‘Health care’ got two shout-outs. The Affordable Care Act? Not even a name-check,” (per Kliff).

To think of it another way, consider how Daily Briefing editor Dan Diamond broke it down — the president spent 44 words on health reform, accounting for 0.6% of the total speech.

As Politico pointed out, “Obama spent so little time on the [health reform] law that he didn’t even acknowledge an audience member the White House had brought to the speech — a cancer survivor who could have been an example of someone with a pre-existing condition who was helped by the law.”

The White House had announced earlier Tuesday that this young man, Adam Rapp, would be sitting in the first lady’s box. Rapp was diagnosed with testicular cancer on his 23^rd birthday, the same day that he would have lost health insurance coverage were it not for the Affordable Care Act (per CBS) – a potentially powerful testament touting the impact of ACA, and yet one that went unmentioned.

All of this is more staggering when you consider what a departure it represents from years past.

Medscape Medical News reports that, “Obama mentioned either “healthcare” or “health insurance” only 3 times, compared to 6 references in 2011 and 10 in 2010.”

The California Healthline blog lays it out a bit differently, explaining that, “Two years ago, the president spoke for several minutes — a total of 570 words — in urging Congress to pass the Affordable Care Act. Last night, Obama devoted just 44 words to his health reforms — never once touting the law’s actual impact, like 2.5 million young Americans gaining coverage through the ACA. In comparison, the president spent more than 130 words on his renewed cause of streamlining the government.”

And for you visual learners and/or infographics enthusiasts like myself out there, Dan Diamond tweeted this graphic a few hours ago, which I think best serves to drive the point home.

Wondering what Obama spent 70 commercial-free minutes talking about, then? According to the Washington Post, the economy mostly. Check out WaPo’s interactive infographic breaking down the speech by time spent/mentions per subject, and how this year’s spread compares to his previous SOTUs, here.

Meanwhile, the GOP rebuttal, delivered by Indiana Gov. Mitch Daniels, was only marginally better to us health wonks – at least for our interest’s sake. While it steered clear of “repeal and replace,” it did echo Rep. Paul Ryan’s pitch for an overhaul of entitlement programs.

“Medicare and Social Security have served us well, and that must continue. But after half and three-quarters of a century respectively, it’s not surprising that they need some repairs,” Daniels said. “We can preserve them unchanged and untouched for those now in or near retirement, but we must fashion a new, affordable safety net so future Americans are protected, too.”

No one would deny that the SOTU, above all, is an act of political theater. But were there even more theatrics occurring last night than usual? Many Beltway insiders have seemed to indicate this, saying that the SOTU was not only a list of goals for the year, but also, as Kliff put it, “an opening campaign gambit.”

If that is the case, it raises some interesting questions about what we can expect to hear in the fall. After all, as The Hill’s Healthwatch blog pointed out, “Although Democrats insist that Obama will be able to campaign on the healthcare law, it was almost entirely absent from a speech that helped establish the themes and frames of his reelection campaign.”

Just because the president seems to be steering the narrative away from health care so far doesn’t mean it won’t be issue in the upcoming presidential election. Odds are that the Republican nominee – whoever it turns out he (or she… hey, you never know!) may be – will want to discuss health reform, as it has certainly been a hot topic on the campaign trail.

How important of an issue do you think health reform will be in the upcoming election? Will a candidate’s position on health reform and the Affordable Care Act impact your decision to support him or her? Tell us your thoughts in the Comments section below!

By Randi Kahn. As many of you may have read, Evelyn Lauder, the senior corporate vice president of Estee Lauder Companies and daughter-in-law of founder Estee Lauder, a champion of breast cancer research, died of ovarian cancer at her home in Manhattan Saturday. Her death came on the same day I finally got around to watching “The Education of Dee Dee Ricks,” a documentary that follows the journey of a woman battling breast cancer while attempting to raise millions of dollars to help treat other breast cancer patients without resources, and also shares the story of a woman named Cynthia who was uninsured and ended up passing away in a hospital after her breast cancer, which was caught late, spread to her liver.

I have been unable to get these strong, Disruptive Women out of my mind, and could not help thinking about both Evelyn and Cynthia while listening to the National Journal’s “Living Well at the End of Life” event on Tuesday, wondering what their conversations about end of life care were like with their clinicians, and if there was a difference between them as a result of their insurance and financial statuses. Did Cynthia choose to live her final days in the hospital?  Did her medical situation necessitate it? Was she given proper information about her hospice and palliative options?

Although we’ll never know the answers to those questions, it is interesting to take a look at barriers that exist for clinicians in end of life care that are likely impacting potential disparities. (more…)

By Mary Grealy. Yesterday, USA Today devoted its front page to a topic many of us have been discussing intensely for some time – how to address Medicare’s escalating costs. 

