Cross posted at Daily Kos

Welcome to the second edition of the Holy Handgrenade’s Healthcare News Round-up. My goal with this Series is to focus on healthcare related news items that I feel would be of interest to the Booman community.

Today’s column will focus on possible reductions to the Medicaid roles in North Carolina, hospital closings, the uninsured and core blood collections.

(more below the flip)

North Carolina Medicaid Cuts

First up Today is an item from The News and Observer, out of the Raleigh/Durham region of North Carolina, titled 57,000 Might Lose Medicaid Benefits. In an effort to meet state budget requirements, the North Carolina Department of Health and Human Services has proposed a Medicaid budget that would lower the income levels that are used to determine Medicaid eligibility.

The budget also imposes a freeze on reimbursement levels for hospitals and physicians, as well as nursing homes and pharmacies.

These cuts would focus on the dual eligible Medicaid recipients (those eligible for Medicare as well as Medicaid). These members would lose access to services that Medicaid traditionally covers the Medicare co-insurance amounts, such as home nursing services and, in the case of younger, disabled recipients, their prescription coverage.

United HealthCare Posts Strong Earnings from Higher Premiums

The next item is one that I find more than just a bit troubling (as someone who deals with managed care payers on a daily basis). It is illustrative of the current trend in managed care in the healthcare industy.

In an article titled UnitedHealth Profit Up on Higher Premiums, Yahoo indicates that United HealthCare (UHC) has reported a 41% increase in first quarter earnings, far exceeding expectations. The profits are based on UHC’s increased premiums and cost cutting.

The reason I find UHC’s profits troubling is due to their current negotiation strategy with physician groups. UHC has taken the tactic that any non-participating provider will not be paid directly, instead sending payment to the member. This creates a difficult situation for both the provider and the patient and is used as a strong arm to force providers into participation status. A participation status that is usually accompanied with sub-par reimbursement rates.

UHC’s negotiation tactics, coupled with their recent purchases of Oxford Health and MAMSI (a large managed care payor in Maryland),  have put providers at a distinct disadvantage, creating cash losses that are generally shifted to other charge paying payors and the uninsured population.

It is disturbing to think the United HealthCare is reaping great rewards at the expense of providers, their members and patients unaffiliated with UHC.

Shifting Burden of Uninsured ER Care

The next item for today is an article from the LA Times titled Study Sees Shift in ER Care. A report by the National Health Foundation reviewed the trends in uninsured emergency department visits in Los Angeles County for the five year period of 2000 – 2005. The report indicates that, while insured care at the four county public hospitals has dropped by 27% during the sample period, the number of uninsured patients treated at private hospitals jumped by a third. This shift from non-profit public hospitals to for-profit private hospitals is a major factor in the closure of nine private emergency departments in LA County during the last few years.

The study also indicates that more than 2 million LA County residents are currently without health insurance, falling mainly in the 19-64 year old demographic. This is one of the highest percentages of uninsured versus overall population of a major metropolitan area in the country. Many of the uninsured in LA County are employed, just with jobs that do not provide healthcare, or cannot afford the premiums for healthcare their employers are offering.

GOP Turning on Bush’s Medicaid Cuts

In a Yahoo article titled House GOP Balk at Size of Medicaid Cuts. In what is a welcome surprise, 44 GOP reps feel that the Medicaid cuts put forth by Bush’s budget proposal are excessive.

The reductions “will negatively impact people who depend on the program and the providers who deliver health care to them,” the GOP lawmakers said in a letter to Rep. Jim Nussle, R-Iowa, chairman of the House Budget Committee.

Considering the dire situation that most state’s Medicaid programs are facing, it is refreshing to see that both sides of the floor are prepared to fight the Bush administration’s attempts to gut the program.

The money quote in the article comes from Nancy Pelosi:

“It is crystal clear that a majority of both House and Senate members support a budget resolution that does not require such cuts,” said a press release from House Democratic leader Nancy Pelosi and Democratic Whip Steny Hoyer. “The question now is whether the Republican leadership and the Republican chairmen of the budget committees will honor the wishes of the majorities in both houses by reporting a conference report on the budget resolution with no cuts to Medicaid.”

The final budget will most likely contain some level of cuts to Medicaid funding. Hopefully a bi-partisan effort can prevent a catastrophic dismantling of the system.

Call for Federal Program Overseeing Use of Cord Blood

Finally, we have an article from the NY Times titled Group Calls for U.S. Program to Oversee Use of Cord Blood. A call for a new federal program to oversee the promotion and use of umbilical cord blood (a by-product of healthy childbirth) has been made by Congress’s main medical advisory group. As opposed to trying to explain cord blood usage myself, I’ll defer to the text of the article:

Collected with the donor mother’s permission, stem cells from umbilical cords represent a promising therapy for the thousands of people with leukemia, lymphoma and other diseases who cannot currently undergo bone-marrow transplants because they cannot find the right match. About 600 cord-blood transplants were performed in this country last year.

But broader use of the technique has been impeded by a limited supply of donor blood and doctors’ difficulties in finding compatible blood types among the 50,000 or so units now scattered among about 20 cord-blood banks around the country.

The recommendation is for another 100,000 units to be harvested. The main stumbling block of this effort is the high cost of the collection process, about $1,100 per unit collected. Of course, many insurers will not cover this process (speaking from experience here, I paid out of my own pocket to have this done when my daughter was born almost five years ago). Many samples collected currently are stored solely for the private use of the infant’s family (as are the samples collected in my case).

The goal is to create a public bank of cell samples, much like the current blood bank system. This is an issue that I will be watching very closely, especially considering the current administration’s stance on embryonic stem cell collection.

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