Sunday, November 11, 2012
Friday, November 9, 2012
With Obama Re-Elected, States Scramble Over Health Law
By ABBY GOODNOUGH and ROBERT PEAR
After nearly three years of legal and political threats that kept President Obama’s health care law in a constant state of uncertainty, his re-election on Tuesday all but guarantees that the historic legislation will survive.
Now comes another big hurdle: making it work.
The election came just 10 days before a critical deadline for states in carrying out the law, and many that were waiting for the outcome must now hustle to comply. Such efforts will coincide with epic negotiations between Mr. Obama and Congress over federal spending and taxes, where the administration will inevitably face pressure to scale back some of the costliest provisions of the law.
Mr. Obama faces crucial choices about strategy that could determine the success of the health care overhaul: Will the administration, for example, try to address the concerns of insurers, employers and some consumer groups who worry that the law’s requirements could increase premiums? Or will it insist on the stringent standards favored by liberal policy advocates inside and outside the government?
But for now — with Democrats retaining control of the Senate and Mitt Romney’s vow to “repeal and replace” the law no longer a threat — supporters are exulting.
“For our district and for our country, the debate on Obamacare is over,” declared Bill Foster, a Democrat elected Tuesday to the House from a suburban Chicago district.
Many supporters feel one of Mr. Obama’s most important tasks will be to step up efforts to promote and explain the law to a public that remains sharply divided and confused about it. In exit polls on Tuesday, nearly half of voters said the law should be either partly or fully repealed.
“There is still a tremendous amount of disinformation out there,” said Jeff Goldsmith, a health industry analyst based in Virginia. “If you actually are going to implement this law, people need to know what’s in it — not just the puppies-and-ice-cream parts, but ‘Here are the broader social changes intended and how they can help you.’ ”
Sanofi Halves Price of Cancer Drug Zaltrap After Sloan-Kettering Rejection
In an unusual move, a big drug company said on Thursday that it would effectively cut in half the price of a new cancer drug after a leading cancer center said it would not use the drug because it was too expensive.
The move — announced by Sanofi for the colon cancer drug Zaltrap — could be a sign of resistance to the unfettered increase in the prices of cancer drugs, some of which cost more than $100,000 a year and increase survival by a few months at best.
Zaltrap came to market in August at a price of about $11,000 a month. Soon after, Memorial Sloan-Kettering Cancer Center in New York decided not to use the drug, saying it was twice as expensive but no more effective than a similar medicine, Avastin from Genentech. Both drugs improved median survival by 1.4 months, doctors there said.
Three doctors at Sloan-Kettering publicized the cancer center’s decision last month in an Op-Ed article in The New York Times.
“Ignoring the cost of care is no longer tenable,” they wrote. ”Soaring spending has presented the medical community with a new obligation. When choosing treatments for patients, we have to consider the financial strains they may cause alongside the benefits they may deliver.”
Sanofi executives argued that the price they had set was very similar to that of Avastin. “The intent was not to charge a premium,” Christopher A. Viehbacher, the chief executive of Sanofi, said in an interview last month.
Sloan-Kettering, he said, was basing its price comparison on a dose of Avastin that was half the dose Sanofi used in its own comparison.
On Thursday, Sanofi backed down. “We believe that Zaltrap is priced competitively as used in real-world situations,” it said in a statement. “However, we recognize that there was some market resistance to the perceived relative price of Zaltrap in the U.S. — especially in light of low awareness of Zaltrap in the U.S. market. As such, we are taking immediate action across the U.S. oncology community to reduce the net cost of Zaltrap.”
Attacking Ailments With Small Doses
DISAPPOINTED voters, runners with blisters and headache sufferers alike are getting some unexpected relief from a pop-up pharmacy that opened this week in the nation’s capital.
The “help shop,” which offers low-dose drugs for everyday woes, is the idea of Help Remedies, a start-up company that sells minimalist white packets directed at single medical issues like nausea, headache or insomnia.
The company, the collaboration of two marketers, is creating quirky scenes including a high-heel wearing model walking on a treadmill to market its “Help, I have a blister” packet of bandages, or a performer sleeping in a store window to drum up interest for its “Help, I can’t sleep” caplets.
This week, shoppers and passers-by attracted by the napper, for example, could go inside the temporary pharmacy to investigate its 10 over-the-counter remedies for conditions like body aches and allergies.
The store’s team fanned out to polling stations on Tuesday to hand out its headache packets, and then on Wednesday to the nearby Republican National Committee to share nausea relief. Their marketing may be seen as fun and zany, but the company founders, Richard Fine and Nathan Frank, say they have a serious message.
“We want people to see that there are simple solutions,” said Mr. Fine, who said his straightforward approach was influenced by his parents, who are medical professors specializing in epidemiology.
“Most people shop by brand or product, and it’s difficult to know what you should be buying and taking,” he said. “It is a confusing space for people who are not experts.”
Mr. Fine and Mr. Frank, who met while working in branding and advertising, decided to try to streamline what they see as an antiquated and cluttered pharmaceutical market.
