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Período de inscripción caótico pone en peligro cobertura de latinos

Kaiser Health News:HealthReform - October 30, 2017

Los latinos, que hace apenas un año eran los consumidores más buscados para inscribirse y obtener cobertura a través de los mercados de seguros creados por la Ley de Cuidado de Salud Asequible (ACA), puede que este año sean los grandes ausentes.

Navegadores y activistas comunitarios temen que el enfoque de la administración Trump —dejar que el Obamacare se vaya muriendo, quitar fondos y reducir el tiempo del período abierto de inscripción, entre otras medidas— pueda revertir los logros alcanzados en el número de latinos con cobertura de salud.

Los latinos fueron el blanco de los esfuerzos de la administración Obama, porque la comunidad tiene una alta tasa de no asegurados, y también porque una larga proporción es joven y bastante saludable, un detalle muy apreciado por las aseguradoras para balancear el gasto que generan los pacientes mayores y más enfermos, de hecho los que se inscriben con más facilidad.

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Cerca de un millón de personas que se identificaron como latinas o hispanas se inscribieron para tener planes de salud a través del mercado de seguros en el período de inscripción anterior, que terminó el 31 de enero de 2017, componiendo una décima parte de los consumidores. La tasa de personas sin seguro entre los latinos bajó de 43% en 2010 a menos del 25% en 2016. Pero todavía millones son elegibles y permanecen sin seguro.

Un período de inscripción más corto y recortes en los fondos federales para publicidad y para los grupos de navegadores —expertos en el mercado de seguros que ayudan a registrarse—, potencialmente pueden reducir de manera drástica la inscripción de latinos.

En los 39 estados que usan el sitio web federal la inscripción empieza el 1 de noviembre y termina el 15 de diciembre, cerca de un mes y medio más corta que el período anterior. Algunos estados que gerencian sus propios mercados de seguros han extendido la inscripción hasta el 31 de enero.

Claudia Maldonado, directora de programas de Keogh Health Connection, una organización que conecta a personas vulnerables con servicios de salud en Phoenix, Arizona, dijo que la incertidumbre domina estos días. “Estamos listos, porque sabemos que va a ser un período abierto de inscripción difícil”.

Oficiales federales dijeron que el sitio web para inscribirse en español, cuidadodesalud.gov, va a estar operando de nuevo esta vez, pero sufrirá los mismos cierres por mantenimiento programados para su hermano anglo, healthcare.gov.

Los Centros para Servicios del Medicare y Medicaid (CMS, por sus siglas en inglés), que gerencian los mercados de seguros federales por internet, anunciaron el mes pasado que los sitios estarían “cerrados por mantenimiento” la mitad del día los domingos, durante el período abierto de inscripción. Los estados que manejan sus propios mercados, como California y Nueva York, no se verán afectados por estos cierres programados.

En la oscuridad

Es desafortunado que la interrupción del servicio de cuidadodesalud.gov sea los domingos, dijo Daniel Bouton, director de servicios de salud en el Community Council of Greater Dallas, en Texas, una organización sin fines de lucro que ayuda a los latinos a inscribirse para tener atención de salud. “El día que los hispanos van a la iglesia, en donde están todos juntos y en donde los ayudamos a inscribirse en períodos anteriores”, agregó.

“Las personas quieren tener resuelto el tema de su cobertura de salud”, expresó Anne Packham, directora del proyecto de mercados de seguros en Covering Central Florida, una organización con sede en Orlando, Florida. “Y todos los anuncios sobre el Obamacare los frustran”.

Inscribir a un consumidor en el mercado no es un proceso de 10 minutos. Una familia puede comprar un plan de salud en el sitio web, o averiguar si algunos de los miembros son elegibles para el Medicaid o para CHIP, el programa federal de salud infantil con base en los estados para familias de bajos ingresos, pero que ganan demasiado para calificar para el Medicaid. La sesión con un navegador, que han ayudado a millones de latinos a inscribirse en todo el país, puede llevar una hora y media o más.

Muchos hispanos prefieren inscribirse para cobertura en persona, con un navegador entrenado, dijeron muchas personas con experiencia en ayuda a consumidores.

En un correo electrónico, los CMS dijeron que los cierres de los sitios web no afectarán el flujo de inscripción y que el centro de llamadas federal para responder preguntas de consumidores y navegadores “continuará asistiendo a las personas”.

