For the past six months insurance regulators in California have been working through negotiations with Anthem, a BC insurer whose initial premium rate hikes became a cause célèbre for healthcare consumers in that state and the Obama administration, alike. The previously proposed 39% increases created a firestorm in healthcare policy circles and provided Obama and HHS a temporary PR headache as a solution to lower premium increases was sought. The end result after scrutiny of state ledgers is a “smaller” increase —  of approx. 14 percent. | MP3 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. [↩]

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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A conservative health and public policy think tank reports on the consequences of a federally managed pharmaceutical approval and regulatory process and how that impacts patient access to timely and appropriate care — with respect to pharma availability. The Pacific Research Institute released its white paper detailing what it describes as the bureaucratic morass of “stymied pharmaceutical regulation” within the FDA’s drug approval process. A snippet:

During a 12-month period in 2008 and 2009, the European Union’s European Medicines Authority (EMA) and the Food and Drug Administration (FDA) approved a total of 39 new medicines. Fifteen were approved only by the FDA, 11 were approved only by the EMA, and 13 were approved by both regulators.

In five of the 13 cases where the FDA and EMA both approved the medicine, the EMA was the first to approve, and it issued those approvals 552 days faster than the FDA, on average. Even if we include all 13 medicines approved by the FDA and the EMA, the EMA approved those 97 days faster, on average.

The report goes on to describe the effects on impassive procedures of the FDA and its correlation to unnecessary medical tourism for similarly approved pharmacological treatments elsewhere. Although the report confirms what we all know about the costs of healthcare respect to governmental and regulatory mechanisms, perhaps this is another area in which Obama’s pick to head another regulatory agency addresses the need to apply quality and efficiency to the rather staid and arcane process of pharma approval.

As President Obama’s vision of healthcare reform begins to gel in the minds of physicians, health systems, insurers, and policymakers alike; the phased rollout of coverage mechanisms by Big Insurance will provide a timeline of sorts into the character of reform from a third-party perspective.

Via mandates, deadlines, and tax breaks; insurance coverage will be moving forward in the first half of the 2010s at a deliberate and measured pace — eventually covering some 30 M Americans without coverage and adequate access, as promised by Obama. One of the care delivery mechanisms is in the coordination of care of those with chronic diseases (such as diabetes, obstructive lung disease, and asthma) and the incentivization of primary care providers in those systems who choose to embrace such a plan.

Coordination of care reduces the fragmentation of delivery to those with chronic illness. Improving referral systems, rewarding primary care providers’ participation in innovative models such as the medical home, and emphasizing the importance of preventive care services in reimbursement schemes are important first steps to increasing access, decreasing acute care costs, and increasing quality in healthcare delivery. | LINK

HIV is once again in the news lately — first with news of a new strategy to combat the infection with enhanced vaccination research, the commitment of HHS in reallocating funds for HIV research on a global scale, and now the creation of the first “national HIV strategy” by a sitting president.

In the report, the administration calls for steps to reduce the annual number of new H.I.V. infections by 25 percent within five years. [..] [T]he administration will redirect money to areas with the greatest need and population groups at greatest risk, including gay and bisexual men and African-Americans.

Obviously, simple “redirection” of federal funds for medications and treatments of HIV/AIDS is not the final mechanism of care access for the millions of patients afflicted with this chronic disease; it is unclear where these funds will provide an absolute siphon for spending. Kudos to the administration in its efforts to reacquaint an entirely new generation of Americans on the urgency of this disease, but it’s got a long way to go to reduce sharply its transmission rates and healthcare policy atrophy in this area. | LINK

The fact that President Obama is naming Don Berwick, MD, CMS head via recess appointment shows his commitment to quality in healthcare delivery. It’s welcome news given that his drive for cost and access were the other cornerstones of recently passed reform legislation. Via the WH blog:

There’s no question that Don Berwick is the right choice to be our next CMS administrator: he’s the founder of the Institute for Healthcare Improvement and has spent decades as a practicing physician and a Harvard professor. He’s dedicated his career to finding ways to make our health care system work better for patients and cost less for taxpayers.

The choice of Berwick to fill this post is the perfect fit for an administration in search of the holy grail in healthcare delivery: quality. | LINK

Needy HIV+ patients a victim of the economic recession? With the rise once again in jobless claims in this country and the possibility of a much-maligned scenario of a double-dip recession, government programs that formed the cornerstone of HIV and AIDS treatment for patients who could not afford traditional access to those treatments are now closing — creating a fallout in states in which waiting lists are the result.

What’s more surprising than this development is the lack of safety funding for depleted federal and state programs; the Obama administration has yet to guarantee any sort of budgetary proposal or stimulus mechanism for saving these programs. In the state of Georgia, waiting lists for accessibility to HIV treatments is up to almost 1300 persons.^[1] In Florida, almost three-hundred.

An increasingly sad state of affairs in this early drive toward reform. This segment of the indigent care population could succumb to the same restrictions on eligibility those who are mentally ill perennially seem to face from many government-run programs. Will it take a redux of the same levels of prevalence rates of HIV not seen in 20 years to jar the Obama administration to attention on this issue? | LINK

1. Pregnant women, children and adolescents, and patients with “extreme conditions” can be exempt from the waiting list. [↩]

• It’s on. The mega union only needed 66%. They got over 80% ‘yea’. [LINK]
• At ninety days into the new reform law, Obama makes public safeguards inherent within. [LINK]
• FDA approves new diagnostic test that more rapidly detects antibodies and antigens. Excellent. [LINK]
• More controversy than there needs to be? The president’s pick to be new CMS chief engenders strong feelings on both sides [LINK]

Hospital executives who have worked with Dr. Berwick describe him as a visionary, inspiring leader. [..] Republicans are using the nomination to revive their arguments against the new health care law, which they see as a potent issue in this fall’s elections, and Dr. Berwick has given them plenty of ammunition. In two decades as a professor of health policy and as a prolific writer, he has spoken of the need to ration health care and cap spending and has confessed to a love affair with the British health care system.

3/23/2010: That was the date that was supposed to change everything — the date the reform bill was signed into law by President Obama. Although the WH focus tonight was squarely on the tragedy that continues to unfold in the Gulf, the potential for healthcare and its role as a policy game-changer in the November midterms continues to loom as an unexpected burden for Obama.

Gone is the self-serving satisfaction he and the WH can revel in until beneficial changes for healthcare consumers begin to trickle in over the next year or so. The trepidation Americans feel over the true impact of the new reform legislation is just another concern amidst a strong recession and weak job recovery. Not only are consumers (employees) feeling the pressure to understand reform and its meaning for them, employers — particularly small employers — are wondering if their responsibilities in financing coverage will become more ponderous than Obama has promised.

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