US House passes amended mental health bill

Jenkins among lawmakers who opposed provisions that worried disability advocates

by Andy Marso, KHI News Service

The US House of Representatives passed a sweeping mental health reform bill Wednesday after portions that worried Kansas disability rights advocates had been removed.

House Resolution 2646 passed 422-2 without substantial changes to the authority of Protection and Advocacy for Individuals with Mental Illness, or PAIMI, program.

The bill as originally introduced by US Rep. Tim Murphy, a Republican from Pennsylvania who is a psychologist, included language that sought to curtail activities of the disability rights centers that administer the PAIMI program.

Those provisions were dropped when the bill was extensively amended in committee.

"Those are now out of the bill," said Rocky Nichols, executive director of the Kansas Disability Rights Center.

US Rep. Lynn Jenkins, a Republican who represents most of eastern Kansas except for the Kansas City area, was among those who opposed the PAIMI provisions.

In a news briefing before Wednesday's vote, she said the amended bill provided a more effective path for treating mental illness, which she called "a national problem."

"There are few families in America that have escaped the challenge of depression or addiction or other forms of mental illness," Jenkins said, adding that she had visited Valeo Behavioral Health Care in Topeka just a week earlier. "This legislation will drive innovation and fight the ongoing crisis regarding the shortage of mental health beds in rural populations and provide the much-needed resources to those who don't have access to the care they need."

Among other items, the bill as passed creates an Assistant Secretary for Mental Health and Substance Use Disorders within the presidential Cabinet, provides liability protections for mental health care volunteers and requires Medicare's Part D prescription drug program to cover antidepressants and antipsychotics.

House Speaker Paul Ryan connected the mental health legislation to other efforts to prevent mass shootings and praised Murphy for his persistence in pursuing it.

"He has spent years working on mental health reform," Ryan said.

The bill has not been heard in the US Senate, which has its own mental health legislation, Senate Bill 2680.

That bill cleared committee in April but has not been taken up by the full Senate.

The House also passed a bill Wednesday authored by Jenkins that would repeal a portion of the federal Affordable Care Act related to health savings accounts and flexible spending accounts.

House Resolution 1270 would allow consumers to use the tax-deferred accounts to purchase over-the-counter medications -- a practice restricted by the ACA, which is commonly known as "Obamacare."

"This regulation makes no sense, requiring individuals to see their doctor simply to get a prescription for common cold medication," Jenkins said of the ACA restriction.

The bill garnered the support of 10 Democrats as it passed 233-164. It has not had a Senate hearing.

Both houses of Congress plan to adjourn this month for a long summer break.

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.

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Board of Ed has not negotiated fairly

To the Editor:

I take issue with Jim Feehan's statement, "[e]veryone deserves an increase, who's doing their job properly," Feehan said. "These are non-union employees who have a lot less benefits than the union employees and they're deserving of an increase just like anyone else."

He is incorrect or it’s an outright lie. My husband has been a union employee of the Board of Education for 31 years - a custodian. He went without a contract and without a raise because these "professionals" would not negotiate fairly. Their benefits are not over and above - they get paid sick time, vacation, health care coverage.

Most of the time their annual increase is less than a cost of living adjustment and doesn’t even cover what the increase for health care premiums are. They are paid pennies compared the administration. Sure, some pensions, but they’ve paid into it for years. They also must put more into their health savings accounts, while non-union puts less. Many maxed out on step increases, so they only get whatever their contract states for an annual raise. Many years, it was 1% or 1.5%, while administration got more, including annuities or stipends.

Don't be fooled. The collective bargaining agreements for all Board of Ed union employees are on the Board of Ed website - read them for yourselves. If they call the clothing allowance or longevity extra benefits over and above what non-union receive - let's see what the stipends for those non-union employees amount to. Feehan should post those.  I’d like to know what benefits Feehan is talking about.

I also take issue with Feehan’s comment that Center School only had 37 students. That was true for this past school year only because John Harkins’ attempted takeover by force last August 2015 when he gave the BOE two weeks to evacuate the building. Before that, the building housed several programs and had over 100 or more students in it. His statement is a way to make keeping the building senseless. It only became that way because of John Harkins and his crack Economic Development department.

Patricia C. Sperling

Even 'good' insurance comes with hidden hospital bills

The claims were processed by three major health insurers that cover patients in all 50 states: Aetna, UnitedHealthcare and Humana.

The team examined expenses accrued by hospitalized adults ages 18 to 64. The study also looked specifically at bills for seven common reasons for hospitalization: heart attack, childbirth, pneumonia, appendicitis, heart bypass surgery, total knee replacement and spinal fusion.

The result: Out-of-pocket costs averaged $1,013 in 2013, up from $738 at the start of the study.

