By Stephanie Innes Arizona Daily Star | June 3, 2017
An AARP television advertisement airing in Arizona again this week takes aim at federal health reform and is targeted to U.S. Sen. Jeff Flake.
Republicans have a slim 52-48 majority in the Senate, and opponents of the American Health Care Act of 2017 (AHCA) are heavily lobbying Republican senators like Flake who are viewed as possible “no” votes.
The AARP ad features a couple visiting a financial-services company not-so-subtly called “Ryan and Associates” (House Speaker Paul Ryan has been one of the bill’s most-vocal proponents).
One of the first things the financial adviser tells the couple in the ad is that since they are over 50, their health insurance is about to get more expensive due to a so-called “age tax” in the bill.
Mike Christy / Arizona Daily Star – Dr. Marcia Klotz, center, and others staged a sit-in Friday at Sen. Jeff Flake’s Tucson office, urging him to oppose the American Health Care Act.
And also, the man’s asthma means insurers can charge consumers “thousands more,” the adviser tells the bewildered couple.
FLAKE RESPONDS - Reactions to the ad from health-care experts contacted by the Star last week were mixed, with some critics pointing out that the health-care bill that passed the House 217-213 on May 4 will be changed before the Senate votes on it.
When asked for a response to the ad, that’s what Flake, an Arizona Republican, said, too.
“The AHCA isn’t expected to come up for a vote in the Senate, so the Senate is drafting its own legislation,” Flake spokesman Jason Samuels wrote in an email. “Once that bill is written, released, reviewed, and scored we’ll have more clarity on its impacts.”
The ad started airing May 23 on Tucson and Phoenix television stations and will run until June 11. It targets five U.S. senators, including Flake, say AARP officials. The other senators are Lisa Murkowski and Dan Sullivan of Alaska, Cory Gardner of Colorado and Dean Heller of Nevada. “Tell your senator: Vote ‘no’ on the healthcare bill,” the ad says.
AARP, the nation’s largest seniors group, made a “six-figure buy” for the ad in Arizona, as it did in each of the other three states targeted, said Alez Juarez, communications director for AARP Arizona.
SUPPORT FOR THE AD’S CLAIMS - The language of the AHCA does not include the term “age tax” that’s used in the ad. But the ad does give consumers accurate information about the bill passed by the House, said health-policy expert Dr. Dan Derksen, who is director of the Arizona Center for Rural Health at the University of Arizona.
“The AARP isn’t referring to some possible legislation, whatever ends up being introduced by the Senate. It’s absolutely accurate on the AHCA,” Derksen said.
The House version of the AHCA does allow insurers in 2018 to charge older enrollees five times more than younger enrollees, Derksen said. Under the current Affordable Care Act law, which was passed under President Obama, insurers are allowed to charge older enrollees up to three times more than younger people.
“So the AARP ad is correct,” Derksen said.
The AHCA also allows states to waive many of the Affordable Care Act’s most popular consumer protections and thereby stop requiring insurers to include essential health benefits such as preventive services, newborn care and maternity coverage, Derksen said. It would also enable states to go back to charging more for pre-existing conditions if a person had not maintained continuous coverage, he said.
CRITICISM - And therein lies one of the problems that critics have with the ad. Most people with pre-existing conditions aren’t going to allow their coverage to lapse, said Ray Magnuson, a Tucson health-insurance broker and owner of Magnuson & Associates. He calls the ad “disingenuous” and “misleading.”
“All these ads are in that gray area where you can’t say it’s an outright lie,” he said. “But it’s making assumptions.”
States will indeed be allowed to apply for waivers under the AHCA, and they will be able to apply to charge more for pre-existing conditions. However, in order to get waivers the states
“have to jump through five different steps,” said Magnuson, an incoming regional vice president of the National Association of Health Underwriters.
“I think the ad is a lot of political posturing,” said Naomi Lopez Bauman, director of health-care policy for the conservative-leaning Goldwater Institute in Phoenix.
“We already know the House bill is completely independent of what the Senate is working on. ... The Senate has signaled quite clearly they are working on their own legislation,” she said.
Lopez Bauman thinks the Senate bill will address the so-called “age tax” and look more at income rather than age when structuring premium subsidies.
“There is a lot to be sorted out and we’re still early in the process,” she said. “The ad is not particularly educational. It’s political.”
The purpose of the ad is to make sure folks in Arizona “know we’re watching,” said AARP’s Juarez.
