Tag Archives: hospitals

Oklahoma Supreme Court throws out anti-abortion law

The Oklahoma Supreme Court this week threw out a law requiring abortion clinics to have doctors with admitting privileges at nearby hospitals, saying efforts to portray the measure as protecting women’s health are a “guise.”

The law would require a doctor with admitting privileges at a hospital within 30 miles be present for any abortion. The court found it violates both the U.S. and Oklahoma Constitutions. The U.S. Supreme Court earlier this year struck down a similar provision in Texas.

“Under the guise of the protection of women’s health,” Oklahoma Justice Joseph Watt wrote, “(the law) creates an undue burden on a woman’s access to abortion, violating protected rights under our federal Constitution,” referring specifically to the Texas case.

Republican Gov. Mary Fallin signed the measure, Senate Bill 1848, into law in 2014, but courts had blocked it from taking effect. This week’s ruling overturns a lower court’s decision in February that upheld the law.

The New York-based Center for Reproductive Rights challenged the law on behalf of Dr. Larry Burns, a Norman physician who, at the time the lawsuit was filed in October 2014, performed nearly half of Oklahoma’s abortions.

Burns has said he applied for admitting privileges at hospitals in the Oklahoma City area but was turned down.

Also, at the time, the only other clinic in the state that performed abortions was in Tulsa. However the Trust Women South Wind Women’s Center opened in south Oklahoma City in September and Planned Parenthood opened in the northwest Oklahoma City suburb of Warr Acres in November.

“Today’s decision is a victory for Oklahoma women and another rebuke to politicians pushing underhanded laws that attack a woman’s constitutionally guaranteed right to safe, legal abortion,” Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement.

Oklahoma Attorney General Scott Pruitt did not immediately respond to a request for comment, but previously has said that bill was passed to protect the health and safety of Oklahoma women.

The court also found that the law violates the Oklahoma Constitution’s ban on measures containing more than one subject, a practice known as logrolling. The law included “12 separate and unrelated subsections,” the court said.

“The sections in SB 1848 are so unrelated and misleading that a legislator voting on this matter could have been left with an unpalatable all-or-nothing choice,” according to the ruling.

The court’s ruling came the same day that the Oklahoma Board of Health approved new requirements for hospitals, nursing homes, restaurants and public schools to post signs inside public restrooms directing pregnant women where to receive services as part of an effort to reduce abortions in the state.

The provision mandating the signs was tucked into a measure the Legislature passed this year that requires the state to develop informational material “for the purpose of achieving an abortion-free society.”

Businesses and other organizations estimate they will have to pay $2.3 million to put up the signs because the Legislature approved no funding for them.

The Legislature and the governor must ratify the board’s rules for the signs before they are scheduled to go into effect on Jan. 1, 2018, board attorney Donald Maisch said.

In Ohio, Republican Gov. John Kasich this week signed a 20-week abortion ban while vetoing stricter provisions in a separate measure that would have barred the procedure at the first detectable fetal heartbeat. The so-called heartbeat bill would have prohibited most abortions as early as six weeks into pregnancy.

In Florida, the American Civil Liberties Union filed a lawsuit asking a federal judge to block additional parts of a contentious Florida abortion law. The lawsuit contends that the law violates constitutional rights by requiring groups to register with the state and pay a fee if they advise or help women seek abortions. The lawsuit also challenges a provision requiring groups to tell women about alternatives to abortion.

Doctors, hospitals say ‘show me the money’ before treating patients

Tai Boxley needs a hysterectomy. The 34-year-old single mother has uterine prolapse, a condition that occurs when the muscles and ligaments supporting the uterus weaken, causing severe pain, bleeding and urine leakage.

Boxley and her 13-year-old son have health insurance through her job as an administrative assistant in Tulsa, Oklahoma. But the plan has a deductible of $5,000 apiece, and Boxley’s doctor said he won’t do the surgery until she prepays her share of the cost. His office estimates that will be as much as $2,500. Boxley is worried that the hospital may demand its cut as well before the surgery can be performed.

“I’m so angry,” Boxley said. “If I need medical care I should be able to get it without having to afford it up front.”

At many doctors’ offices and hospitals, a routine part of doing business these days is estimating patients’ out-of-pocket payments and trying to collect it up front.

Eyeing retailers’ practice of keeping credit card information on file, “there’s certainly been a movement by health care providers to store some of this information and be able to access it with patients’ permission,” said Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Massachusetts, who works with hospitals on addressing financial barriers to care.

But there’s a big difference between handing over a credit card to cover a $20 copayment versus suddenly being confronted with a $2,000 charge to cover a deductible, an amount that might take months to pay off or exceed a patient’s credit limit. Doctors may refuse to dispense needed care before the payment is made, even as patient health hangs in the balance.