Patients with individual market plans fared the worst. The study found they were stuck with an average bill of $1,875 per hospitalization by 2013, followed by roughly $1,200 for those with consumer-directed health plans. These plans generally allow more consumer decision-making, often with health savings accounts alongside high deductibles.

In particular, average deductibles what consumers pay before insurance kicks in nearly doubled, jumping from $145 to $270.

And co-insurance ballooned 33 percent, from an average of $518 to $688.

Although the study was conducted before Obamacare, the team pointed to recent Kaiser Family Foundation figures that suggest the upward trend is continuing unabated. Today, Kaiser says 81 percent of patients with employer-based insurance will face an annual deductible approaching $1,300.

These results are very similar to an analysis we put out a couple months ago, said Kaiser senior vice president Larry Levitt.

Out-of-pocket health costs are increasing rapidly for people with health insurance at the same time that wages have been stagnant, he said. This can be a particular challenge for low-wage workers, who often dont have enough savings to cover a financial emergency like a major illness.

The results illustrate the changing nature of health insurance, with the bottom-line being less generous coverage, Levitt added.

The best response, said Kevin Lucia, a senior research professor at Georgetown University in Washington, DC, is to arm consumers with information.

Health insurance works for many until you actually have to use it, Lucia said. And thats because theres a very low level of health literacy among consumers, both among those who have a history of having insurance and all the new people Obamacare is bringing in.

Insurance is a very complicated instrument, Lucia added. But its very important that we provide the resources to help consumers get involved and better understand the policies theyre buying and their financial risk, so there are fewer surprises, he said.

The findings were published online June 27 in the journal JAMA Internal Medicine.

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Healthcare affordability remains an issue despite ACA

Affordability of coverage remains a persistent problem for some individuals and families, even as people gain health insurance coverage as a result of the Affordable Care Act (ACA), according to a Kaiser Family Foundation (KFF) issue brief.

Marketplace enrollees who reported difficulty affording their premium in 2014 were similar to other marketplace enrollees in some ways, but they faced greater financial insecurity generally and also as a result of their use of healthcare services, according to the KFF brief.

The brief also focuses on the trouble many Americans enrolled in the insurance exchanges are having with affording their premiums and out-of-pocket costsacirc;even with the availability of subsidies. High-deductible plans that require people to pay out of pocket when they visit a doctor, have an X-ray or lab test, or need a prescription drug seemed to be a particular problem for these individuals.

Compounding this problem was the lack of understanding of what was covered by their health plan and what cost-sharing rules applied, which could lead to unexpected costs.

White

acirc;The study is further confirmation that Americans are having problems affording coverage, largely because health costs are too high and growing too fast,acirc; according to Joel White, president, Council for Affordable Health Coverage. acirc;Growing concerns with affordability raise into question the long-term viability and success of the insurance exchanges.acirc; acirc;uml;acirc;uml;

The KFF brief focuses on the characteristics of consumers during the first year of ACA implementation (2014). acirc;uml;

acirc;cent; One-third of those with marketplace insurance coverage reported difficulty paying their premium.

acirc;cent; Six out of 10 adults who had trouble paying their premiums had incomes below 250% of the FPL and 3/10 were under aged 35 years. acirc;uml;

acirc;cent; Nearly half of those who had trouble paying their premiums had dependent children. acirc;uml;

acirc;cent; Those who had problems paying for their coverage also were::.

acirc;cent; More likely to postpone care than those who do not have trouble affording acirc;uml;coverage. acirc;uml;

acirc;cent; More likely to report not understanding aspects of their health coverage.

acirc;cent; More likely to report problems with their coverage. acirc;uml;

acirc;While this study focused primarily on the exchange market, the overall tide of rising health costs affects all consumers and stakeholders and their ability to buy plans on or off exchanges,acirc; White says. acirc;uml;

In fact, in similar news, the 2016 Milliman Medical Index showed that the cost of care for the typical American family of four has more than tripled since its value of $8,414 in 2001 to an average of $25,826 in 2015.

Managed care can help

Whatacirc;s the solution? Managed care can help, according to White.

acirc;Managed care executives who are skilled at bringing strategies to bear on the cost problem will be in high demand in the coming years as Congress seeks to address head on the affordability challenge,acirc; White says. acirc;uml;

Managed care executives should be marketing health savings accounts (HSAs) to help cover the cost-sharing requirements.

acirc;I would be lobbying Congress to expand HSAs in the exchange and non-exchange markets,acirc; he says. acirc;These plans will increase in popularity as cost sharing increases, but the plans are also becoming more difficult to offer due to regulatory changes. Fighting those rules, such as the restrictions included in the 2017 Notice of Benefit and Payment Parameters, should be a high priority.acirc;