“As the number of opioid overdoses and deaths increase at an alarming rate, we must take action.”
PHOENIX — Governor Doug Ducey today signed an emergency declaration to address the growing number of opioid deaths in our state.
Newly released data from the Arizona Department of Health Services shows in 2016, 790 Arizonans died from opioid overdoses – an average of more than two people per day. The trend shows an alarming increase of 74 percent over the past four years. Today’s declaration by the Governor directs the Arizona Department of Health Services to rapidly respond to this public health emergency.
“As the number of opioid overdoses and deaths increase at an alarming rate, we must take action. It’s time to call this what it is — an emergency," said Governor Ducey. “Most of us know someone impacted by substance abuse – our family, our friends, our neighbors. Our hearts ache for them, but that isn’t enough. We must do more. I’m declaring a statewide health emergency, because we need to know more about the epidemic, including enhanced data that illustrates when and where these overdoses occur so that we can develop real, targeted solutions.”
The declaration gives the state the ability to coordinate public health efforts between state, local, and private sectors and allow the state to utilize all its public health resources and help put naloxone into the community to help prevent drug overdose deaths. The declaration and enhanced surveillance advisory will provide for enhanced reporting of overdose deaths from doctors and hospitals.
“The only way we will be able to make an impact in the opioid epidemic is to come together as a community and this declaration helps us move forward quickly,” said Dr. Cara Christ, director of the Arizona Department of Health Services. “We will look into helping improve prescribing practices, addressing poly drug use, and analyzing raw data on overdose deaths that occur to see where the problem areas are and learn how we can make changes to save lives.”
As part of this public health emergency the Arizona Department of Health Services will identify ways to:
prevent prescription opioid drug abuse through appropriate prescribing practices,
develop guidelines to educate healthcare providers on responsible prescribing practices,
expand access to treatment, especially Medication Assisted Treatment (MAT), and
reverse overdoses through the distribution of naloxone.
View a copy of today’s emergency declaration along with information and updates on our progress in turning the tide on the Arizona opioid epidemic here: http://azhealth.gov/opioid.
by Alexandria Bachert | Staff Writer, MedPage Today May 26, 2017
House Republicans and the White House have recently proposed massive reductions in the Medicaid program which could shave more than $1 trillion from projected expenditures over the next 10 years.
Much of the debate over these cuts has centered around the effects on children and the poor, but about 40% of the Medicaid budget pays for long-term care for the elderly, many of whom are poor only on paper. In this edition of “Friday Feedback,” experts discuss the critical role Medicaid plays in the healthcare system, particularly for America’s increasingly numerous seniors, and what might happen if funding is slashed.
…won't budget cuts simply deprive the poor of access to care?
Daniel Derksen, MD, Arizona Center for Rural Health: You don't save money by throwing millions off of coverage. That strategy shifts costs to states, to individuals and their families, and to physicians, hospitals, clinics and nurses through uncompensated and charity care. It strains credulity to cut almost a trillion dollars of federal funding to state Medicaid programs over the next 10 years, and claim that bill gives states more autonomy.
Tucson News Now | Wednesday, May 24, 2017, 8:45 pm
The National Rural Health Association (NRHA) honored Copper Queen Community Hospital (CQCH) CEO, James Dickson earlier this month with the 2017 Louis Gorin Award for Outstanding Lifetime Achievement in Rural Health Care.
Award recipients are selected based on their creativity, unselfishness, compassion and cooperative attitude in seeking ways to make lasting contributions to rural health care.
“It is a rare opportunity for someone to be able to serve and help the community like I have for over 18 years, ” said James Dickson, “I would like to thank my staff, Board of Directors, and Physicians for believing in the vision and being able to provide access to primary healthcare in medically underserved communities.”
Jim Dickson, has an unwavering commitment to providing rural southern Arizonans with accessible, affordable, high-quality health care. His efforts brought state-of-the-art care to southern Arizona through renovation and expansion of the hospital and RHC diagnostic and treatment services.
Dickson has achieved this through innovative and unparalleled collaborations with major health care systems in Arizona using telemedicine for sophisticated diagnostic and specialty care in Cochise County, saving residents the expense and travel to Tucson or Phoenix for services.
In addition to his work in health care, Dickson identifies and addresses unmet community needs, creating the first library for middle school students in Bisbee and offering scholarships to Cochise County high school graduates for training to land well-paying local jobs.
