The huge drive to immunize the masses against threat of H1N1 in the 2009/10 influenza season (which the WHO has officially declared concluded) has created more than a watershed moment in 21st century public health response to a potential biological catastrophe, it has also touched off a political debate that’s just getting started. And it all has to do with authoritarian mandate of the vaccine for healthcare workers.

Contrary to popular thought, many healthcare workers do not receive the vaccine; in fact, approximately 40 percent of said workers actively refused [PDF link] the vaccine last year — during infection’s peak. This notion does not sit well with a couple of policy organizations — one academic and one medical. Both groups say mandatory influenza vaccine should be a condition of employment. The groups stress increased availability of the vaccine, a steadier supply of healthy workers to administer care in times of a crisis, and an overall decrease in the incidence of influenza-related deaths in already compromised inpatients with other medical problems.

Already, the state of New York is hard at work in developing regulatory actions for its public healthcare workers. | LINK

The AARP today released a watchdog analysis (using Medicare claims data) depicting the general increase in the price of the most popular prescription medications relative to prevailing inflationary trends. And, surprise! The lobbying group notes an almost 10 percent increase in the price of branded preparations straight from the manufacturer for 2009. Apparently, all but 6 of the over 200 brands studied showed any increase over the rates of inflation for that period. Pharma is quick to dispute the group’s findings as they do not include more precise reporting of actual point of purchase data to the consumer, forgoing mentions of rebates and plan discounts. | PDF LINK of AARP’s report

The retooled GAMC health plan initiated due to the budget crisis in this state earlier this year appears to be at a crossroads of sorts — and it involves payments to the participating safety-net hospitals.

The discussions began because Hennepin County Medical Center (HCMC) in Minneapolis has had a smaller percentage of potential patients enroll than the other three participating hospitals and, as a result, is getting paid more than twice the amount per patient.

The capitated-type payments to the hospitals which have the resources to participate in the GAMC overhaul was introduced as a way to complement patient enrollment caps to each of those participating hospitals. However, it appears that there is a breakdown in access-to-care and cost-per-patient parity, with HCMC getting the lions’ share of patients outside of the scope of its available general assistance medical funds. | LINK

Medical loss ratios (MLRs), those metrics used by insurance companies to gauge medical costs as a percentage revenues from premiums, will be attracting some attention this week thanks to a provision in the recently passed reform bill that will allow a third party to be instrumental in determining how much insurers can ultimately spend on those admin costs — influencing profits in the process. That third party — the National Assn. of Insurance Commissioners (NAIC) — could have far-reaching authority in determining Insurance’s role in final implementation of the healthcare reform law come 2014.

HHS Sec’y Kathleen Sebelius could be at the mercy of the NAIC with respect to these new rules, creating disquietude among top Dems who favored reform with as little corporate influence as possible. Although the federal government has final say over where MLRs begin and end, states’ insurance commissioners actions will give lobbyists and insurers alike time to affect ultimate MLR regulations under reform law. Expect a mildly bumpy road at the hands of Insurance — which desires as little distance as possible between administrative quotas and earnings. | LINK

Illinois will offer this week the first-in-the-nation coverage plan for its uninsured since health reform was enacted. Currently, the state has almost 2 million uninsured by estimates. The plan to place them on coverage rolls will not reach them all — only a fraction, actually. Illinois’ Pre-existing Condition Insurance Plan can only enroll enough in its high risk pool because of federal funding limitations.^[1]

The creation of high-risk insurance pools under reform is one way over the next 4 years President Obama has said he will rein in coverage costs by mimicking enrollment/disenrollment policies of states; creating service areas of operation with HHS guidance; issuing creditable appeals processes for enrollees; preventing employers from creating disincentives for employee enrollment in those pools; and utilizing accountability rules to prevent fraud.