The strategy leaves patients financially vulnerable. Once a charge is on a patient’s credit card, they may have trouble contesting a medical bill. Likewise, a service placed on a credit card represents a consumer’s commitment that the charge was justified, so nonpayment is more likely to harm a credit score.

Approximately three-quarters of health care and hospital systems ask for payment at the time services are provided, a practice known as “point-of-service collections,” estimated Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an industry group. He could not say how many were doing so for higher priced services or for patients with high-deductible plans, situations that would likely result in out-of-pocket outlays of hundreds or thousands of dollars.

“For providers, there’s more risk with these higher deductibles, because the chance of being able to collect it later diminishes,” Gundling said.

But the practice leaves many patients resentful.

After arriving by ambulance at the emergency department, Susan Bradshaw lay on a gurney in her hospital gown with a surgical bonnet on her head, waiting to be wheeled into surgery to remove her appendix at a hospital near her home in Maitland, Fla. A woman in street clothes approached her. Identifying herself as the surgeon’s office manager she demanded that Bradshaw make her $1,400 insurance payment before the surgery could proceed.

“I said, ‘You have got to be kidding. I don’t even have a comb,’” Bradshaw, a 68-year-old exhibit designer, told the woman on that night eight years ago. “I don’t have a credit card on me.”

The woman crossed her arms and Bradshaw remembers her saying, “You have to figure it out.”

As providers aim to maximize their collections, many contract with companies that help doctors and hospitals secure payments up front, often providing scripts that prompt staff to talk with patients about their payment obligations and discuss payment scenarios as well as software that can estimate what a patient will owe.

But as hospitals and doctors push for point-of-service payments to reduce bad debt from patients with increasingly high deductibles, the risk is that patients will delay care and end up in the emergency room, Rukavina said. “Patients are essentially paying for their procedures up front,” he said. “It may not be a significant amount compared to their salary, but they don’t necessarily have it available at the time of service.”

The higher their deductible, the less likely patients are to pay what they owe, according to an analysis of 400,000 claims by the Advisory Board, a health care research and consulting firm. While more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36 percent of those with deductibles of more than $5,000 did so, the analysis found.

Fifty-one percent of workers with insurance through their employer had a deductible of at least $1,000 for single coverage this year, according to the Kaiser Family Foundation’s annual survey of employer health insurance. (KHN is an editorially independent program of the foundation.)

Boxley pays $110 a month for her family plan. She could not afford the premiums on plans with lower deductibles that her employer offered. She plans to talk with the doctor and hospital about setting up a payment plan so she can get the surgery in January.

“I’ll make payments,” Boxley said, although she acknowledged what she could pay monthly would be small. If that doesn’t pan out, she figures she’ll have to use student loan money she got for graduate school to cover what she owes.

Still, experts say that trying to pin patients down for payment in more acute settings, such as the emergency department, may cross a line.

Under the federal Emergency Medical Treatment and Labor Act (EMTALA), a patient who has a health emergency has to be stabilized and treated before any hospital personnel can discuss payment with them. If it’s not an emergency, however, those discussions can occur before treatment, said Dr. Vidor Friedman, an emergency physician who is the secretary-treasurer of American College of Emergency Physicians’ board of directors.

Bradshaw finally got her appendix removed by calling a friend, who read his MasterCard number over the phone. The surgery was uneventful and Bradshaw was home within 24 hours.

“It’s a very murky, unclear situation,” Friedman said of Bradshaw’s experience, noting that a case might be made that her condition wasn’t life threatening. “At the very least it’s poor form, and goes against the intent if not the actual wording of EMTALA.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Published courtesy of Kaiser Health News.

Frustration runs deep for those forced to routinely change health plans

Andrea Schankman’s three-year relationship with her insurer, Coventry Health Care of Missouri, has been contentious, with disputes over what treatments it would pay for. Nonetheless, like other Missourians, Schankman was unnerved to receive a notice from Coventry last month informing her that her policy was not being offered in 2017.

With her specialists spread across different health systems in St. Louis, Schankman, a 64-year-old art consultant and interior designer, said she fears she may not be able to keep them all, given the shrinking offerings on Missouri’s health insurance marketplace. In addition to Aetna, which owns Coventry, paring back its policies, UnitedHealthcare is abandoning the market. The doctor and hospital networks for the remaining insurers will not be revealed until the enrollment period for people buying individual insurance begins Nov. 1.

“We’re all sitting waiting to see what they’re going to offer,” said Schankman, who lives in the village of Westwood. “A lot of [insurance] companies are just gone. It’s such a rush-rush-rush no one can possibly know they’re getting the right policy for themselves.”

Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. The instability, which preceded the health law, is intensifying in the fourth year of the Affordable Care Act’s marketplaces for people buying insurance directly instead of through an employer.