“Es importante destacar que la duración potencial de los cortes es el máximo tiempo permitido para mantenimiento; pero podrían ser más cortos”, agregaron en el correo.

Un sitio alternativo

El sitio web en español tuvo un comienzo accidentado cuando se lanzó el Obamacare en 2013: abrió dos meses después que la versión en inglés. Sin embargo, los navegadores dicen que cuidadodesalud.gov a menudo ha servido como el “último recurso” para todos los consumidores, latinos o no, cuando tenían problemas con el sitio en inglés.

“En períodos de inscripción anteriores, muchas veces cuando healthcare.gov estaba caído, el sitio en español no lo estaba”, comentó Bouton.

Recursos

Preguntas y respuestas frecuentes:

Centro de llamadas, disponible las 24 horas, los 7 días de la semana: 1-800-318-2596

“Los navegadores son bilingües y generalmente usan el sitio en inglés, pero cuando éste no está funcionando bien, terminan el proceso de inscripción en cuidadodesalud.gov, que generalmente funcionó mejor [que healthcare.gov] en años anteriores”, dijo Julia Holloway, directora de desarrollo de programas y servicios de navegadores para Affiliated Service Providers of Indiana, en Indianapolis. Oficiales federales le anunciaron que su programa tendría 82% menos dinero para navegadores durante este período de inscripción.

El menor flujo de consumidores en cuidadodesalud.gov ha hecho que la versión en español sea tecnológicamente más estable.

Como ejemplo, desde noviembre de 2015 hasta el 2 de enero de 2016, cerca de 20 millones de personas usaron healthcare.gov, comparado con 953,708 que navegaron cuidadodesalud.gov.

Miedo a las deportaciones

Edgar Aguilar, gerente de programas en Community Health Initiative, una red de organizaciones de base en California que asiste con el proceso de inscripción para tener cobertura, dijo que, aunque California no enfrente algunos de los obstáculos que tendrán los estados que usan el mercado de seguros federal, la inscripción este año va a ser un desafío.

Aguilar está a cargo de la operación en el condado de Kern, en el Valle Central, que cuenta con una alta población de latinos que trabajan en granjas y cultivos.

“Tuvimos éxito inscribiendo a latinos en el pasado, el porcentaje de latinos sin seguro en el condado es de menos del 8%; pero la confusión sobre lo que está pasando con el Obamacare y el miedo a tener problemas migratorios, hace que las personas lo piensen dos veces antes de renovar un plan de salud o inscribir a sus hijos en el Medicaid o en CHIP”, explicó.

Navegadores encuestados para esta historia dijeron que han sentido más tensión este año, en los días previos a que comience el período abierto de inscripción.

En agosto, miembros hispanos del Congreso enviaron una carta al Departamento de Salud y Servicios Sociales (HHS, por sus siglas en inglés) pidiendo un compromiso para que los latinos siguieran inscribiéndose. Una vocera del caucus dijo que un representante del HHS prometió organizar una reunión sobre el tema, pero ésta nunca se concretó.

Un obstáculo para la inscripción es el miedo a las deportaciones. Los inmigrantes indocumentados no tienen derecho a comprar un seguro de salud a través de los mercados de ACA, pero hay miles de familias con estatus migratorio mixto, y los defensores temen que puedan dudar en comprar un seguro o solicitar subsidios para ayudar a pagar la cobertura.

“Desde que asumió el nuevo gobierno, cuando aumentaron las redadas y se puso en peligro el estatus de los ‘Dreamers’ (jóvenes que fueron traídos al país sin papeles cuando eran niños), las personas comenzaron a cancelar sus citas con los navegadores, y dejaron de inscribir a sus niños en el Medicaid o en CHIP”, aseguró Bouton.

Sin embargo, los navegadores dijeron que no se dan por vencidos. “Seguimos haciendo llamadas. Tenemos la misma meta de inscribir a más personas”, dijo Maldonado. Su organización está operando con 30% menos de presupuesto para navegadores. En su estado, Cover Arizona, una red de entidades sin fines de lucro, continúa organizando eventos, repartiendo folletos y llamando a las personas para alentarlos a que se inscriban.

“Tuvimos que cortar el presupuesto para publicidad, pero otra organización que tiene un poco más de dinero nos ayuda repartiendo nuestros materiales”, dijo Bouton. Más que nunca, dicen los navegadores, el foco está puesto en el trabajo en equipo.

