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Obamacare Repeal Could Leave Millions Uninsured

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In a first, marijuana substance reduces seizures for some epilepsy patients in clinical trial

Marijuana is seen under a magnifier at the medical marijuana farmers market at the California Heritage Market in Los
         Angeles, California July 11, 2014. Photo by David McNew/REUTERS/File Photo

Marijuana is seen under a magnifier at the medical marijuana farmers market at the California Heritage Market in Los Angeles, California July 11, 2014. Photo by David McNew/REUTERS/File Photo

For the first time, scientists have demonstrated that a component of cannabis reduces seizures in children with a rare form of epilepsy, marking a significant step in efforts to use marijuana and its derivatives to treat serious medical conditions.

The company that sponsored the Phase 3 trial, GW Pharmaceuticals, had already announced some of the results, but researchers said the full peer-reviewed study, published Wednesday in the New England Journal of Medicine, validated the importance of the research. They also pointed out that the drug, cannabidiol, helped some patients more than others and was associated with a range of sometimes severe side effects, a significant finding because some families have been treating their children on their own in states where recreational marijuana use is legal.

“We now have solid, rigorous scientific evidence that in this specific syndrome, cannabidiol is effective at reducing seizures,” said Dr. Orrin Devinsky, a neurologist at New York University Langone Medical Center and an author of the new study. But, he added, “This is not a panacea.”

Cannabidiol, which GW has branded as Epidiolex, is a non-hallucinogenic component of marijuana that can be purified and administered in oil.

READ MORE: The DEA is looking for candidates to grow marijuana for research — but will it find any takers?

For the trial, researchers enrolled 120 children from 2 to 18 years old with Dravet syndrome, a rare genetic form of epilepsy that kills up to 20 percent of patients by the time they are 20. There are no drugs approved specifically for Dravet.

During the study, the patients stayed on their normal treatment regimen, and half of them also received cannabidiol while the remainder were given a placebo. Over a 14-week treatment period, the median number of convulsive seizures in the cannabidiol group decreased from 12.4 to 5.9 per month; for the placebo group, the number went from 14.9 to 14.1.

In the cannabidiol group, 43 percent of patients had their number of seizures cut in half or more, compared with 27 percent in the placebo group. And 5 percent of patients taking cannabidiol saw their seizures disappear, compared with none in the placebo group.

Common side effects seen in the cannabidiol group included vomiting, fatigue, fever, drowsiness, and diarrhea. Eight patients in the group withdrew from the trial because of the severity of the side effects.

In an editorial published with the study, Dr. Samuel Berkovic of the University of Melbourne called the trial “welcome” and “the beginning of solid evidence for the use of cannabinoids in epilepsy.” But he noted that it needs to be replicated and that other studies will be required to know if cannabinoids — the different components of cannabis — can help with other forms of epilepsy and to treat adults.

As desperate families have sought to treat their children with cannabis or cannabidiol on their own, experts have cautioned that it can be risky. Researchers don’t know, for example, how cannabidiol will interact with other medications, and they know even less about how adding THC — a hallucinogenic cannabinoid — to the mix might affect children with epileptic syndromes. They also don’t know the long-term effects of taking cannabidiol.

For the trial, researchers enrolled 120 children from 2 to 18 years old with Dravet syndrome, a rare genetic form of epilepsy that kills up to 20 percent of patients by the time they are 20. There are no drugs approved specifically for Dravet.

During the study, the patients stayed on their normal treatment regimen, and half of them also received cannabidiol while the remainder were given a placebo. Over a 14-week treatment period, the median number of convulsive seizures in the cannabidiol group decreased from 12.4 to 5.9 per month; for the placebo group, the number went from 14.9 to 14.1.

In the cannabidiol group, 43 percent of patients had their number of seizures cut in half or more, compared with 27 percent in the placebo group. And 5 percent of patients taking cannabidiol saw their seizures disappear, compared with none in the placebo group.

Common side effects seen in the cannabidiol group included vomiting, fatigue, fever, drowsiness, and diarrhea. Eight patients in the group withdrew from the trial because of the severity of the side effects.