“In 2017, just because of all the carrier exits, there are going to be more people making involuntary changes,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, a New Jersey philanthropy. “I would imagine all things being equal, more people are going to be disappointed this year versus last year.”

Forty-three percent of returning consumers to the federal government’s online exchange, healthcare.gov, switched policies last year. Some were forced to when insurers stopped offering their plans while others sought out cheaper policies. In doing so, consumers saved an average of $42 a month on premiums, according to the government’s analysis. But avoiding higher premiums has cost many patients their choice of doctors.

Jim Berry, who runs an internet directory of accountants with his wife, switched last year from Blue Cross Blue Shield of Georgia to Humana after Blue Cross proposed a 16 percent premium hike.

Despite paying Humana $1,141 in premiums for the couple, Berry, who lives in Marietta, a suburb of Atlanta, said they were unable to find a doctor in the network taking new patients. They ended up signing up with a concierge practice that accepts their insurance but also charges them a $2,700 annual membership, a fee he pays out of pocket. Nonetheless, he said he has been satisfied with the policy.

But last month Humana, which is withdrawing from 88 percent of the counties it sold plans in this year, told Berry his policy was not continuing, and he is unsure what choices he will have and how much more they will cost.

“It’s not like if I don’t want to buy Humana or Blue Cross, I have five other people competing for my business,” Berry said. “It just seems like it’s a lot of money every year for what is just basic insurance, basic health care. I understand what you’re paying for is the unknown — that heart attack or stroke — but I don’t know where the break point is.”

To be sure, the same economic forces — cancelled policies, higher premiums and restrictive networks — have been agitating the markets for employer-provided insurance for years. But there is more scrutiny on the individual market, born of the turmoil of the Affordable Care Act.

Dr. Patrick Romano, a professor of medicine at the UC Davis Health System in Sacramento, Calif., said the topic has been coming up in focus groups he has been convening about the state insurance marketplace, Covered California. Switching doctors, he said, “is a disruption and can lead to interruptions in medications.”

“Some of it is unintentional because people can have delays getting in” to see their new doctor, he said. “Some of it may be because the new physician isn’t comfortable with the medication the previous physician prescribed.”

Dr. John Meigs, an Alabama physician and president of the American Academy of Family Physicians, said that whatever the source of insurance, changing doctors disrupts the trust a patient has built with a physician and the knowledge a doctor has about how each patient responds to illnesses. “Not everything is captured in a health record” that can be passed to the next doctor, Meigs said.

There is little research about whether switching doctors leads to worse outcomes, said Dr. Thomas Yackel, a professor of medicine at Oregon Health & Science University in Portland. In some cases, he said, it can offer unexpected benefits: “Having a fresh set of eyes on you as a patient, is that really always a bad thing?”

With the shake-up in the insurance market, access to some top medical systems may be further limited. Blue Cross Blue Shield of Tennessee, which has included the elite Vanderbilt University Medical Center in its network, is pulling out of the individual marketplace in the state’s three largest metro areas: Nashville, Memphis and Knoxville. Bobby Huffaker, CEO of American Exchange, an insurance firm in Tennessee, said so far, no other carrier includes Vanderbilt in its network in the individual market.

In St. Louis, Emily Bremer, an insurance broker, said only two insurers will be offering plans next year through healthcare.gov. Cigna’s network includes BJC HealthCare and an affiliated physicians’ group, while Anthem provides access to other major hospital systems, including Mercy, but excludes BJC and its preeminent academic medical center Barnes-Jewish Hospital.

“These networks have little or no overlap,” she said. “It means severing a lot of old relationships. I have clients who have doctors across multiple networks who are freaking out.”

Aetna said it will still offer policies off the healthcare.gov exchange. Those are harder to afford as the federal government does not provide subsidies, and Aetna has not revealed what its networks will be. In an email, an Aetna spokesman said the insurer was offering those policies to preserve its option to return to the exchanges in future years; if Aetna had completely stopped selling individual policies, it would be banned from the market for five years under federal rules.

Even before St. Louis’ insurance options shrunk, Bremer said she had to put members of some families on separate policies in order for everyone to keep their physicians. That can cost the families more, because their combined deductibles and maximum out-of-pocket payments can be higher than for a single policy, she said.

“Every year our plan disappears,” said Kurt Whaley, a 49-year-old draftsman in O’Fallon, Mo., near St. Louis. After one change, he said, “I got to keep my primary care physician, but my kids lost their doctors. I had to change doctors for my wife. It took away some of the hospitals we could get into.”

Brad Morrison, a retired warehouse manager in Quincy, Ill., said he has stuck with Coventry despite premium increases — he now pays $709 a month, up from $474 — because the policy has been the cheapest that would let him keep his doctor. “That’s the one thing I insisted on,” he said. “I love the guy.”