Illinois is the first state to test the waters in this transition to healthcare exchanges set to begin in 2014. | LINK

1. Funding comes from premiums and from the federal government, which is giving the state $196 million to run the plan until 2014 when healthcare exchanges will be required under the 2010 Affordable Care Act. [↩]

CMS has informed state Medicaid directors the terms of qualification for federal matching funds for administrative costs toward information technological infrastructures. Specifically, states must comply with the following stipulations: administration of Medicaid incentive payments to Medicaid eligible professionals and eligible hospitals; oversight of the Medicaid electronic health record (EHR) Incentive Program; and the pursuit of initiatives that encourage the adoption of certified EHR technology for the promotion of health care quality and the electronic exchange of health information.

Besides the latter bullet point above, the entrance of individual states into EHR IT initiatives carries with it a commitment to Medicaid funds in this era of reform. Some states are already on board, like California — whose governor couldn’t be more excited to get the ball rolling.

“What we are launching today is a new era for healthcare,” Schwarzenegger said. “Through a simple broadband link, this state-of-the-art system will save lives by instantly connecting people from across the state, including under-served and rural areas, with the best and brightest doctors. The California Telehealth Network marks the beginning of a new digital highway that will fundamentally change the future of how healthcare is provided.”

Others, like Minnesota, are leaving some state government agencies — and patients they serve — in a lurch.

Millions of dollars in health care funds seemingly destined for Minnesota after last week’s emergency session of Congress have yet to clear a final hurdle: the signature of Gov. Tim Pawlenty, an outspoken critic of the new federal spending.

UPDATE: In an unsurprising PR move, leading Dem candidate for Pawlenty’s job come November — former one-term U.S. Senator Mark Dayton — wants Pawlenty to just accept fed funds. | LINK

It has already happened in the Minneapolis/St. Paul metro. Now Duluth is in the midst of a nurses strike.

Nurses in Duluth voted overwhelmingly to reject a new labor contract, setting the stage for a 24-hour strike.

More than 90 percent of nurses who voted from St. Mary’s Medical Center and SMDC Medical Center, and more than 86 percent of those from St. Luke’s Hospital voted to reject the contract offer primarily because it did not include language that would allow them to close a unit to new admissions if they felt overwhelmed.

Again, the issue appears to be faulty staffing (nurse:patient) ratios. | LINK

I have always viewed as circumspect the interest of certain medical specialty societies which take stands that could be viewed by some as political. The need for these groups to make some sort of societal statement applied to medical corollary without the acknowledgement of the majority of its members implies ever so slightly of a kind of elitism better served by organizations more overtly deemed “political”.

Consider the statement by the APA on the recent effects of the oil spill on the incidence of mental illness diagnoses and subsequent insurance claims for treatment.

Mental illnesses brought on by difficult situations surrounding the BP oil spill may be less visible than other injuries, but they are real. An entire way of life has been destroyed, and this is causing anxiety, depression, [PTSD], substance use disorders, thoughts of suicide and other problems,” said APA President Carol A Bernstein, M.D.

The position –  the result of a response to BP’s chief claims administrator essentially denying payment equity with physical ailments payable with the government’s escrow relief funds — sounds more like a pitch to the feds and Big Insurance for more action guaranteeing accessible mental health care under reform. Since the biggest oil fiasco in this country’s history won’t be fading in importance anytime soon, the drive is on for greater awareness of the need for improved access to mental healthcare services.

While there is nothing wrong in actively lobbying the federal government for goals like this — the timing of this announcement, the association with a prominent DC-area mental health lobby, and the strong interest in this particular tragedy (as opposed to other numerous, less newsworthy ones) — should remind healthcare providers of the blurred line between political activism and healthcare advocacy.

Healthcare reform begets the need for laws to ensure the intent of reform. This has never been truer than on the eve of implementation of the major role individual states’ insurance commissions in keeping Insurance accountable. As coverage begins to expand to include demographics never before considered by insurers, many states have no mechanism to face enforcements of the central tenets of the reform law. Most outstanding, states will now have the ability to review insurance premium hikes, for example — the number one stealth maneuver of insurers of late to guarantee profitability.