“Jim Dickson’s work at the CQCH critical access hospital and affiliated RHCs, and most recently, to create one of the state’s first rural freestanding emergency departments (ED) at the Douglas Medical Complex, underscores his unwavering commitment to providing rural southern Arizonans with accessible, affordable, high quality health care.” stated Daniel Derksen, MD from the Arizona Center for Rural Health at The University of Arizona.
“For 20 years, Jim has led health care improvements in Cochise County that spans over 6,200 sq. miles, has a pop. density of 20 persons/sq.mi., and 17 percent poverty rate. For comparison, Connecticut is smaller at 5,500 sq.mi., has a pop. density of 650 persons/sq.mi. and 10.7 percent poverty rate.
His efforts brought state-of-the-art care to southern Arizona through renovation and expansion of the hospital and RHC diagnostic and treatment services.
He does this through innovative and unparalleled collaborations with major health care systems in Arizona using telemedicine for sophisticated diagnostic and specialty care in Cochise County, saving residents the expense and travel to Tucson or Phoenix for services.”
Summary: The AHCA cuts $1.5 trillion dollars in federal funding over 10 years by slashing state Medicaid (-$830B), eliminating Marketplace subsidies (-$665B) to individuals and families, and causing 23 million Americans to become uninsured over 10 years. The President’s budget cuts $2 trillion dollars in health spending over 10 years, disproportionately affecting low-income, elderly and rural Americans.
Increase U.S. uninsured by 14 million in year 2018, and 23 million uninsured by year 2026.
Increase the uninsured total to 51 million Americans by year 2026, versus 28 million who would lack insurance in 2026 under the current Affordable Care Act (ACA) law.
Decrease by almost $1.5 trillion dollars the federal funding of health coverage over 10 years (2017-2026) by cutting Medicaid funding to states ($830 billion) and eliminating ($665 billion) in marketplace subsidies to help low-income Americans buy health plans (page 39 CBO Report1).
Disproportionately affect the frail elderly, blind, disabled and rural Medicaid enrollees.
Cut by $830 billion dollars over 10 years in federal Medicaid funding to states, resulting in 14 million fewer Medicaid enrollees by 2026.
Reduce by $665 billion dollars over 10 years in federal subsidies to help individuals buy health insurance (also known as the nongroup or individual health insurance market) by eliminating in year 2020 the ACA’s refundable tax credits and cost sharing reductions. These would be replaced by $275 billion in tax credits for nongroup insurance in year 2020.
Allow insurers in 2018 to charge older enrollers five times more than younger enrollees, versus three times more under current law.
Allow insurers to impose a 30% charge to individuals who did not maintain continuous coverage.
Allow states to waive the Affordable Care Act’s consumer protections and thereby stop requiring insurers to include the 10 essential health benefits (such as preventive services, newborn care, and maternity coverage), and allow insurers to go back to charging people more for pre-existing conditions (eliminates the community rating) if a person had not maintained continuous coverage.
Appropriate $8 billion dollars per year in 2018 in funding for states that obtain a waiver for a Patient and State Stability Fund starting in 2018 for those with pre-existing conditions.
Provide $15 billion in funding to states choosing to waive the ACA requirements for community rating and essential health benefits for maternity coverage, newborn care, prevention, treatment, or recovery services for people with mental and/or substance use disorders.
Payson Roundup | by Peter Aleshire roundup editor May 9, 2017
Most Gila County residents will likely face a much harder time getting health care if the U.S. Senate adopts the Affordable Care Act Repeal the U.S. House narrowly approved last week.
Rim Country’s representative Paul Gosar (R-Prescott) voted for the bill, which he says will save the health care system and restore free market competition.
“Millions of Americans are drowning right now under the tidal wave of Obamacare regulations and mandates that have destroyed our entire health care system. The American Health Care Act is a life raft to those suffering and represents a down payment towards a true market-based solution. Additionally, the AHCA preserves protections for all Americans with pre-existing conditions and gives states the control needed to lower premiums, provide increased patient-centered choices and stabilize the insurance market,” he said.
However, some health care groups strongly criticized the bill.
Almost all of Arizona’s Republicans threw their support behind the replacement for the Affordable Care Act, which narrowly passed the U.S. House on Thursday.
Four of Arizona’s five House Republicans voted for the American Health Care Act. Republican Rep. Andy Biggs, who represents a conservative district in the East Valley, joined Arizona's Democrats in opposing the bill.
Before the vote, Biggs criticized the legislation for not being a "clean repeal of Obamacare" and said he was disappointed that two amendments he had submitted were not adopted.