Next: Five key policy solutions

White also suggests five key policy solutions including:

acirc;cent; Better choices for workers. acirc;Unlike in pension world, employers face strong headwinds in providing defined contributions to their workers,acirc; White says. acirc;Creating more flexibility to provide a defined contribution health plan would define and limit risk for employers and expand choices for workers.acirc;

acirc;cent; Plan flexibility. Greater flexibility for plans and freedom from government mandates would allow insurers to offer products demanded by consumers, rather than those dictated by bureaucrats or lawmakers, according to White.

acirc;cent; Transparency. Improving access to accurate and actionable comparative information on health plan and provider choices will help consumers to make more informed decisions that lower health costs.

acirc;cent; Medication adherence. Policies that improve medication adherence can help patients improve outcomes while lowering systemic costs by avoiding unnecessary, expensive hospitalizations and emergency room visits, White says.

acirc;cent; Incentives for wellness. acirc;Right now, employers can offer workers discounts on premiums if they engage in healthy behaviors,acirc; White says. acirc;It is illegal to offer the same discounts to people in the individual market, despite the known benefits of staying well.acirc;

acirc;These five changes could save up to $500 billion annually or almost 20% of health costs every year,acirc; White says.

The KFF brief also suggests that informing lower-income consumers about the availability of cost-sharing reduction plans that have lower deductibles and copayments can reduce the out-of-pocket burden many of these consumers face.

acirc;Marketplace assisters play an essential role in educating consumers and helping them select the plans that best meet their needs, but broader efforts to improve health literacy appear to be needed,acirc; according to the report.



Paul Ryan Wants to Increase the Medicare Eligibility Age to 67

Republicans announce a lot of health care plans. All of them are essentially the same, a familiar hodgepodge of tax credits, health savings accounts, high-risk pools, block granting of Medicaid, tort reform, and interstate purchase of health plans. Today, after months of cogitating, House Republicans have finally agreed on yet another health care plan. Its not a hodgepodge, however, its a backpack. Beyond that, however, it should sound pretty familiar:

In place of President Barack Obamas health law, House Republicans propose providing Americans with refundable tax credits.... catastrophic insurance.... health-savings accounts.... plans offered in other states.... fee-for-service insurance through a newly created Medicare insurance exchange [not a voucher! not a voucher! absolutely positively not a voucher! ed.].... pay taxes on the value of whatever health insurance employers provide.

Hmmm. Theres no mention of high-risk pools or tort reform or Medicaid block grants. What the hell is going on here? Who was responsible foroh, wait. Maybe the Wall Street Journal just did a lousy job of describing the GOP plan. I can hardly blame them for not taking it too seriously. Lets check in with the Washington Post:

The GOP plan floats a variety of proposals.... refundable tax credit.... health savings accounts.... high-risk pools.... Medicaid funds would be handed to the states either as block grants or as per-capita allotments.

Now were talking. Every single buzzword is there except for tort reform. But maybe I should check in with Reuters:

The Republican proposal would gradually increase the Medicare eligibility age, which currently is 65, to match that of the Social Security pension plan, which is 67 for people born in 1960 or later....The Republican plan includes medical liability reform that would put a cap on non-economic damages awarded in lawsuits, a measure aimed at cutting overall healthcare costs.

Tort reform is there after all! And as an extra added bonus, the Medicare eligibility age goes up to 67. Hallelujah!

How could this possibly have taken more than five minutes to write? Its identical to every health care plan ever proposed by Republicans. There is, of course, no funding mechanism, possibly because Republicans know perfectly well that it will do nothing and therefore require no funding. But heres my favorite bit of well-hidden snark from the Washington Post account:

The most significant omission from the Republican health-care plan, though, is to what degree it will maintain or, more likely, reduce insurance coverage for Americans....Asked about the plans effect on coverage, a Republican leadership aide said Monday, Youre getting to the dynamic effect of the plan and we cant answer that until the committees start to legislate.

But there is a significant clue in the GOP plan that it anticipates a surge in the ranks of the uninsured. Before the Affordable Care Act, the federal governments primary mechanism for compensating health providers for delivering care to the uninsured was through disproportionate share hospital payments, or DSH, which are allocated to facilities that treated large numbers of the uninsured. Under Obamacare, DSH payments were set to be phased out because coverage rates were expected to increase dramatically.... The Republican plan would repeal those cuts entirely.

Bottom line: this is just the usual conservative mush. It would accomplish nothing. It would insure no one. It would wipe out all the gains of Obamacare. Millions of people would have their current health care ripped away from them, all so that Republicans can repeal the 3.8 percent tax on high-earner investment income that funds Obamacare.

And just for good measure, it will also raise the Medicare eligibility age to 67. Because apparently, the old hodgepodge just wasnt quite Scrooge-like enough.