With Coventry leaving the Illinois exchanges, Morrison is unsure whether his alternatives will include his physician. His bright spot is that he turns 65 next spring. “I’m trying to hold out until I get to Medicare,” he said.

This report originally appeared in Money. It was made available by Kaiser Health News through a Creative Commons license. KHN is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

America’s other drug problem: Copious prescriptions for hospitalized elderly

Dominick Bailey sat at his computer, scrutinizing the medication lists of patients in the geriatric unit.

A doctor had prescribed blood pressure medication for a 99-year-old woman at a dose that could cause her to faint or fall. An 84-year-old woman hospitalized for knee surgery was taking several drugs that were not meant for older patients because of their severe potential side effects.

And then there was 74-year-old Lola Cal. She had a long history of health problems, including high blood pressure and respiratory disease. She was in the hospital with pneumonia and had difficulty breathing. Her medical records showed she was on 36 medications.

“This is actually a little bit alarming,” Bailey said.

He was concerned about the sheer number of drugs, but even more worried that several of them — including ones to treat insomnia and pain — could suppress Cal’s breathing.

An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don’t communicate with each other. If those patients are hospitalized, doctors making the rounds add to the list — and some of the drugs they prescribe may be unnecessary or unsuitable.

“This is America’s other drug problem — polypharmacy,” said Dr. Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica. “And the problem is huge.”

The medical center, where Bailey also works, is intended specifically for treating older people. One of its goals is to ensure that elderly patients are not harmed by drugs meant to heal them.

That work falls largely to Bailey, a clinical pharmacist specializing in geriatric care.

Some drugs can cause confusion, falling, excessive bleeding, low blood pressure and respiratory complications in older patients, according to research and experts.

Older adults account for about 35 percent of all hospital stays but more than half of the visits that are marred by drug-related complications, according to a 2014 action plan by the U.S. Department of Health and Human Services. Such complications add about three days to the average stay, the agency said.

Data on financial losses linked to medication problems among elderly hospital patients is limited. But the Institute of Medicine determined in 2006 that at least 400,000 preventable “adverse drug events” occur each year in American hospitals. Such events, which can result from the wrong prescription or the wrong dosage, push health care costs up annually by about $3.5 billion (in 2006 dollars).

And even if a drug doesn’t cause an adverse reaction, that doesn’t mean the patient necessarily needs it. A study of Veterans Affairs hospitals showed that 44 percent of frail elderly patients were given at least one unnecessary drug at discharge.

“There are a lot of souvenirs from being in the hospital: medicines they may not need,” said David Reuben, chief of the geriatrics division at UCLA School of Medicine.

Some drugs prescribed in the hospital are intended to treat the acute illnesses for which the patients were admitted; others are to prevent problems such as nausea or blood clots. Still others are meant to control side effects of the original medications.

University of California, San Francisco researcher and physician Ken Covinsky, said many doctors who prescribe drugs in hospitals don’t consider how long those medications might be needed. “There’s a tendency in medicine every time we start a medicine to never stop it,” Covinsky said.

When doctors in the hospital change or add to the list of medications, patients often return home uncertain about what to take. If patients have dementia or are unclear about their medications, and they don’t have a family member or a caregiver to help, the consequences can be disastrous.

One 2013 study found that nearly a fifth of patients discharged had prescription-related medical complications during their first 45 days at home. About 35 percent of those complications were preventable, and 5 percent were life-threatening.

UCLA hired Bailey about three years ago, after he completed a residency at University of California, Davis. The idea was to bring a pharmacist into the hospital’s geriatric unit to improve care and reduce readmissions among older patients.

Speaking from his hospital bed at UCLA’s Santa Monica hospital, 79-year-old Will Carter said that before he was admitted with intense leg pain, he had been taking about a dozen different drugs for diabetes, high blood pressure and arthritis.

Doctors in the hospital lowered the doses of his blood pressure and diabetes medications and added a drug to help him urinate. Bailey carefully explained the changes to him. Still, Carter said he was worried he might take the drugs incorrectly at home and end up back in the hospital.

“I’m very confused about it, to tell you the truth,” he said after talking to Bailey. “It’s complicated. And if the pills are not right, you are in trouble.”

Having a pharmacist like Bailey on the team caring for older patients can reduce drug complications and hospitalizations, according to a 2013 analysis of several studies published in the Journal of the American Geriatrics Society.

Over a six-month stretch after Bailey started working in UCLA’s Santa Monica geriatric unit, readmissions related to drug problems declined from 22 to three. At the time, patients on the unit were taking an average of about 14 different medications each.

Bailey is energetic and constantly on the go. He started one morning recently with a short lecture to medical residents in which he reminded them that many drugs act differently in older patients than in younger ones.

“As you know, our elderly are already at risk for an accumulation of drugs in their body,” he told the group. “If you put a drug that has a really long half-life, it is going to last even longer in our elderly.”