“Somos apasionamos en lo que hacemos, y vamos a tratar de inscribir a la mayor cantidad de gente posible”, concluyó Holloway.

Big Gains In Latino Health Coverage Poised To Slip During Chaotic Enrollment Season

Kaiser Health News:HealthReform - October 30, 2017

Latinos, who just a year ago were highly sought customers for the Affordable Care Act’s marketplace plans may not get the same hard sell this year.

The Trump administration’s laissez-faire approach toward the upcoming enrollment period for the health law’s insurance marketplaces could reverse advances made in the number of Latinos with coverage, fear navigators and community activists.

Enrollment outreach efforts during the Obama administration targeted Latinos, both because they have a high uninsured rate and because a large proportion of the community is young and fairly healthy, criteria prized by insurers to help balance older, sicker customers, who are more likely to sign up.

This KHN story also ran in USA Today. It can be republished for free (details).

Nearly a million people who identify themselves as Latino or Hispanic enrolled in marketplace plans this year, making up a tenth of customers. The uninsured rate among Latinos dropped from 43 percent in 2010 to under 25 percent in 2016. Still, millions are eligible and remain uninsured.

A shorter enrollment season and cutbacks in federal funding for marketing and navigator groups have the potential to allow Latino enrollment to slip, the advocates say.

Enrollment for the 39 states using the federal website begins Nov. 1 and ends Dec. 15, about a month and a half less than in the previous year. Some states running their own exchanges have extended that period into January.

Claudia Maldonado, program director for the Keogh Health Connection in Phoenix, an organization that connects underserved people with health services, said uncertainty is what dominates these days. “We’re getting ready, because we know it’s going to be a difficult open enrollment period.”

The Spanish-language enrollment website, cuidadodesalud.gov, will be operating again this year, federal officials said, but it will face the same scheduled maintenance shutdowns as its Anglo sibling, healthcare.gov.

The Centers for Medicare & Medicaid Services (CMS), which manages the federal online insurance marketplaces, announced last month that the sites would be “closed for maintenance” for half the day on Sundays during the open enrollment period. The states that run their own marketplaces, such as California and New York, will not be affected by the shutdowns.

In Darkness

It’s unfortunate the service disruption of cuidadodesalud.gov will happen on Sundays, said Daniel Bouton, director of health services for the Community Council of Greater Dallas, a nonprofit that helps Latinos sign up for health care. “The day that Hispanic families go to church, where they are all together and where we have been enrolling them in previous years.”

“People want to have the issue of their health coverage resolved,” said Anne Packham, director of the insurance marketplace project at Covering Central Florida, an Orlando-based organization. “And all the announcements about Obamacare frustrate them.”

Enrolling a consumer on the exchanges is not a 10-minute process. A family can purchase a health plan there and also learn if they are eligible for Medicaid or CHIP, the federal-state insurance program for children in low-income families that earn too much to qualify for Medicaid. It can take up to an hour and a half and often requires more than one session with the navigator, who are the certified insurance market experts who have helped enroll millions of Latinos across the country.

Many Hispanics prefer to sign up for coverage in person with a trained navigator, said several people with experience helping consumers.

In an email, CMS said that scheduled website outages would not affect the enrollment flow and that the federal call center where consumers can get help with enrollment questions “will continue to assist callers.”

“It is important to note that the duration of the potential Sunday outages are the maximum amount of time allowed for the maintenance; actual outage times could be shorter,” the email added.

An Alternative Website

The Spanish-language website had a rough start when Obamacare plans launched in 2013, not coming online until two months after the English version. Still, navigators say that cuidadodesalud.gov often serves as a “last resort” for consumers, both Latinos and others, when they have technical problems with the English version.

Resources

Frequently asked questions:

CMS call center, available 24/7: 1-800-318-2596

“In past registrations, many times when healthcare.gov was down, the Spanish site was not,” said Bouton.

“Navigators are bilingual and generally use the site in English, but when it is not working well, they end the registration process in cuidadodesalud.gov, which often worked better [than healthcare.gov] in previous years,” said Julia Holloway, director of program development and navigator services for Affiliated Service Providers of Indiana, in Indianapolis. Her program has been told by federal officials that it will get 82 percent less money for navigators during the open season this fall.