Even the state's Republican members of the House who voted for the bill struck a measured tone.
Congressman Paul Gosar, part of the far-right House Freedom Caucus, acknowledged the bill was not a full repeal, but said there were enough "conservative, time-tested" changes to this version of the AHCA to win his vote.
"Millions of Americans are drowning right now under the tidal wave of Obamacare regulations and mandates that have destroyed our entire health-care system. The American Health Care Act is a life raft to those suffering and represents a down payment towards a true market-based solution," Gosar said in a statement following the vote.
Congresswoman Martha McSally echoed those sentiments, saying she faced a "binary decision" and that the AHCA wasn't a "perfect bill."
“I will continue to work with state and local stakeholders and closely monitor this bill throughout the legislative and implementation process to ensure that my constituents have access to the care they need, that the most vulnerable are protected, and that Southern Arizona is better off in the future,” McSally said in a statement.
Congressmen David Schweikert and Trent Franks were the other Republicans from Arizona to vote yes.
The bill passed without a full analysis from the Congressional Budget Office, but some in Arizona's health-care industry say the new version of the AHCA will dramatically scale back Medicaid funding and, in the short term, cause premiums to rise for certain groups.
As written, the AHCA would allow states to apply for a waiver to what's known as the "community rating" requirement, which protected people with expensive medical conditions from being charged more than others.
"By removing that, insurance plans could charge people with pre-existing conditions significantly more to the tune where they could no longer be able to afford health insurance," Marcus Johnson of Vitalyist Health Foundation, which helps enroll people in Arizona's marketplace, said.
The AHCA allocates billions of dollars to help cover those with pre-existing conditions, but an initial analysis from Avalere Health shows that funding would not be nearly enough to cover everyone. Arizona has about 48,000 people with pre-existing conditions in its marketplace.
If Arizona pursues a waiver to establish a high-risk pool, Johnson said it's unclear whether Arizona would have the funding to cover the "demand of our aging and low-income population."
Arizona could also request exemptions from the "essential health benefits" that the ACA requires every insurance plan to include.
The Republican legislation also has major implications for Medicaid. It phases out the extra federal funding that Arizona received to expand the program.
More than 400,000 people in Arizona have joined the rolls of the state's Medicaid program since the state restored and expanded it. The new legislation keeps that enhanced funding for those already enrolled so long as they don't fall off the program, which is common among that population.
"This increases uncompensated care and forces hospitals to cost shift to commercial payers and businesses. There really isn't any free lunch in all of this," Debbie Johnston with the Arizona Hospital and Healthcare Association told KJZZ.
Johnston said the hospitals that won't be able to cost shift because of their payer mix may become financially unviable.
"We are deeply disappointed with the passage because it will jeopardize coverage for hundreds and hundreds of thousands of Arizonans," Johnston said.
"When you shift the risk and the blame from the federal government to states, it is going to make state government much more challenging with much less resources to do it," Dr. Daniel Derksen, director of the University of Arizona's Center for Rural Health, said about the changes to Medicaid.
"This isn't increasing or preserving choices. This is really reducing choices," Derksen said.
Along with rolling back the expansion, the AHCA changes Medicaid from an open-ended federal program to one that's capped. That most likely means less money for a state like Arizona, which already has a low-cost program.
Dr. Jeffrey Singer, who’s a surgeon in the Valley and a fellow at the Cato Institute, said that’s a good thing.
“By freeing states from the shackles of Washington, that money can go a lot farther. States need to be able to control their budgets because the way Medicaid is growing, it’s not leaving room for anything else,” Singer said.
In response to the vote, a spokesperson for Governor Doug Ducey emphasized that the legislation is still a work in progress:
"The governor remains supportive of the effort to repeal and replace Obamacare. As he has maintained, he wants a replacement that improves health care for Arizonans and ensures that no ones has the rug pulled out from under them. The House bill is the first step in this process, not the last. Now, the Senate will have its say, and we will be working with Senators McCain and Flake to ensure the bill is improved in a way that addresses Arizona's concerns and still achieves the ultimate goal, which is repealing Obamacare and restoring insurance markets that function so Arizonans can have access to high-quality and affordable health care."
Health policy expert Dan Derksen, MD, the Walter H. Pearce Endowed Chair and professor of public health policy and management at the University of Arizona Mel and Enid Zuckerman College of Public Health, has been appointed President of the Arizona Academy of Family Physicians (AzAFP). AzAFP’s 1,600 members include allopathic and osteopathic family physicians, family medicine residents, and medical students. It is the state chapter of the American Academy of Family Physicians with 120,000 members.