The geriatric unit has limited beds, so older patients are spread throughout the hospital. Bailey’s services are in demand. He gets paged throughout the day by doctors with questions about which medications are best for older patients or how different drugs interact. And he quickly moves from room to room, reviewing drug lists with patients.

Bailey said he tries to answer several questions in order to determine what’s best for a patient. Is the drug needed? Is the dose right? Is it going to cause a problem?

One of his go-to references is known as the Beers list — a compilation of medications that are potentially harmful for older patients. The list, named for the doctor who created it and produced by the American Geriatrics Society, includes dozens of medications, including some antidepressants and antipsychotics.

When he’s not talking to other doctors at the hospital, Bailey is often on the line with other pharmacists, physicians and relatives to make sure his patients’ medication lists are accurate and up to date. He also monitors patients’ new drugs, counsels patients about their prescriptions before they are discharged and calls them afterward to make sure they are taking the medications properly.

“Medications only work if you take them,” Bailey said dryly. “If they sit on the shelf, they don’t work.”

That was one of his main worries about Cal, the 74-year old with chronic obstructive pulmonary disease. Standing at her bedside, Bailey pored over the list of 36 drugs. Cal told him she only took the medications that she thought seemed important.

Bailey explained to Cal that he and the doctors were going to make some changes. They would eliminate unnecessary and duplicate drugs, including some that could inhibit her breathing. Then she should take as prescribed all of the medications that remained on the list.

Bailey said he’s constantly weighing the risks versus the benefits of medications for elderly patients like Cal.

“It is figuring out what they need,” he said, “versus what they can survive without.”

This story was reported while its author, Anna Gorman, participated in a fellowship supported by New America Media, the Gerontological Society of America and The Commonwealth Fund.

KHN’s coverage of aging and long-term care issues is supported by a grant from The SCAN Foundation, and its coverage of late life and geriatric care is supported by The John A. Hartford Foundation. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Should big insurance become like Walmart to lower health costs?

Retail titan Walmart uses its market dominance to inflict “ruthless,” “brutal” and “relentless” pressure on prices charged by suppliers, business writers frequently report.

What if huge health insurance companies could push down prices charged by hospitals and doctors in the same way?

The idea is getting new attention as already painful health costs accelerate and major medical insurers seek to merge into three enormous firms.

Now that hospitals have themselves combined, in many cases, into companies that dominate their communities, insurance executives argue the only way to fight bigness is bigness.

No. 2 health insurer Anthem’s proposed marriage to No. 6 Cigna would let the combined company “manage the cost drivers that negatively impact affordability for consumers,” Anthem CEO Joseph Swedish told Congress last year. The bigger company could “negotiate better reimbursement rates” with medical providers, says Anthem spokeswoman Jill Becher.

In metro areas with only a few big insurers, hospital and doctor bills tend to be lower than what economists would otherwise expect. If only one or two insurers are bidding to include providers in their networks, hospitals and doctors must submit to the offered deal or risk getting shut out of a huge piece of business.

“There’s some literature out there that does show that when you have relatively concentrated insurance markets, they tend to keep actual hospital costs down,” said Yevgeniy Feyman, a researcher at Harvard’s T.H. Chan School of Public Health and a fellow with the Manhattan Institute.

The American Hospital Association as well as the American Medical Association, trade groups for hospitals and doctors respectively, have long worried that insurance mergers do just that. Now that Anthem is trying to buy Cigna, and No. 3 health insurer Aetna wants to buy No. 5 Humana, they’re even more concerned.

Both deals “have the very real potential to reduce competition substantially” and “diminish the insurers’ willingness to be innovative partners with providers and consumers,” AHA lawyer Melinda Reid Hatton wrote to antitrust authorities after the combos were announced.

But hospitals have built their own market power through numerous mergers, giving them broad ability to raise prices paid by employers, taxpayers and consumers beyond what a competitive market would allow, economists argue.

Hospitals “are much more concentrated than insurance markets,” said Glenn Melnick, a health care economist at the University of Southern California who has researched the matter. “They face a lot less competition than the [health] plans do.”

Why not give hospital giants somebody their own size to negotiate with?

For one thing, insurers might just pocket higher profits from low provider prices instead of passing the savings to consumers and employers.

“I don’t find any evidence that reduction in provider payment leads to reduction in insurance premiums, and I don’t know of any study that does,” said Leemore Dafny, an expert in insurance markets and an economist at Harvard Business School.

Feyman suggests requiring insurers in concentrated areas to spend 90 percent of their revenue on medical care. That might reduce their ability to boost profits with premium increases while preserving their ability to hold down hospital and doctor costs, he said.

But he sees such a measure as only a “worst-case scenario” for the most monopolized insurance markets, not a recipe to allow the Anthem and Aetna deals to go through.

