Utah Gov. Gary Herbert
No sooner had we posted an update on the prospects for Medicaid expansion in several states, including the three that passed ballot initiatives in November, than news came of obstacles emerging in Utah.
The state legislature may take one or more of these actions: delay the April start; cover fewer people; add work requirements or other conditions. Continue reading
Photo: joelip via Flickr
Advocates in three conservative states – Utah, Idaho and Nebraska – are trying to get Medicaid expansion on the ballot in November.
Organizers in Utah already have submitted signatures, which are now being verified. They have surplus signatures so odds are that they will make it. According to an article by Dylan Scott of Vox, a recent poll by the Salt Lake Tribune and the University of Utah found 62 percent of Utah voters support the ballot initiative. Continue reading
By Nov. 16, states must make firm decisions about whether they will run a state exchange, whether they will allow the federal government to set up the exchange in the state, or whether the state and HHS will partner on the exchange – divvying up responsibilities for a year or two as the state gradually assumes more responsibility. The election obviously puts the long-term future of health reform in doubt but, as of the Nov. 16 deadline day, the Affordable Care Act will still be in force.
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.
We had an AHCJ webcast last week with three experts on state exchanges to explain some of the choices and factors in the decision making. Interestingly, all of them think state-based exchanges will remain part of the health reform lay of the land, no matter who wins in November, though the context may change. If Barack Obama is re-elected, the law survives and all states must have an ACA-compliant exchange ready on Jan. 1, 2014. If Mitt Romney is elected, he’s promised to repeal it – and leave a lot of the problem solving to the states. Exchanges could be part of the state approach, in some shape or form, particularly as many states have already done a fair amount of the groundwork.
The three experts have a great deal of state-focused health policy experience. All three have on-the-ground experience in state government, all have worked in Washington, D.C., and they bring a mix of foundation/think tank/academic/private sector consulting background. Continue reading
Reporting on how drug shortages are impacting paramedics, The Associated Press’ Jonathan Cooper discovered things had deteriorated to the point that, he writes, “Paramedics reported asking some of those facing medical emergencies: ‘Is it OK if we use this expired drug?’”
Based in Oregon, Cooper found that, in fact, paramedics around the northwest have been forced to dig up supplies of expired drugs to meet critical needs. He writes that, while manufacturers don’t seem to be willing to discuss drug effectiveness beyond declared lifespans, “Medications are only guaranteed to work as intended until their expiration date. When stored properly, most expired drugs won’t be harmful to patients but will become less effective with time, according to medical professionals.”
State public health officials, who license ambulances and in some cases dictate the medications they must carry, are loosening their rules to help emergency responders deal with the various shortages. Oregon health officials last week began allowing ambulances to carry expired drugs, and southern Nevada has extended the expiration dates for drugs in short supply. Arizona has stopped penalizing ambulance crews for running out of mandated medications.
Some agencies have reported keeping their drug kits fully stocked by substituting alternative medications, some of which have additional side effects or higher costs, or by diluting higher dosages to get the less-concentrated dose needed.
Past shortages have included key painkillers and sedatives. Current critical needs include epinephrine and morphine – and you don’t have to be a pharmacist to imagine why a shortage of those might be problematic for front-line medics.
Manufacturing quality lapses, production shutdowns for contamination and other serious problems are behind many of the shortages, according to manufacturers and the FDA. Other reasons include increased demand for some drugs, companies ending production of some drugs with small profit margins, consolidation in the generic drug industry and limited supplies of some ingredients.
Wholesome, clean-living and thrifty, Provo, Utah, has always been a Dartmouth Atlas darling. But in recent years, health costs in Provo – like those in similarly cheap markets nationwide – have risen faster than in the rest of the country. Kaiser Health News’ Jordan Rau takes a deeper look at the Utah college town in an effort to figure out why, despite recent efforts to bring everybody else down to Provo’s cost level, Provo seems to instead be climbing up to join its costlier cousins.
Provo, Utah (Photo by jpstanley via Flickr)
In Provo, the costs seem to come down to a few interlocking factors which should already be familiar to anyone who has investigated health care costs in the past. They include advancing technology and more aggressive treatment, all driven by an increase in the number of hospitals and clinics competing in the area. It’s a combination that’s looking increasing irresistible.
To some, it’s inevitable low cost areas such as Provo will catch up to their more expensive peers as a greater proportion of medical spending goes toward expensive machines and nursing salaries, which are rising, says Greg Poulson, senior vice president at Intermountain. Aggressive marketing of the latest technology also is making it more likely that patients everywhere are demanding the same novel treatments, even ones that aren’t proven to work better, Poulson says.