In an editorial published with the study, Dr. Samuel Berkovic of the University of Melbourne called the trial “welcome” and “the beginning of solid evidence for the use of cannabinoids in epilepsy.” But he noted that it needs to be replicated and that other studies will be required to know if cannabinoids — the different components of cannabis — can help with other forms of epilepsy and to treat adults.

As desperate families have sought to treat their children with cannabis or cannabidiol on their own, experts have cautioned that it can be risky. Researchers don’t know, for example, how cannabidiol will interact with other medications, and they know even less about how adding THC — a hallucinogenic cannabinoid — to the mix might affect children with epileptic syndromes. They also don’t know the long-term effects of taking cannabidiol.

This article is reproduced with permission from STAT. It was first published on May 24, 2017. Find the original story here.

The post In a first, marijuana substance reduces seizures for some epilepsy patients in clinical trial appeared first on PBS NewsHour.

Insurers continue to hike prices, abandon ACA markets

People shopping for insurance through the Affordable Care Act in yet more regions could face higher prices and fewer choices next year as insurance companies lay out their early plans for 2018. Photo by Mike Segar/Reuters

People shopping for insurance through the Affordable Care Act in yet more regions could face higher prices and fewer choices next year as insurance companies lay out their early plans for 2018.

Blue Cross and Blue Shield of North Carolina is asking regulators for a 23 percent price hike next year because it doesn’t expect crucial payments from the federal government to continue. That announcement comes a day after Blue Cross and Blue Shield of Kansas City said it will leave the individual insurance market next year, a decision that affects about 67,000 people in a 32-county area in Kansas and Missouri.

The Kansas City company’s decision also will leave shoppers in 25 counties with no options for coverage sold on public insurance exchanges, unless another insurer steps in, according to data compiled by The Associated Press and the consulting firm Avalere. The law’s insurance exchanges are the only place where people can buy coverage with help from an income-based tax credit.

Other insurers around the country, such as Aetna and Humana, have already said they will not offer coverage on exchanges next year, though several, including Centene, say they will.

Options are growing thin in many markets. The Kansas City insurer’s decision means that only 10 of Missouri’s 115 counties will have more than one insurer selling coverage on the exchange next year.

Blue Cross and Blue Shield of North Carolina sells coverage in all 100 North Carolina counties, and it is the lone option in 95. It said Thursday that its participation for next year is not guaranteed.

Insurers still have a couple months to consider their options before finally committing to selling coverage in 2018.

The North Carolina insurer said it expects no help from federal cost-sharing reduction payments next year, and that’s reflected in its initial rate request that calls for a 23 percent price increase, on average. If it could be assured of the subsidies that are part of the law and have been paid in the past, it said prices would rise about 9 percent. The insurer covers more than 460,000 people who bought coverage on the exchange.

It said about two thirds of those customers get cost-sharing help, but the price increase for providing insurance without this help will be spread over all of its customers in that market.

“Many ACA customers will pay more for coverage that is already a large portion of their household income,” said Brian Tajlili, director of actuarial and pricing services for the insurer.

The government has been giving insurers money to help customers with modest incomes cover out-of-pocket expenses like co-payments and deductibles. But the future of those payments, which are separate from the income-based tax credits that help people buy coverage, is in political limbo.

Republicans had sued the Obama Administration to stop the subsidies, and that case is now tied up in court. President Donald Trump’s administration has sent mixed signals over how it will pursue the case or whether the payments will continue. Insurers want some assurance that the payments, which total about $7 billion, will continue through 2018.

Tajlili said his company wants to see some sort of a legal guarantee, like Congress appropriating the money, in order to feel comfortable that the payments will actually be made through 2018.

Some of the biggest companies on the exchanges have yet to announce their coverage plans for next year. Those include Anthem Inc., which covers more than 1 million people through Affordable Care Act exchanges, offering Blue Cross-Blue Shield insurance in large states like New York, California and Ohio.

Many insurance companies have faced large financial losses selling this type of insurance and have responded by either raising prices or abandoning that kind of coverage altogether. Blue Cross and Blue Shield of North Carolina said earlier this year that it lost $38 million on ACA plans last year and more than $400 million between 2014 and 2015.

___

AP data journalist Meghan Hoyer contributed to this report from Washington, D.C.