The newspaper listed five ways to “squeeze” Medicare spending and then discussed the political arguments for and against each.  Some, such as gradually raising the Medicare eligibility age from 65 to 67 and requiring higher-income beneficiaries to pay full premiums for their Medicare Part B (physician services) and Part D (prescription drug) coverage are recommendations that the Healthcare Leadership Council has made to the congressional deficit reduction “super committee.”

But, in a number of ways, the USA Today article missed the mark:

In discussing cutbacks to Medicare providers, including physicians, hospitals and pharmaceutical companies, the newspaper expanded on the likelihood that those health sectors would strenuously argue against any cuts, but there was no reporting on the impact those reductions would have upon beneficiaries.

This is a pet peeve of mine, as I’ve noted previously.  Too often, both politicians and commentators speak of the value of cutting providers instead of patients, obscuring the fact that reduced payments to providers has an impact on both the accessibility and quality of healthcare.  If, as the Obama Administration has proposed, pharmaceutical companies are required to send over $100 billion in rebates back to the government, can there be any other outcome besides higher prices for consumers and less money available for research and development of new innovative medicines? (more…)

By Stephanie Mensh. We probably don’t need a new report to tell us this: middle class people cannot afford the cost of nursing home services or long term home health care services.    The AARP, Commonwealth Fund, and SCAN Foundation joined  forces to examine state-by-state affordability,  accessibility, choice, quality, and–interestingly–support  for family caregivers, in their first-ever “State Scorecard  on Long-Term Services and Supports for Older Adults, People  with Physical Disabilities, and Family Caregivers,”  just published earlier this month.

Caregiver supports are defined by the Scorecard to include:

• Percent of caregivers getting needed support
• Legal and system supports for caregivers
• Health tasks able to be delegated to aides.

The Scorecard showed that 77% of family caregivers who were surveyed a few years ago reported that they get emotional and social support when they need it.   Legal and system supports scores were much lower, averaging a “3″ on a 12-point scale. These supports  were defined as:  state family medical leave laws;  mandatory paid family and sick leave; protection of  caregivers from employment discrimination; the  extent of financial protection for the spouses of  Medicaid beneficiaries who receive nursing home or  long term community support services; and  assessments of the caregiver’s health, quality of  life, etc.    The researchers also proposed that family caregivers would benefit if state nursing license laws permitted aides to perform a list of key “health maintenance” activities, such as administering medications, and diabetes testing and injections. (more…)

By Rozalynn Goodwin. Everyone seems to be quoting and tweeting the tender line of Miss Aibileen in “The Help”, “You is kiiiind. You is smaaaart. You is important.”

But there was another line in the blockbuster movie that moved me even more. I heard it and the heavens seemed to open. The light bulb came on.

Hilly Holbrook’s new maid is $75 short on one of the college tuitions for her twin sons and asks Hilly and her husband for a loan so she doesn’t have to choose which son should go to college. Doing the ‘Christian thing,’ Hilly refuses, “God does not give charity to those who are well and able.”

Twelve simple words from a fictional 1960’s character summed up our nation’s current political will regarding the poor. And allow me to condense this into just one word: selfishness.

We movie-goers were quick to see the bigotry in Hilly’s statement. The maid and her husband had been saving money from their meager wages for a long time and she wasn’t seeking a hand-out, but a loan she would pay off with her thankless labor. But I was also quick to see the hipocracy in those of us who identify ourselves as Christians regarding the poor–many like this maid are in temporarily tight spots by no fault of their own. I was convicted by the thought that a selfish Christian is just as much of an oxymoron as a Christian murderer. (more…)

By Robin Strongin. In the 1993 movie Dave, the temp agency owner posing as the President of the United States (if you haven’t seen the film, just trust me on this) is determined to come up with the funding to save a federal homeless shelter program.  Gathering all of the cabinet officials together with pencils, legal pads and calculators, they brainstorm different wasteful programs that can be cut, totaling numbers as they go, until they come up with the necessary $350 million.

A bit of Hollywood silly escapism?  No doubt.  But, you can say this for President Dave and his fictional cabinet.  At least they approached the budget process with a constructive purpose and vision.

We can only hope that the same holds true for the supercommittee, the panel of 12 Senators and Representatives created as part of the cobbled-together solution to the debt ceiling debacle.  By Thanksgiving, the supercommittee must come up with $1.5 trillion in deficit reduction that must then be ratified by the full Congress no later than December 23.

There’s no question that health care will play a key role in those calculations.  When it comes to finding ways to reduce federal deficits, health spending is the rapidly growing elephant in the room. 