Antitrust regulators are siding with the hospitals and doctors.

Late last month the Justice Department sued to block both insurance mergers, arguing that competition is important to keep premiums down and that the deals “would leave much of the multitrillion-dollar health insurance industry in the hands of three mammoth insurance companies.”

They also rejected the Walmart argument, which is related to what economists call “monopsony.”

Monopsony is the opposite of monopoly: Instead of using market dominance to raise prices for consumers, huge buyers force down prices from suppliers. Walmart is often described as holding monopsony-like power.

But critics of the insurance deals say monopsony can go too far. If the buyer pushes prices too low, suppliers stop producing, making needed goods and services unavailable.

“As a result of the merger, Anthem likely would reduce the rates that … providers earn by providing medical care to their patients,” the Justice Department argued. “This reduction in reimbursement rates likely would lead to a reduction in consumers’ access to medical care.”

Accepting Walmart logic for health care might bolster arguments for an even bigger, more powerful buyer of medical services: the government.

A “single-payer,” government health system, of the type advocated by Democratic presidential candidate Bernie Sanders, would be the ultimate monopsony: one buyer, negotiating or dictating prices for everybody.

Neither the hospitals nor the insurance companies want that.

This report was published by Kaiser Health News and ran on NPR. KHN is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Appeals court: Wisconsin abortion law is unconstitutional

In a ruling that Planned Parenthood of Wisconsin called “an important victory for Wisconsin women,” the U.S. Court of Appeals for the 7th Circuit yesterday rejected a Wisconsin law requiring abortion providers to get admitting privileges at nearby hospitals is unconstitutional.

The 7th U.S. Circuit Court of Appeals panel’s 2–1 decision doesn’t put the question to rest. The U.S. Supreme Court agreed earlier this month to hear a challenge to a similar Texas law in a case that could settle the issue nationally.

The Wisconsin case centers on a lawsuit filed by Planned Parenthood and Affiliated Medical Services. The groups argue that the 2013 Republican-backed law amounts to an unconstitutional restriction on abortion.

The law’s supporters counter it ensures continuity of care if a woman developed complications from an abortion and needed to be hospitalized. But the lawsuit said the statute would force AMS’s clinic in Milwaukee to close because its doctors couldn’t get admitting privileges. That in turn would lead to longer waits at Planned Parenthood clinics. Therefore, the lawsuit maintained, the law amounts to an illegal restriction on abortions.

U.S. District Judge William Conley sided with the abortion providers in March, saying the law served no legitimate health interest. The Wisconsin Department of Justice later appealed to the 7th Circuit.

Writing for the 7th Circuit majority, Judge Richard Posner called the contention that the law would protect women’s health “nonexistent.” He said the law would put more women in danger by increasing the waiting times for abortions, which could push some procedures into the second trimester.

“What makes no sense is to abridge the constitutional right to abortion on the basis of spurious contentions regarding women’s health — and the abridgement challenged in this case would actually endanger women’s health,” he wrote.

Posner added that the law was obviously designed to close down abortion clinics, had nothing to do with women’s health and was a “clear flouting of Roe vs. Wade.”

He also said that a woman who experiences complications from an abortion will go to the nearest hospital, which will treat her regardless of whether her abortion doctor has admitting privileges there.

The medical community agrees that requiring admitting privileges does not increase patient safety, Planned Parenthood of Wisconsin said in a statement to the press. Legal abortion is one of the safest medical procedures in the United States (and) admitting privileges do not hasten a patient’s care and are not required for any other medical procedure in Wisconsin, the group added.

The Wisconsin Medical Society joined the American Congress of Obstetrics and Gynecologists and the American Medical Association in a friend of the court brief explaining why admitting privileges do not enhance patient safety. The Wisconsin Hospital Association, the Wisconsin Public Health Association, the Wisconsin Academy of Family Physicians, the Wisconsin Association of Local Health Departments and Boards, and the Wisconsin Alliance for Women’s Health all oppose Wisconsin’s admitting privileges statute.

“At Planned Parenthood, our top priority is patient safety. As the court affirmed, this law does nothing to enhance the health and safety of patients,” said Teri Huyck, CEO of Planned Parenthood of Wisconsin. “The intention of this law was to put obstacles in the path of women seeking safe, legal abortion care in Wisconsin.”

In his ruling, Posner noted that the law required providers to obtain privileges within two days of Gov. Scott Walker signing it, even though the process typically takes months. If Conley hadn’t imposed a preliminary injunction, AMS’ Milwaukee clinic as well as Planned Parenthood’s Appleton facility would have had to close immediately because providers at both facilities lacked privileges without

“The legislature’s intention to impose the two-day deadline … is difficult to explain save as a method of preventing abortions that women have a constitutional right to obtain,” Posner wrote.