The lower flow of consumers on cuidadodesalud.gov has made the Spanish version technologically more stable than the English version.

From Nov. 1, 2015, to Jan. 2, 2016, nearly 20 million people used healthcare.gov, compared with 953,708 who navigated cuidadodesalud.gov.

Fear Of Deportations

Edgar Aguilar, program manager with Community Health Initiative, a network of grass-roots organizations in California that assist people signing up for insurance, said even though California does not face some of the same challenges as states using the federal marketplace, enrollment this year will be challenging.

He is in charge of the operation in Kern County, in the Central Valley, which has a high population of Latino farmers.

“We were successful signing up Latinos in the past, there are less than 8 percent of Latinos without insurance in the county, but the confusion about what is happening with Obamacare and the fear of immigration problems make people think twice before renewing a health plan or [signing] up their kids for Medicaid or CHIP”, he said.

Navigators surveyed for this article said they feel more tension this year in the days leading up to the start of enrollment.

Hispanic members of Congress sent a letter to the Department of Health and Human Services in August seeking reassurance that enrollment outreach would continue for Latinos. A spokesperson for the caucus said an HHS representative promised to set up a meeting on the issue, but it never happened.

One hurdle to enrollment is the fear of deportations. Undocumented immigrants do not have the right to buy health insurance through the ACA markets, but there are thousands of families with mixed immigration status, and advocates fear they may be hesitant to buy insurance or apply for subsidies to help pay for coverage.

“Since the new government took office, when raids increased and the legal status of ‘Dreamers’ [young people brought to the U.S. while children] was in jeopardy, people started canceling their appointments with the navigators, and stopped enrolling their children in Medicaid or CHIP,” said Bouton.

However, navigators said they aren’t giving up. “We keep making calls. We have the same goal of registering more people,” said Maldonado. Her organization is operating with a 30 percent lower budget for navigators. In her state, Cover Arizona, a network of nonprofit organizations, continues to organize events, hand out leaflets and make calls to encourage enrollment.

“We had to cut the budget for marketing, but another organization that did not have that cut helps us and distributes our brochures,” said Bouton. More than ever, navigators say, the focus is on teamwork.

“We are passionate about what we do, and we will try to enroll as many people as possible,” said Holloway.

Money For Health Law Navigators Slashed — Except Where It’s Not

Kaiser Health News:HealthReform - October 30, 2017

Despite all the efforts in Congress to repeal the health law this summer and fall, the Affordable Care Act is still the law of the land. People can start signing up for health insurance for 2018 starting Nov. 1. But the landscape for that law has changed a lot.

Take navigators. Those are specially trained people who help consumers sign up for coverage. The federal government cut navigator funding by 41 percent. But that’s not an across-the-board cut. Some groups and states are dealing with far deeper cuts, while others will have dollars close to what they had last year.

South Carolina and North Carolina are cases in point. South Carolina’s navigator funding is about two-thirds less than the state had last year, while most of North Carolina’s funding is intact.

The Trump administration has said that it is rewarding groups that did a good job and cutting off those that didn’t. But the strategy may have the effect of hobbling navigators who have the most daunting job signing up people.

This story is part of a partnership that includes WFAE, NPR and Kaiser Health News. It can be republished for free. (details)

“We are between the rock and the hard place,” said Shelli Quenga, who runs programs at the nonprofit Palmetto Project, South Carolina’s largest navigator group. “We know that people in rural areas don’t have as much internet access. The people who need help are probably in the rural areas, but we can’t afford [to send navigators there].”

Instead, Quenga said, she will have to be strategic about where she plans to place navigators.

“It is based on those areas that are a) more densely populated and b) had a higher level of ACA enrollment for 2017,” she explained.

That means about two-thirds of the state’s counties will not have any navigators. Quenga said she is still planning to help people in those areas by using screen-sharing technology to walk people through sign-ups. People can always call the federal call center for help, but that’s not ideal, she said.

Ilia Henderson (left) plans to sign up for a health insurance plan on the federal marketplace with help from Charlotte, N.C.-based navigator Julieanne Taylor again this year. (Alex Olgin/WFAE)

Quenga said her employees really take the time to work through complicated cases. For example, she said, “lots of people have family members sleeping on their couch. Do you count that person as a tax dependent or not?”