If states are not able to carry out insurance compliance in accordance with with reform law, the feds step in to guarantee standards. Problem is, as intricate as the central aspects of reform are, the provisions in many states’ laws are just as myriad.

Some state regulators said they would ask state legislators to expand their authority by putting the federal standards into state law next year. Others said they would rely on their powers of persuasion, the good will of insurers or general state laws that ban unfair or deceptive trade practices.

Despite assurances to states by the federal government that, ultimately, such oversight is well within their scope, gaps in executive powers vary widely; these inconsistencies place yet another wrinkle on the rapid rollout of reform provisions the Obama administration hopes will result in a smooth transition between the parties that will continue to drive healthcare in this country (insurers) and the ultimate functional unit of healthcare commerce (the physician-patient partnership). | LINK

The initial impact of the new healthcare reform law won’t begin until late September/early October. But how much do Americans really know about the legislation’s benefits and changes? President Obama has embarked on some PR jaunts to remind the public of the virtues of reform, but is the White House’s awareness campaign really enough to get the word out that reform is actually imminent? Apparently not.

Many key parts of the new law, signed by President Obama in March, take effect in several stages beginning next month and continuing through 2015. Because it’s so complex, consumer advocates worry that people won’t take advantage of its benefits, so they have embarked on a nationwide education campaign. [..]

“People are still afraid that there are death panels . . . or that Medicare is going to go away,” says Cheryl Matheis of AARP, the nation’s largest seniors organization. “We have an obligation to get the information out there…”

It’s the new reality. Focus groups, polls, lobbies. To bad reform won’t cover the cost of these mechanisms of information dissemination. | LINK

Critics of President Obama’s rosy outlook on Medicare reform as part of the Affordable Care Act are pointing to the entitlement’s chief actuary as proof that his sudden realization of Medicare’s fiscal virtues under reform are peppered with politics. As recently as last weekend, Obama praised the almost half a trillion in savings over the next decade to the federal budget as not only the most fiscally responsible action the government has implemented as part of reform, but also as part and parcel of the overall commitment to the nation’s seniors with respect to the affordable access to healthcare.

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Two thousand ten just may go down as the year that Medicare is finally getting the recognition it deserves. Well, perhaps in a half-perverse way, anyway. The government entitlement program, which has just celebrated 45 years as the godfather of all payers in healthcare, continues to gain ink in an otherwise unrelated news cycle. President Obama appears to be taking credit for saving the program’s solvency singlehandedly, as his vision of healthcare reform would be far less vital without a provision to forming a leaner, meaner CMS.

In his weekly address to the American people, Obama reiterated his commitment to a program that is more “secure” than ever, a “commitment to America’s seniors” — never wavering from that core point. Obama will likely continue that same tenor as he campaigns for (some of the more vulnerable) Democrats in this year’s midterms, highlighting Medicare’s fiscal leanness with such tenacity, that to acknowledge that the country is still mired in a recession flirting with across-the-board double digit unemployment and ever-spiraling jobless claims is completely tangential.

At this stage, it is not clear how this gambit of Obama’s will play out in November, especially when wide swaths of the general population demographic — not just seniors — need the reassurance he continues to express on health reform as generalizable and essential to economic recovery in this country. All the while, the GOP will continue to hold up Obama’s enthusiasm for government’s role in Medicare as reason that 16% of this country’s GDP is one of the prime causes of the current economic disarray.

President Obama had yet to deal with sinking approval ratings; had yet to encounter such outrage over Arizona’s lukewarm SB1070 law; and had yet to consider how his actions over the previous 18 months of his presidency may impact midterms. Nope. This time last year, the most powerful 48 year-old in the world had to contend with the initial inklings of voter discontent with the looming vote on reform. Late summer 2009 — in the span of the healthcare debate/debacle — represented the germination of alternative voices to his heretofore mostly respected push for guaranteed access to heatlhcare.

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