Judge David Manion was the lone dissenter, saying the law protects women’s health and doesn’t amount to an undue constitutional burden.

Eleven states have imposed similar admitting privilege requirements on abortion providers; courts have blocked the requirements in six states, including Wisconsin, according to the Guttmacher Institute, which supports legal access to abortion.

The Wisconsin Department of Justice, run by Republican Attorney General Brad Schimel, defended the law.

Court: Namibia forcibly sterilized women with HIV

Namibia’s Supreme Court upheld a ruling that health workers sterilized HIV-positive women without their consent, a human rights group said this week.

The 2012 judgment that was upheld had found that health workers had coerced three HIV-positive mothers to sign sterilization consent forms they did not fully understand, and while in labor, the Southern Africa Litigation Center said. 

The center said the ruling sends a message to the government to stop the practice in the southwestern African nation, and elsewhere.

“This decision has far-reaching consequences not only for HIV-positive women in Namibia but for the dozens of HIV-positive women throughout Africa who have been forcibly sterilized,” Priti Patel, the center’s deputy director said in a statement.

Sterilization is a drastic tactic to treat HIV-positive women, as mother-to-child transmission of HIV and AIDS can be prevented with medication.

Namibia’s high court will assess how much money the three women should be awarded, according to the center. The women had all sought care at government hospitals in Namibia while in labor, with one woman signing a form that used only acronyms to describe the procedure, while another signed after being told she didn’t have a choice, the center said.

Since the case was first filed in 2009, dozens more women have told stories of similar experiences at public hospitals to the Namibian Women’s Health Network. The organization first began documenting allegations of forced sterilization of HIV-positive women in 2007.

“These three women are only the tip of the iceberg,” the network’s director Jennifer Gatsi-Mallet said in a statement. “The government needs to take active steps to ensure all women subjected to this unlawful practice get redress.”

The rights organizations said they hoped the Namibian government would initiate investigations into the other alleged cases.

Federal court blocks enforcement of Louisiana anti-abortion law

A Louisiana state law intended to close abortion clinics across the state will not be enforced on Sept. 1, according to a federal district court ruling issued over the weekend.

Louisiana health care providers filed a suit in federal district court in Baton Rouge last week seeking an immediate injunction against House Bill 388, which requires a doctor who provides abortion care to obtain admitting privileges at a local hospital. With the federal decision, physicians providing abortion services will not be forced to comply with the law if they are in the process of applying for hospital admitting privileges.

Admitting privileges requirements were pushed around the country, including in Wisconsin, by anti-choice politicians. Yet, studies show that admitting privileges provide no increased benefits for the fewer than 1 percent of abortion patients who experience complications. Also, privileges can often be impossible to obtain due to individual hospital policies or biases toward abortion providers for reasons not related to the doctors’ qualifications.

Nancy Northup, president and CEO of the Center for Reproductive Rights, said the federal ruling “ensures Louisiana women are safe from an underhanded law that seeks to strip them of their health and rights. Politicians cannot be given free rein to lie about their motives without recourse, and expect women and their families to pay the consequences.”

She continued, “As the flimsy façade of these laws grows thinner by the day, we continue to look to the courts to uphold the Constitution and protect access to safe and legal abortion for all women regardless of where they happen to live.”

Ilene Jaroslaw of the Center for Reproductive Rights, Demme Doufekias of Morrison & Foerster and William E. Rittenberg of Rittenberg, Samuel, and Phillips, LLC represent Hope Medical Group for Women, Causeway Medical Clinic and Bossier City Medical Suite in the legal challenge to the Louisiana law.

If the law had been put into effect on Sept. 1, at least three of the state’s five clinics would have been forced to stop providing abortion services or close.

Hospitals, clinics rated on care for LGBT patients


5 ranked as leaders in Wisconsin

The Human Rights Campaign on July 11 released its annual health care equality index, showing vast improvements in care for LGBT patients and their families at U.S. hospitals and clinics.

HRC released the report at the Department of Veterans Affairs in Washington, D.C., which has 121 medical centers that have pledged to provide equal treatment to LGBT patients.

“The country’s health care facilities are leading figures in our nation’s movement toward full equality and inclusion for LGBT Americans,” HRC president Chad Griffin said in an news release. “The Department of Veterans Affairs’ participation in the HEI is another example of President Obama’s unwavering commitment to those who put their lives on the line for the country they love, regardless of who they love.”

The index includes a survey of 718 facilities. About 74 percent of the respondents won recognition as “Leaders in LGBT Healthcare Equality” after meeting four main criteria for equitable LGBT care.

In a breakthrough, 121 of the 151 Veterans Health Administration medical centers participated in the HEI 2013, compared to just one VHA participant in the HEI 2012. Nearly 80 percent of the participating VHA facilities were awarded Equality Leader status in the 2013 index.