And that leads to genuine concerns about this process.  Already, policymakers are bouncing around ideas to extract more money from the healthcare system and tighten belts further.  Medicare provider payment cuts.  New home health care co-pays and budget reductions.  Mandated Medicare Part D prescription drug rebates.  The upshot of each of these steps will be a health care system that’s more expensive, less accessible, but not necessarily better. (more…)

By Hope Ditto. Most of the country is sweltering its way through this week’s heat wave, but there is one thing here in DC rising faster than the mercury in our thermometers – tensions on the Hill as the debt ceiling stalemate continues. Whispers [well, tweeted whispers] of default “what ifs” abound here in the nation’s capital as lawmakers continue to play a high-stakes game of chicken through day after day of floor debates, committee hearings and negotiating sessions. With interest rates, Social Security payments and America’s credit score dangling in the balance, and the clock ticking towards the Aug. 2 deadline, the air is even thicker with panic than it is with humidity (though my frizzy hair would say otherwise). (more…)

By Rozalynn Goodwin. The rise of the Tea Party has come with increased concern over the federal deficit and strained state budgets, and cries for less government spending. The Medicaid program has a bright red bull’s eye target on its back, mainly because several erroneous stereotypes exist about its recipients who often don’t have the means to speak and fight for themselves.

The situation is no different in my state of South Carolina. Last week, one of our state senators referred to South Carolina’s Medicaid program as a “Mercedes health plan.”  Our Department of Health and Human Services responded by saying, “It’s a little bit of a stretch to call it a Mercedes.”

This morning, that same senator posted a guest editorial on FITSNews, “A Hand Up, Not a Hand-Out.”  In this piece, the independent pharmacy manager claims that Medicaid’s benefits are better than those of hundreds of insurance plans he works with.

“Hard working South Carolina taxpayers are forced to pay for premium coverage for others. These same hard working taxpayers could never afford these benefits themselves. Where’s the fairness in that? Welfare programs should be a “hand up” instead of a “handout.” Government assistance should be a temporary benefit instead of a lifestyle.”

The Senator says he and his colleagues in the Senate should focus on those unable to help themselves like the low-income elderly and mentally disabled. He then goes on to give two examples about welfare recipients who would rather get a check than work.

It’s disturbing that one of only six legislators in the entire South Carolina General Assembly with any type of health care experience would intermingle Medicaid and welfare as if the programs are the same. Some confuse the typical Medicaid recipient with the infamous Reagan-era “welfare queen.”  What an outrageous comparison.  Medicaid recipients don’t receive checks.  They receive access to health care services like primary care, prescription drugs, screenings, and hospitalizations.  High-paying-job-producing, tax-paying businesses get the checks and pump billions of dollars into the state economy both directly and indirectly. South Carolina hospitals, for example, employ more than 80,000 citizens, and contribute greatly to our state’s well-being and prosperity. Not to mention all the physician practices, nursing homes, health centers and other providers that do the same.

Let’s set the record straight on these Medicaid recipients seeking a hand-out in South Carolina:

• Two-thirds of Medicaid recipients live in working families, but their incomes are too low to afford insurance,
• Eligible families stay on Medicaid an average of only two years,
• A single parent making just more than $7,000 a year is too rich to qualify for Medicaid in South Carolina,
• And adults without children, regardless of their income, cannot qualify for Medicaid because they are categorically ineligible. (more…)

The completely updated 200-page Alliance sourcebook, “Covering Health Issues, 6th Edition,” is now available.

Written with reporters in mind, “Covering Health Issues” is useful for anyone looking for concise information on health policy issues, and experts from across the political spectrum. Chapters contain fast facts, background, tips for reporters, story ideas and experts with contact information. The book also includes an extensive glossary, ideas and examples for TV and radio reporters, and links to polls on health issues. Supported by a grant from the Robert Wood Johnson Foundation.

To see a video demonstration of the book by Julie Rovner of NPR, click here. To see individual chapters, click on any of the chapter titles below. To download the entire sourcebook as a PDF, click here.

For all chapters, links are available to local news stories on the chapter topic. For many chapters, there is also a short video featuring one of the nation’s top health policy experts.