The answer is complicated. How much someone gets financial aid is based on his or her taxable income, which changes with the number of dependents, she said. “Choosing whether to include that person as a dependent can have big consequences in terms of your financial assistance,” she said. “The call center is not set up to run those scenarios for you.”

And with less help from the federal government, Quenga said, she feels the pressure mounting to get more people signed up for coverage during this year’s shorter enrollment period. If she does, there’s a chance her navigator group will be better funded next year.

The picture is very different in North Carolina. There, navigator groups had only about 10 percent of their federal funding cut.

Jennifer Simmons coordinates North Carolina’s largest navigator program, the NC Navigator Consortium, and said she’s happy to report there will be someone available in each of the state’s 100 counties during the six weeks of open enrollment this year.

They’ll help people like Ilia Henderson, who is 26 and lives in Huntersville, just outside of Charlotte. She is one of those young, healthy people insurance companies want and she’s getting ready to sign up for coverage with navigator Julieanne Taylor.

Last year, Taylor helped Henderson, a massage therapist and student, sign up for a medical and dental plan within half an hour for a good price — just over $100 a month. She looks forward to working with Taylor to find a similarly good deal for 2018. Simmons said her navigators will be in libraries, public health departments and even churches around the state.

“We are remaining really laser-focused on making sure that consumers across North Carolina are able to get info they need,” she said.

“There are a lot of people that need renewal services and help in making sure that the marketplace has their updated information and that the plan that they are in is still the right plan for their family,” Simmons said. “But we are also trying to reach new people.”

Last year, North Carolina had one of the highest enrollments, with more than half a million people signing up. South Carolina, with about half of North Carolina’s population, has more than 183,000 people enrolled.

Sabrina Corlette with Georgetown University’s Center on Health Insurance Reform predicts enrollment numbers will drop during this open enrollment period.

“It’s just been decision after decision,” she said, “including this navigator funding cut that will ultimately lead not to just lower enrollment in the marketplaces but sicker enrollment in the marketplaces.”

And if that happens, Corlette said, count on higher premiums with fewer people in the insurance pool.

This story is part of a partnership that includes WFAE, NPR and Kaiser Health News.

Flurry Of Federal And State Probes Target Insulin Drugmakers And Pharma Middlemen

Kaiser Health News:Marketplace - October 30, 2017

With the price of a crucial diabetes drug skyrocketing, at least five states and a federal prosecutor are demanding information from insulin manufacturers and the pharmaceutical industry’s financial middlemen, seeking answers about their business relationships and the soaring price of diabetes drugs.

Attorneys general in Washington, Minnesota and New Mexico issued civil investigative demands this year and are sharing information with Florida and California, according to various corporate financial filings.

Insulin makers Eli Lilly, Novo Nordisk, Sanofi and top pharmacy benefit manager CVS Health are targets in the state investigations. Several of the financial filings note that the state and federal prosecutors want information regarding specific insulins for specific dates in relation to “trade practices.”

They appear to be looking into potentially anti-competitive business dealings that critics have leveled at this more than $20 billion niche market of the pharmaceutical industry, according to analysts and court filings reviewed by Kaiser Health News. These include whether drugmakers and middlemen in the supply chain have allowed prices to escalate in order to increase their profits.

This KHN story also ran on NBC. It can be republished for free (details).

At the same time, prominent class-action lawyers are bringing suits on behalf of patients. Steve Berman, an attorney best known for winning a multibillion-dollar settlement from the tobacco industry, alleged collusion and said it was time to break up the “insulin racket.”

The price of insulin — a lifesaving drug — has reached record highs as Eli Lilly, Novo Nordisk and Sanofi raised prices more than 240 percent over the past decade to often over $300 a vial today, with price rises frequently in lockstep, according to information technology firm Connecture.

Those prices take a toll on patients like 21-year-old Hunter Sego, who needs about four vials a month for his Type 1 diabetes. When he went to the pharmacy last year, the drug was no longer on a preferred tier and the price had risen to $487 a vial, compared with about $200 from a few years ago. Insurance companies often take drugs off a preferred list in response to pharmaceutical price rises to discourage overuse, a business strategy that leaves patients stuck in the middle.

“I was absolutely floored,” Sego said.

The DePauw University junior began skipping doses, knowing that his parents were paying cash until they met their health plan’s high deductible. Sego lost weight and felt lethargic, and his grades suffered. Sego’s college football coach finally called his mother to ask what was going on.