“We were pleased to have this opportunity to foster a more inclusive environment for our LGBT Veterans and their families,” said Robert L. Jesse, VHA principal deputy Under Secretary for Health. “Our participation in the HEI 2013 exemplifies our untiring efforts in the pursuit of health equity for all of our veterans.”

About 93 of HEI 2013 participants explicitly prohibit discrimination against lesbian, gay and bisexual patients, and 87 percent ban discrimination against transgender patients.

Additionally, 90 percent of respondents explicitly guarantee equal visitation rights to same-sex couples and same-sex parents. This represents a significant increase since the U.S. Department of Health and Human Services issued rules in 2011 requiring all hospitals that receive federal Medicare and Medicaid funding – nearly every hospital in America – to protect the visitation rights of LGBT people. 

The HEI 2013 required participating facilities to document that employees in key work areas had received expert training in LGBT health needs. As a result, nearly 5,000 healthcare personnel nationwide, including senior administrators, participated in training provided through the HEI, a unique educational initiative.

Studies, including a 2011 Institute of Medicine report, have repeatedly shown that the LGBT community faces health disparities and healthcare discrimination and that many LGBT Americans are concerned about experiencing bias in healthcare. But as the HEI 2013 indicates, healthcare facilities are increasingly seeking to assure them that they will receive equal treatment.

“No one should have to worry about receiving discriminatory healthcare,” said Griffin. “We’re very pleased to offer hospitals and clinics a comprehensive resource for equitable care, and we celebrate all of those who used the HEI 2013 to welcome LGBT patients, employees and families.”

In Wisconsin

Wisconsin has five health care facilities that received “leader” rankings in the survey. Leader facilities in the state include American Family Children’s Hospital, University of Wisconsin Hospital & Clinics and VA William S. Middleton Memorial Veterans Hospital in Madison; AIDS Resource Center of Wisconsin in Milwaukee and the VA Tomah Medical Center in Tomah.

On the Web… 

Healthcare Equality Index

Catholic hospitals split with U.S. bishops on birth control compromise

In a split with U.S. bishops, a trade group for Catholic hospitals said this week it can accept the Obama’s administration latest compromise on birth control coverage by religious employers.

“We are pleased that our members now have an accommodation that will not require them to contract, provide, pay or refer for contraceptive coverage,” said the Catholic Health Association.

Under President Barack Obama’s health care law, most employers are required to cover birth control as a free preventive service for women workers. Churches and other houses of worship are fully exempt from the mandate. But religiously-affiliated hospitals, universities and social service groups are not.

The compromise, in a final regulation from the administration, attempts to create a buffer for these employers. It requires insurers or the health plan’s outside administrator to pay for birth control coverage, and creates a mechanism for reimbursing them.

However, U.S. Roman Catholic bishops are suing to overturn the entire requirement, saying it trespasses on freedom of religion.

Sister Mary Ann Walsh, a spokeswoman for the bishops, said the hospital association had notified the bishops’ conference about its stand late on July 8.

Walsh said the bishops “did not contribute to the (group’s) analysis or the statement itself.”

Catholic dioceses, charities and universities are among the plaintiffs in more than 60 lawsuits challenging the rule. The cases are expected to reach the U.S. Supreme Court.

The regulation has become another contentious issue in the health care overhaul Obama signed into law in 2010.

The Catholic hospitals’ group, led by Sister Carol Keehan, joined other prominent Catholics in defying the bishops to support passage of the health law at a critical stage of the congressional debate.

More recently, the group had joined the bishops and leaders of other faiths in pressing the Department of Health and Human Services for a broader religious exemption from birth control coverage.

The birth control coverage requirement was widely praised by women’s groups, and supported by medical societies as good for both mothers and children.

The administration’s original birth control rule, introduced early last year, exempted churches and other houses of worship. However, faith-affiliated charities, universities and other nonprofits were required to comply.

After a public outcry, the Obama administration floated a series of compromises that resulted in a final accommodation June 28.

The latest version of the regulation attempts to create a buffer between the faith-affiliated charities and contraceptive coverage by requiring insurers or another third-party to provide contraceptive coverage instead of the religious employer.

New York Cardinal Timothy Dolan, president of the bishops’ conference, said in a statement last week that the bishops were still studying the regulation, adding that it does not appear to address all their concerns about religious freedom. The bishops have also sought a religious exemption for owners of for-profit businesses.

The National Association of Evangelicals, which represents Protestant churches across the country, announced Monday it also rejects the compromise.

The Catholic Church prohibits the use of artificial contraception. Evangelicals generally accept the use of birth control, but some object to specific methods such as the morning-after contraceptive pill, which they argue is tantamount to abortion, and is covered under the policy.

The hospital trade group’s decision was first reported by the National Catholic Reporter.