“We wanted to take what’s basic and works, and make it human,” Mr. Fine said. Their strategy of providing single ingredients in low dosages is aimed at basic medical conditions that do not require hospitalization.
Thursday, November 8, 2012
Facing brain surgery, a health economist finds the health-care market hard to navigate
By Dahlia K. Remler, Published: November 5“You should never have an HMO,” the neurosurgeon’s secretary told me on the phone, her voice filled with scorn. “You don’t have any out-of-network benefits. Dr. Bruce participates with no insurance plans. Only out-of-network benefits can be used.”
I felt sick — not because of the recently discovered benign tumor in my pituitary gland or the resulting excess cortisol in my body or the delicate neurosurgery required. Rather, I felt sick with embarrassment and a sense of professional failure.
I am a health economist, a professor with a PhD from Harvard. I’m supposed to be an expert on health insurance and its complexities. How did I end up in such a bind?
I tried to recover my dignity and act like an expert: “How much does it cost if you pay out of pocket? $20,000?”
“For the surgeon. . . . But you have to pay for the hospital, too, even if the hospital is in-network. When you use an out-of-network surgeon, the whole thing counts as out-of-network,” she said.
How could I have forgotten that? I hung up with the depressing impression that having Bruce as my surgeon would cost me around $60,000 out of pocket.
Anthem clerical error adds anxiety to woman's breast cancer fight
After Ann Walton-Teter has a double mastectomy, she learns her coverage has been canceled. Anthem Blue Cross admits mistake but timing couldn't have been worse.
November 6, 2012
Ann Walton-Teter was diagnosed with breast cancer in September. About a month later, she was informed by her health insurer, Anthem Blue Cross, that her coverage had been canceled because of a missed payment.
Anthem would eventually admit that it was mistaken. But Walton-Teter, 43, had to battle the insurance giant to have her coverage restored just as she was recovering from a double mastectomy and preparing for chemotherapy.
In other words, the Santa Monica resident had to go up against a corporate bureaucracy while she was at her weakest and most vulnerable — a situation that plays out time after time nationwide as insurers challenge patients' claims or doctors' prescriptions in the midst of medical crises.
To all those who believe the U.S. healthcare system is second to none, Walton-Teter's case serves as a stark reminder that things can go horrendously wrong even if the patient does everything right.
"It's like they were bullying me to go away," Walton-Teter told me. "You buy insurance in case anything comes up. But when it does, this is how they treat you."
WASHINGTON — President Obama’s victory all but assures that his landmark healthcare law and its guarantee of insurance coverage for all Americans will be implemented, essentially putting an end to the Republican campaign to derail the law.
Starting in 2014, millions of Americans should be able to get health insurance for the first time. Millions more who don’t get coverage through work should be able to buy a health plan that meets new basic standards.
“It’s all over but the shouting,” said Families USA Executive Director Ron Pollack, an influential consumer advocate and leading champion of the law. “What was very questionable at the start of the year has been settled. … The Affordable Care Act will be a permanent fixture of the American healthcare system.”
California speeds revamp of health insurance market
With Obama victory, state officials move ahead with implementing healthcare changes under the Affordable Care Act and expand insurance coverage.
By Chad Terhune, Los Angeles Times
5:51 PM PST, November 7, 2012
With President Obama's reelection lifting a potential roadblock, California officials are rushing to implement the federal healthcare law and revamp the insurance market for millions of Californians starting next fall.
Republican challenger Mitt Romney had vowed to overturn the Affordable Care Act, casting uncertainty over efforts in California to use billions of federal dollars to extend coverage to many of the state's 7 million uninsured.
Wednesday, California officials disclosed plans to spend nearly $90 million next year on marketing and outreach to millions of consumers who may become eligible for premium subsidies and other assistance under the federal law starting in 2014."The election removes what was really the last distraction from focusing on the job, which is to get millions of Californians enrolled in health coverage," said Peter Lee, executive director of the California Health Benefit Exchange, which was renamed Covered California last week.
Health Net posts plunge in profit, strikes deal with California
Investors cheer the deal, which ends the insurer's litigation over reimbursement, extends Medi-Cal contracts and promises extra payments if new programs lead to unexpectedly big losses.
By Chad Terhune, Los Angeles Times
November 6, 2012
Woodland Hills insurer Health Net Inc. said third-quarter net income plunged 71%, but its shares rose as the company resolved a dispute with California officials over reimbursement for government health programs.
Health Net disappointed investors in August when it slashed its full-year profit outlook and reported higher-than-expected medical costs. On Monday, Chief Executive Jay Gellert said the company was making progress on its turnaround plans. He cited a wide-ranging agreement with California healthcare officials as a major step forward.
Investors cheered the news, bidding up Health Net shares by $3.03, or 13%, to $25.71.
The deal with the California Department of Health Care Services ended company litigation over government reimbursement. As part of the agreement, Health Net said, the state will extend four existing Medi-Cal contracts by five years and provide additional payments if the company incurs larger-than-expected losses as new government programs get underway next year.