The post Insurers continue to hike prices, abandon ACA markets appeared first on PBS NewsHour.

Less healthy, older Americans would pay more under GOP health bill

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JUDY WOODRUFF: But, first, let’s go back to the health care battle and the new analysis that came out late today from the Congressional Budget Office of the GOP bill that passed the House of Representatives almost three weeks ago. It now sits with the Senate.

The CBO found that the House bill would lead to 23 million more people being uninsured by the year 2026 and it would reduce the deficit by about $119 billion over a decade.

Our Lisa Desjardins has been studying the numbers and watching the politics of all of this, and she joins me now.

So, Lisa, you have had a little bit of time to look at this. Essentially, what is different about the CBO’s look at this version of Republican health care from what the earlier version was?

LISA DESJARDINS: Well, in those top-line numbers, not much.

The changes that the Republicans made meant that there was an improvement in the number of people with insurance by one million people. That’s something Republicans were happy to see, but it’s not really very much.

Judy, I think, overall, the differences are in the individual effects here. We see from CBO a forecast that says under this Republican bill you would see a wide disparity, with the less healthy seeing much higher bills and also older people seeing much higher bills.

JUDY WOODRUFF: So, we know the Republicans were trying to do a number of things with this legislation to make it more palatable to more people to win not only approval in the House, but to win approval in the Senate. They were trying to get premiums down.

Talk about some of the changes they made and what the CBO is saying about that?

LISA DESJARDINS: The biggest change a lot of people would be familiar with is, they want to give states the ability to waive out of requirements called essential benefits.

These are things that say any health insurance must cover the basics. They want states to be able to waive out of that. They also want states to be able to waive out of requirement on preexisting conditions, allow insurers to charge more for the sick than they can now.

CBO looked at those potential waiver changes and what that mean for premiums. Let’s look at an example of what we’re talking about. First of all, a 21-year-old who’s making, say, $26,500, so, low-income — that is who this is targeted at — now that 21-year-old’s premium would be $1,700.

But under this bill in a state that waives out of those requirements, that 21-year-old would pay $1,250. That’s good for that healthy 21-year-old.

Let’s look now instead at a 64-year-old American paying $1,700 now. But, Judy, look at that. Under this GOP bill, with the waivers out of requirements, the CBO thinks that 64-year-old would see their premiums skyrocket. Essentially, what the CBO has found — and it’s going to vary market to market — is that the less healthy and older Americans would see more costs.

JUDY WOODRUFF: So, premiums are part of the story, but we know something else that the CBO was looking at was, frankly, the overall quality of health care under this new legislation.

LISA DESJARDINS: And this is such an important point.

We have talked about premiums. It’s sort of a buzzword in a way, almost. But CBO went deeper and said that, in some of these states with the waivers, premiums may go down for some people, but, overall, they think that health care costs could substantially increase, because what you’re getting are health insurance packages that cover a lot less.

So, if you’re sick, you might have a low premium, but you’re going to pay a lot more out of pocket. Also, Judy, I asked on a call I just got off of with the CBO about stabilization. Are these markets going to be stable?

They told me point blank they think there will be a stability problem in these waiver markets. They say some people may not be able to get premiums at all and it would take those markets back to the days before the Affordable Care Act.

Essentially, Judy, more of a gamble for Americans. You would able to pay less, but you would have much higher risk.

JUDY WOODRUFF: Sounds like this is going to be even more complicated than what the Republicans — it’s going to make what they sent over more complicated and make it challenging to get it passed.

LISA DESJARDINS: I don’t see any Republicans coming out with happy tweets or statements today. No, Democrats are talking about the CBO score, not Republicans.

JUDY WOODRUFF: Lisa Desjardins, following the story, thank you very much.

The post Less healthy, older Americans would pay more under GOP health bill appeared first on PBS NewsHour.

What happens when states go hunting for Medicaid fraud

Now, faced with growing Medicaid enrollment and tight budgets, Republican lawmakers in several other states are taking
         similar steps to ensure that people receiving welfare benefits are eligible for them. Photo by Jonathan Bachman/REUTERS

Now, faced with growing Medicaid enrollment and tight budgets, Republican lawmakers in several other states are taking similar steps to ensure that people receiving welfare benefits are eligible for them. Photo by Jonathan Bachman/REUTERS

By the time Illinois decided to crack down on Medicaid fraud in 2012, state officials knew that many people enrolled in the program probably weren’t eligible. For years, caseworkers hadn’t had the time or resources to check.

