Headlines: April 28, 2011
by Meg Larkin
A year after the passage of the Patient Protection and Affordable Care Act, the debate over health insurance in America is as strong as ever. A number of news stories today covered different aspects of the health insurance debate.
First, in Massachusetts, which passed its own health reform law in 2006, near universal insurance coverage has failed to produce a corresponding decline in ER visits. Supporters of the Massachusetts law had hoped that improvements in insurance coverage would decrease the number of patients going to the emergency room for non-urgent conditions. However, according to the Boston Globe, “Three-quarters of Massachusetts emergency room physicians who responded to a survey last month said the number of patients in their ERs climbed in the last year.” One reason that ERs continue to be overused may be the ongoing shortage of primary care physicians. Often doctors cannot schedule patient visits on short notice, which leads to patients ending up in the emergency room for issues that could ordinarily be dealt with by the family doctor.
In Florida, state legislators are looking to restructure the way that state pays for Medicaid. Medicaid now costs the State of Florida $21 billion a year, or about one third of the State budget. In an effort to cut costs, the State may adopt a new program that expands on a pilot project where the State pays HMOs to deliver care to patients. The New York Times reports that under the new program, “almost all of Florida’s Medicaid recipients would be funneled into state-authorized, for-profit H.M.O.’s or networks run by hospitals or doctors.” Florida’s proposal is different from other states that have adopted a managed care approach because the HMOs would be in a position to deny some benefits to patients, which would require federal approval. However, a study of the pilot program has raised concerns about the cost efficiency of the new program, and health care advocates across the state are worried that the for-profit HMOs will have incentives to deny services to those most in need of the safety net that Medicare traditionally provides. It remains to be seen whether the bill will pass Florida’s legislature later this week.
As an alternative to traditional health insurance, many Christians are turning to services offered by health ministries. The ministries are not insurance and are exempted from the regulations governing health insurance in many states. They allow ministry members to contribute a monthly amount and share one another’s medical expenses. Participation in a health ministry is also recognized as an exception to the individual insurance mandate contained in last year’s health reform law. The nationwide growth of health ministries has led some officials and regulators to raise concerns that participants may think that the ministries are providing insurance.. Lawsuits over unpaid medical bills by members have led some ministries to restrict their operations in some state markets. Another concern is that unscrupulous organizations may pose as Christian health ministries and swindle people out of their money. Consumers are advised to look at the fine print and make sure that an organization claiming to be a ministry actually qualifies for 501(c)(3) tax exempt status and the exemption in the Federal law.
In other government news, Genentech is fighting the use of one of its own drugs. A Federal study that is set to be released later today is expected to find that Avastin, made by Genentech, is a cheaper alternative for the treatment of macular degeneration than Lucentis, also made by Genentech. Avastin costs about $50 per treatment, while Lucentis costs about $2,000. The study is important to the Federal government because macular degeneration is common in elderly populations and so treatment is largely covered by Medicare. Genentech argues that Lucentis is better suited for injection into the eye, and that Avastin may have yet undiscovered adverse side effects when used for that purpose. Genentech is engaging in lobbying on capitol hill to ensure that Medicare continues to pay for Lucentis.
Finally, in research news, Armadillos have been found to transmit leprosy to humans. The New York Times reported that, “Using genetic sequencing machines, researchers were able to confirm that about a third of the leprosy cases that arise each year in the United States almost certainly result from contact with infected armadillos.” If identified early, Leprosy can be treated by antibiotics, but before the armadillo connection was known many cases were not diagnosed because patients had not traveled in parts of the world where leprosy is still common. Because leprosy was not present in the new world until the journey of Christopher Columbus, it is likely that armadillos first contracted the disease from humans several hundred years ago and then passed it back to humans. It has long been known that armadillos were susceptible to the disease, and they have been used to study leprosy in laboratory settings for years.
Meg Larkin is a third year law student at Boston University. Please feel free to email her with any questions, comments, suggestions or concerns.