“I have to watch him like a hawk because I know he is trying to save money,” said his mother, Kathy Sego.

Last year, before the states took action, the U.S. Attorney’s Office for the Southern District of New York, one of the nation’s most powerful federal prosecutors, issued civil investigative demands to Eli Lilly, Novo Nordisk, Sanofi and Express Scripts, according to financial filings.

“There is enough concern about competition in the drug industry to have galvanized forces at the state and federal level to create specific pictures of abuse,” said Diana Moss, president of the American Antitrust Institute after hearing of the investigative demands.

Attorneys general use the legally binding demands to collect evidence, such as documents and emails, and testimony to help “piece together any number of stories about potential competitive harm,” Moss said.

Insulin prices have risen at regular intervals for years, Connecture’s research shows, but the trend has become more pronounced in the past few years. For example, in the final months of 2007, Sanofi’s Lantus cost $88.20 per vial and Novo Nordisk’s Levemir $90.30 a vial. Today, after increasing in tandem over the years, Lantus costs $307.20 per vial and Levemir runs $322.80 for the same amount, based on average wholesale prices.

The increases “don’t all happen on the same exact day, but they happen pretty close to each other on the calendar,” said Jim Yocum, senior vice president of federal contracts with Connecture. “I don’t know of any other industry where such regular price increases have been the norm.”

The United States is one of the few developed countries without regulations on prescription drug pricing. So, one of the few tools available for the government to curb price increases is to show fraudulent or anti-competitive practices.

Late last year, Sen. Bernie Sanders (I-Vt.) and Rep. Elijah Cummings (D-Md.) asked the Department of Justice and the Federal Trade Commission to investigate, noting “the potential coordination by these drug makers may not simply be a case of ‘shadow pricing,’ but may indicate possible collusion.”

Spokespeople for Eli Lilly, Novo Nordisk and Sanofi said in separate statements that each company sets prices independently. Novo Nordisk’s Ken Inchausti added: “We monitor market dynamics and our competitors’ pricing through public and subscription databases that track list prices.”

Each of the pharmaceutical companies said it is committed to ensuring patients have access to medicine. Novo Nordisk, which makes Novolog and Levemir, also pledged to limit price increases. Eli Lilly has announced a discounted insulin program.

State and federal prosecutors often begin investigations because of consumer and whistleblower complaints, several civil and antitrust attorneys said, and gripes about rising insulin prices have been roiling the online diabetes community for the past few years.

Indeed, James Tierney, former attorney general of Maine and a lecturer at Harvard Law School, said the civil investigative demands are not uncommon and the companies “may be totally innocent.”

It’s difficult to know exactly what the state and federal prosecutors are looking for, though, Tierney said. The investigations are often sealed from the public, revealed primarily when public companies acknowledge receiving them in their financial filings.

Nearly all of the federal and state officials declined to confirm or deny the investigations, except Washington and New Mexico officials, who confirmed the existence of the civil investigative demands.

Still, clues about the insulin investigations can be pieced together from corporate filings. They focus on issues like pricing and business relationships. Several ask for information about specific insulins regarding certain years.

Timeline: Insulin Market Under Scrutiny

In January — at about the same time states began filing civil demands — the first of a handful of potential class-action lawsuits that were national in scope were filed.

A U.S. district judge combined Berman’s suit and several other national cases last month, adding the pharmacy benefit managers, or PBMs (Express Scripts, CVS and UnitedHealth Group with its division OptumRx) as defendants.

Berman and the other attorneys declined interview requests. But attorneys at Keller Rohrback, one of the firms whose case was rolled into Berman’s, explained the reason for adding the PBMs in a May letter to the court: “The PBM defendants play a central role in the scheme — selling formulary access in exchange for ‘rebates’ or other payments” from the manufacturers.

Rebates, or negotiated discounts, occur when a manufacturer sets a list price and then agrees to pass money back to the PBMs in return for something, generally a spot on the formulary that determines which drugs can be purchased.

The PBMs say their negotiations ensure drugs are affordable, and two of them pointed fingers back at the drugmakers.

Express Scripts spokesman Brian Henry declined to comment on the investigations or lawsuit but stated in an email that “if prices have gone up in lockstep, that is because they have been priced by the drug makers in lockstep.” UnitedHealth did not respond to questions. And CVS Health called the lawsuit without merit.