Table on contents:

• Introduction and Acknowledgments
• Health Reform
• Cost of Health Care
• Quality of Care
• Employer-Sponsored Health Coverage
• Individual Health Coverage
• Children’s Health Coverage
• Medicare
• Medicaid
• Long-Term Care
• Disparities
• Mental Health and Substance Abuse
• Public Health
• Polls on Health Care Issues
• Covering Health Issues for TV and Radio
• Acronyms and Glossary
• Experts
• Websites

The Alliance for Health Reform is a nonpartisan, not-for-profit health policy education group. We are committed to helping journalists, elected officials and other shapers of public opinion understand the roots of the nation’s health care problems and the trade-offs posed by various proposals for change. Our aim is quality, affordable health coverage for all in the U.S., although we do not lobby or take positions on legislation. Sen. Jay Rockefeller (D-W.Va.) is our founder and honorary chairman; Robert Graham, MD, of the University of Cincinnati is our board chairman.

By Mary Grealy. An interesting comment was made today at the annual national health research forum sponsored by the non-profit organization Research! America, and it drove home the conflict lawmakers face in trying to balance deficit reduction against the need for quality healthcare and better preventive care.

Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said that the ideal American, from a budget standpoint, “is one who dies at age 65 on the drive home from his retirement party.”  His comment gets to the heart of the budget conundrum.  If our healthcare system takes steps to help people live longer in their retirement years, then they consume more Social Security and Medicare resources.

Yet, as Frieden also said, we should all be able to agree to the societal goal that “Americans are better off not dead.”

There are some important points here.  First, that there is not necessarily a perfect alignment between budgetary goals and the imperative to have a healthy population, that funding for medical research and the effort to prevent and cure disease should not be viewed in the same vein as other areas of discretionary spending.  And, second, as Frieden also pointed out, investments in disease prevention do not always fit into the neat, tidy 10-year window that Congress and federal budgeters like to use to score spending, that health prevention measures can sometimes take 20 or 30 years to fully assess their return on investment.

At the same Research! America event, former Congressman Mike Castle said that the need to contain Medicare and Medicaid costs will be one of the major campaign issues in the 2012 elections.  No doubt he’s correct, but let’s hope we hear office holders and candidates provide some creative solutions on how to curb cost growth while still achieving the greater objective of keeping Americans alive and healthy.

First posted on the Prognosis Blog on March 15th.

By Lynn Shapiro Snyder. I have been a managed care, Medicare and Medicaid attorney for over 30 years. Although this focus includes compliance and enforcement work, I also do a lot of work helping entrepreneurs bring new ideas to the health care marketplace. Providing strategic, legal and regulatory assistance for some of these innovations has been some of the most rewarding work for me.

It used to be the case that when an innovator wanted to launch a new drug or device in the United States, the key regulatory tollgate was the federal Food and Drug Administration (FDA). That standard focuses on safety and efficacy. Once that tollgate was satisfied, the company could promote its product, and the product would enjoy general distribution in the marketplace. Those days are over.

Two new additional tollgates include access to identifier codes – especially for certain medical devices and coverage for the innovation. The focus of this blog is on the new coverage challenges to innovation.

In the United States, we have a wide variety of payers of health benefits. There are publicly funded payers such as Medicare and Medicaid. There are privately funded payers such as self-funded employers and private health insurance plans. Traditionally, the scope of covered benefits focused more on illnesses. The new benefits focus on prevention and population health management. There are enumerated benefits, enumerated exclusions and general coverage phrases like covering what is “reasonable and necessary.”

More and more payers will be offering similar benefits as Title I of federal health reform is implemented. This is because a proposed federal regulation will be issued soon by Department of Health and Human Services to define the “Essential Health Benefits Package” for individual and small group health plans. This benefits package is supposed to be comparable to coverage by existing employer plans.

Who decides whether an innovation fits within an existing covered benefit or whether a new coverage decision is needed so that patients can get access to the innovation? And, what is the criteria for confirmation of coverage? Is it enough that the innovation is comparable to existing options? Does it have to be breakthrough? While there is a whole body of literature about randomized control trials and other data points needed to establish FDA approval, what should be the study protocol to establish a positive coverage determination by the payer? Finally, should the new cost of the innovation even play a role in the coverage decision-making process?  These are the key questions across payers.

Centers for Medicare & Medicaid Services (CMS) uses the MEDCAC – the Medicare Evidence Development & Coverage Advisory Committee- to provide independent guidance and expert advice on specific clinical topics.  In its deliberations, the MEDCAC reviews and evaluates available evidence, including medical literature and technology assessments, and listens to public testimony.  The Committee then makes coverage recommendations to CMS based on its review.  Private payers usually have some type of technology assessment processes. (more…)

Do you find yourself a little confused about what happens when with the health care reform law? To help clear up the confusion the Kaiser Family Foundation wrote and produced a short animated video that explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. The video is narrated by Cokie Roberts, a news commentator for ABC News and NPR and a member of Kaiser’s Board of Trustees. View the video.

In addition to this video, the Kaiser Family Foundation has great resources/basic information to help you understand the new law. To access this information, click here.