As director of the Arizona Center for Rural Health (AzCRH), Derksen oversees the state Office of Rural Health, the Rural Hospital Flexibility Program, the Small Rural Hospital Improvement Program, and the AzCRH Navigator Consortium.
After graduating from the University of Arizona College of Medicine in 1984, Dr. Derksen completed his family medicine residency at the University of New Mexico where he worked as a faculty member for 25 years.
While working for Governor Susana Martinez as Director, New Mexico Office of Health Care Reform, Dr. Derksen wrote and was funded ($34.3 million) by the Centers for Medicare and Medicaid Services to establish New Mexico’s state health insurance Marketplace that currently covers over 50,000 New Mexicans.
Dr. Derksen completed a Robert Wood Johnson Health Policy Fellowship in 2008 with U.S. Senator Jeff Bingaman. He researched and drafted federal legislative provisions to improve the nation’s supply and distribution of the health workforce enacted in 2010.
As principal investigator of state, federal, private foundation, and grants in excess of $55 million over his academic career, Dr. Derksen works to improve health insurance coverage and access to high quality health care, emphasizing community-based service-learning models in rural areas.
The Kansas City Star | By Scott Canon
APRIL 03, 2017 1:36 PM
Sen. Claire McCaskill of Missouri calls for GAO report on closings of rural hospitals
Sen. Claire McCaskill, a Democrat, has called on two federal agencies for more details about support of hospitals and schools in sparsely populated areas.
The Missouri senator wrote to the Government Accountability Office seeking answers to several questions about the rate at which rural hospitals are closing, what’s driving those trends and what it means for the quality of health care in those areas. The GAO is the investigative arm of Congress.
She also called on the U.S. Department of Education for a report on how various federal policies affect rural schools.
In a letter to the GAO dated March 31 and shared with The Star on Monday, McCaskill warned that financial pressures on rural hospitals, driven partly by federal policy, pose a particular threat to health care in some parts of the country.
“In recent years,” she wrote, “the number of rural hospital closures has increased significantly and if this trend continues, such closures could have a devastating impact on my constituents and countless other Americans.”
McCaskill also noted that the Centers for Disease Control and Prevention has said people in rural areas face a heightened risk of death from heart disease, cancer, accidents, some respiratory disease and stroke — suggesting that rural hospitals fill a special need.
The senator noted that health care plays a significant economic role in many small towns.
She also cited a Kaiser Family Foundation report issued in January that warned repeal of the Affordable Care Act would signal a “death knell” for some rural hospitals.
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Why So Hard to Kill the Affordable Care Act?
GOP consensus on swift repeal proves disastrously brittle
By Shannon Firth | April 06, 2017 | Washington Correspondent, MedPage Today
WASHINGTON -- For years, Republicans vowed that if they ever got control of the White House and both houses of Congress, the Affordable Care Act would quickly end up in the trash heap. As of January 20, those pieces were firmly in place.Yet nearly 3 months later, the GOP appears no closer to enacting a repeal-and-replace bill than they were when Barack Obama was sitting in the Oval Office.
MedPage Today asked physicians and policy experts why President Obama’s signature legislation is so hard to kill and whether Republicans might give up trying.
“It seems like they are really losing steam, and risking precious political capital on health reform, without a clear consensus or compass for where they want to go,” added Daniel Derksen, MD, director of the University of Arizona Center for Rural Health.
Asked whether the latest effort at compromise giving states an additional $15 billion -- an proposed by two Freedom Caucus members Thursday -- to help them pay for sicker patients would resuscitate the bill, Derksen didn’t think so.
“As a practical matter, funding high risk pools, or variants of that strategy – don’t have great track records of success.... I don’t think this will entice entrenched extremists who wish to do away with public subsidies of health insurance and coverage entirely.”
MEDPAGE TODAY | March 24, 2017
By Joyce Frieden (News Editor), and Shannon Firth
Washington Correspondent, MedPage Today
The House Republicans' proposal to replace the Affordable Care Act (ACA) appeared to be doomed from the start, experts said.
"Other than being able to say 'We repealed Obamacare,' there was little upside to this bill," said David Howard, PhD, of Emory University, in Atlanta, in an email. "It threatened to further destabilize the individual insurance market, and the savings to the federal government were modest. It is hard to have a coherent reform that does not address all aspects of the ACA, which is impossible in the reconciliation process."