CVS spokesman Michael DeAngelis said in an email: “Pharmaceutical companies alone are responsible for the prices they set in the marketplace for the products they manufacture. Nothing in our agreements prevents drug manufacturers from lowering the prices of their insulin products and we would welcome such an action.”

Such lawsuits generally take years to resolve. In the meantime, the suits and the investigations may provide answers to the demands of lawmakers like Sen. Amy Klobuchar (D-Minn.), who sent a letter to drugmakers in July asking for an explanation for the “extreme price increases.”

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

HHS Office for Civil Rights Issues Guidance on How HIPAA Allows Information Sharing to Address the Opioid Crisis

HHS Gov News - October 28, 2017

Following President Trump’s call to action yesterday that led to the declaration of a nationwide public health emergency regarding the opioid crisis, the HHS Office for Civil Rights is releasing new guidance on when and how healthcare providers can share a patient’s health information with his or her family members, friends, and legal personal representatives when that patient may be in crisis and incapacitated, such as during an opioid overdose.

“HHS is bringing all of the resources our department has to bear in order to address this crisis. This will ensure families have the right information when trying to help loved ones who are dealing with the scourge of drug addiction,” said Acting HHS Secretary Eric D. Hargan. “I commend Roger Severino and the HHS Office for Civil Rights for their swift action in clarifying for healthcare providers how they can share information with a patient’s family and friends.”

“We know that support from family members and friends is key to helping people struggling with opioid addiction, but their loved ones can’t help if they aren’t informed of the problem,” said Director Roger Severino, of the HHS Office for Civil Rights.  “Our clarifying guidance will give medical professionals increased confidence in their ability to cooperate with friends and family members to help save lives.”

Current HIPAA regulations allow healthcare providers to share information with a patient’s loved ones in certain emergency or dangerous situations.  This includes informing persons in a position to prevent or lessen a serious and imminent threat to a patient’s health or safety.  Misunderstandings about HIPAA can create obstacles to family support that is crucial to the proper care and treatment of people experiencing a crisis situation, such as an opioid overdose.  It is critical for healthcare providers to understand when and how they can share information with patients’ family members and friends without violating the HIPAA Privacy Rule. 

For more information, visit https://www.hhs.gov/sites/default/files/hipaa-opioid-crisis.pdf

It is important to note that state or other federal privacy laws may also apply.  HIPAA does not interfere with state laws or medical ethics rules that are more protective of patient privacy.

Rural Areas — Already Short On Health Resources — Face Enrollment Hitches

Kaiser Health News:HealthReform - October 27, 2017

ATLANTA — Ms. Stella’s, a home-cooking restaurant in Milledgeville, Ga., serves roast beef, grilled pork chops, chicken wings and oxtails with 24 sides from which to choose. Last spring, owners Jeri and Lucious Trawick opened a second restaurant in Eatonton, about 20 miles away, and Jeri decided to leave her full-time job to help shepherd the expansion.

But she needed to update the couple’s health insurance and went shopping on the Affordable Care Act’s online marketplace. Trawick, 43, who considers herself nearly as skilled with a computer as she is with a skillet, found the Obamacare website daunting.

“It was not exactly user-friendly,” she said. Trawick needs specific medications to control her hypertension, and the section on drug coverage left her “confused.”

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She turned to Insure Georgia, a program funded in large part by federal money to help consumers enroll in Obamacare. A trained navigator showed her how to compare policies on the website, look at drug formularies and examine differences in prices and provider networks.

“I could have done it without her, maybe, but it would have taken me forever,” Trawick said.

This fall, it will be different.

Open enrollment for ACA plans, which begins Nov. 1, has been shortened to 45 days. At the same time, funding for navigator programs and other support for consumers has been cut dramatically in Georgia — by 86 percent — and across the country.

The number of navigators for Insure Georgia, the nonprofit agency that has received the bulk of federal funding for enrollment efforts in past years, will drop to 21 from 42 last year, said Fred Ammons, chief executive officer of Community Health Works, the parent organization of Insure Georgia.

There is no advertising budget to even inform consumers that open enrollment begins. Ammons said he is concerned that with all the past year’s rhetoric among Republicans in Washington about repealing and replacing Obamacare, some people may not even understand that the program is still available.

