Ohio sets up high risk pool; Four drug companies come under scrutiny for payments to Pittsburgh doctors, nurses

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Jul 26 2010

The Associated Press/Bloomberg BusinessWeek: "Ohioans with pre-existing health conditions, such as cancer or diabetes, can apply for coverage under a new high-risk insurance pool beginning Aug. 1." Qualifications include evidence of a pre-existing condition, proof of Ohio residency and U.S. citizenship, state of being uninsured for six months prior to the date of applying for coverage and being "ineligible for coverage under the Medicare program, the Ohio Medical Assistance Program, the Ohio Children's Health Insurance Program, or an employer-sponsored group health plan, unless subject to a mandatory initial waiting period" (7/22).

Pittsburgh Business Times: "Four pharmaceutical companies paid at least $3.5 million to Pittsburgh-area doctors and nurse educators in 2009, in large part to teach other health care professionals about medical treatments that could include use of the companies' products, according to a Pittsburgh Business Times analysis of data filed by the drugmakers. Such payments have come under increasing criticism from physicians and others within the national medical community, such as Dr. Marcia Angell, a Harvard University lecturer and former editor of the New England Journal of Medicine" (Mamula, 7/23).

Orlando Sentinel: "If you're a United Healthcare customer, chances are you've gotten a letter — or a mailbox full of them — in the past week. The reason? The Florida Hospital system and United Healthcare are embroiled in a contract standoff. If the two companies cannot agree on new terms by Aug. 15, about 170,000 United Healthcare customers in Central Florida would be unable to go to the 18 regional hospitals in the Florida Hospital network for nonemergencies or visit doctors employed by and [facilities] owned by the chain. Executives from both sides have been meeting since November, trying to negotiate a contract. But they remain at an impasse. At issue are the rates the insurer pays the hospitals for services" (Shrieves, 7/22).

The Nashua (N.H.) Telegraph: "Dr. John Gorman envisions the day when doctors go back to doing house calls under a new pilot program at Southern New Hampshire Medical Center. The program was created by the state to lower the cost of health care in New Hampshire, and SNHMC is one of five hospitals that has agreed to try it for the next five years. The methods of lowering costs could dramatically alter the way doctors are accustomed to working. … The Accountable Care Health Organization Pilot Project gives health care providers a direct role in controlling costs and holds them accountable for the quality of patient care" (Smith, 7/23).

WTNH.com/News8: Connecticut doctors are sometimes limiting the number of Medicare patients they see or scaling back their practices in order to cope with low Medicare reimbursements and a surging patient base. Surgeon Dr. David S. Katz, president-elect of the Connecticut State Medical Society says "physicians are frustrated and some are taking drastic steps. 'I have seen practices drop Medicare and I have seen practices also continue to see Medicare patients but limit the new patient availability of Medicare patients.'" Add baby boomers as a surging patient base, and the problem could get worse. In the fall, doctors again will face a cut in reimbursement if Congress doesn't act to stop it (Maminta, 7/22).

The Charleston (W. Va.) Gazette: "West Virginia will not run its own insurance pool for people who can't find health coverage because of pre-existing conditions, after Republicans in the House of Delegates said the program might fund abortions and Democrats decided they didn't want to debate the issue. About 1,200 state residents with conditions such as cancer, diabetes and congestive heart failure would have qualified for the high-risk pool program, which is part of federal health-care reform. People will still be able to join through the federal government, but supporters of a state-run pool say it would better serve consumers. The program covers people who have been uninsured for at least six months" (Knezevich, 7/22).

Kansas Health Institute: "A key legislator says he will propose putting a single agency in charge of the state's home and community based services for the elderly and for people with disabilities." Rep. Bob Bethell, an Alden Republican and chairman of the House Committee on Aging and Long-term Care, said "he's already shared the concept - 'but not in great detail' - with advisors to U.S. Sen. Sam Brownback, a Republican considered the front runner in the governor's race" (Ranney, 7/22).

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.