That could be a problem in Georgia, which, after seeing increased enrollment in the first three years of the marketplaces, experienced a 16 percent drop in sign-ups for 2017 coverage. In some rural counties the decline was as much as 36 percent. Georgia ranks third in uninsured residents, behind only Texas and Florida.

Lucious and Jeri Trawick, who have two restaurants in rural Georgia, turned to a navigator to help them decipher their health insurance choices and are nervous about less help being available when they sign up for 2018 coverage. (Family photo)

‘Isn’t Obamacare Dead?’

ACA supporters are concerned that residents in the rural portions of Georgia — which make up about 17 percent of the population — could be most at risk. In recent decades, those rural areas have fallen behind other parts of the state in income, educational achievement and in access to health care.

With enrollment assistance resources so strapped, it will be hard to reach out to rural consumers.

“We had a booth at the PRIDE festival in Atlanta last Sunday, and someone said, ‘Why are y’all even here? Isn’t Obamacare dead?’” Ammons said. “And if they think that in Atlanta, you can only imagine what they think in south Georgia.”

Health economist William Custer, who teaches at Georgia State University in Atlanta, echoed those fears about increases in the number of uninsured in rural Georgia.

The effects of less insurance will be felt hard in those areas, he explained. Nearly half of the state’s counties, most of them in rural areas, do not have an OB-GYN. Seven hospitals in rural Georgia have closed within the past four years. Several have closed their labor and delivery units. If people in rural Georgia lose insurance rather than gain it, efforts made in recent years by state leaders to stanch financial bleeding at rural hospitals could be jeopardized, Custer said.

“This is really the big worry. The problem in Georgia is that we have very different geographics, very different demographics and very different health care. These changes this year really seem to be pushing us even more to two Georgias,” Custer said.

‘Let Obamacare Fail’

Much of the cutbacks and confusion, health care advocates said, follows President Donald Trump’s disparagement of the law. He campaigned on a promise to “repeal and replace the disaster that is Obamacare” and announced in July that he would “let Obamacare fail.” Even though Congress could not pass a replacement bill, the Trump administration’s changes in timing and funding for enrollment will have an effect, the advocates charge.

“The most damaging has been the rhetoric and confusion,” said Laura Colbert, executive director of Georgians for a Healthy Future, an advocacy group. “Overall, this could be a bellwether for future years.”

Enrollment Resources

The federal marketplace English-language website: healthcare.gov

The federal marketplace Spanish-language website: cuidadodesalud.gov

The federal call center for consumer questions, available 24/7: 1-800-318-2596

The Kaiser Family Foundation’s FAQ on the ACA

Insure Georgia: www.insurega.org; 1-866-988-8246

And while the need for insurance is high in the state, Georgia lawmakers have been resistant to the federal health law. Georgia, like 18 other Republican-leaning states, refused to expand Medicaid, as the law allowed. The Legislature also prohibited the state from employing navigators to help enroll consumers.

Ammons, who is from rural Georgia, said he lies awake at night wondering how to reach people who need health insurance.

“I don’t know what I can do to help these uninsured people,” he said, adding that “for a brief moment, I thought ‘We can’t even do this.’”

That was the night he learned, in an email, that Insure Georgia’s funding had been cut from $2.3 million to $328,000.

Ammons said he realized that he would have to lay off full-time employees. He said he also figured out that he would have to cut back on navigators that Insure Georgia typically hired short term for open enrollment.

Next, he cut every non-personnel line item he could, which meant terminating leases and closing offices. The group found donated space in Vidalia, in central Georgia, and in Brunswick, a port city near Savannah. But that leaves the southwestern portion of the state, an especially poor area of Georgia, without a nearby office.

Ammons said that other nonprofit groups have donated money that will allow Insure Georgia representatives to travel to 500 community enrollment events across the state. While Insure Georgia held more than 1,500 community events last year in all of Georgia’s 159 counties, his goal is more modest this year.

“We want to at least be in every county with a Walmart,” he said.

Jeri Trawick said she is worried for herself and for thousands of other Georgians.

To help with enrollment efforts, the Trawicks on Nov. 6 will be serving something else along with their homemade food at Ms. Stella’s in Eatonton.

“We’re going to have an open enrollment event, with a navigator here, from 10 until 6,” she said. “And I’ll be the first one in line.”

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