To catch up, the state hired a private contractor to identify people who might not be eligible for the low-income health program and to make recommendations for whose benefits should be canceled. Within about a year, Illinois had canceled benefits for nearly 150,000 people whose eligibility could not be verified — and saved an estimated $70 million.

Now, faced with growing Medicaid enrollment and tight budgets, Republican lawmakers in several other states are taking similar steps to ensure that people receiving welfare benefits are eligible for them. Under their proposals, which are modeled on legislation drafted by a national conservative group, recipients would face tougher and more frequent eligibility checks. And the checks could be conducted by private contractors who are motivated to justify their hiring by knocking as many people as possible off the rolls.

Mississippi enacted a law in April that will require the state to hire a private contractor to create a new computer system to review and more frequently check the eligibility of people participating in Medicaid and the federal food stamps program, formally called the Supplemental Nutrition Assistance Program. Similar bills are being considered in Oklahoma and Ohio, and Missouri and Wyoming enacted similar laws last year.

Supporters say the measures will root out fraud in the welfare system. Fraud, overpayments and underpayments in all assistance programs cost federal and state governments about $136.7 billion in 2015, out of about $2.8 trillion spent in assistance overall.

In Mississippi, people “are intentionally scamming the system,” said state Sen. Josh Harkins, a Republican who supported the new law there. “This is to make sure we aren’t just carelessly spending state tax dollars.”

But Democratic policy analysts and advocates for people on welfare say that while it’s important to try to reduce fraud, the proposals go about it the wrong way. Roy Mitchell, executive director of the Mississippi Health Advocacy Program, says the bills are meant to sweep even eligible families off the system. “You basically put a bounty on Medicaid recipients,” Mitchell said.

The most concerning part of the new Mississippi law and the other proposals, Mitchell and others say, is that they give people who receive benefits as little as 10 days to respond when they are asked for more information to prove their eligibility. If they don’t respond or can’t provide the information, their benefits are canceled.

Welfare recipients move often, and many will miss the request, Mitchell said. People will be forced off the system, he said, just to re-enroll shortly after — a phenomenon referred to as “churn.”

In Illinois, the state saw savings when it first stepped up eligibility checks. But about 20 percent of those who were kicked off the rolls re-enrolled a short time later, according to state data. Most simply fail at first to respond to the state’s request for information.

Fraud, overpayments and underpayments in all assistance programs cost federal and state governments about $136.7 billion in 2015, out of about $2.8 trillion spent in assistance overall.

Model Legislation

The recent proposals follow model legislation drafted by the Foundation for Government Accountability, a Florida-based nonprofit that favors free-market principles. The point, said Jonathan Ingram, the foundation’s vice president of research, is to preserve finite government resources by ensuring that only eligible people are receiving benefits.

Many states, such as Oregon, are facing a backlog in verifying the eligibility of people enrolled in welfare programs. In a survey last year, officials from six states told the Kaiser Family Foundation that they were facing delays in confirming eligibility for Medicaid recipients, due mostly to challenges with their computer system or staff capacity.

Federal law generally requires eligibility checks once a year for Medicaid recipients and every six months for SNAP recipients, although that varies based on age, disability status and other factors. Eligibility requirements vary by program, but, generally, recipients must prove they make under a certain amount of money, are U.S. citizens and are residents of the state.

To verify citizenship and income, states use information from federal agencies, such as the Social Security Administration. About half of states also use a service provided by Equifax, a consumer credit reporting agency, to get more up-to-date information about wages when verifying Medicaid eligibility.

Many states rely on what recipients tell them about where they live and how many people they live with, which helps determine whether their household is eligible. Some state agencies cross-check the information applicants provide with other state agencies, inside or outside of their state.

The model legislation would require recipients to prove their identity. It would allow states to hire a contractor to collect personal information about welfare recipients, and would require the state to check any information that might indicate a change in eligibility at least quarterly. (The Mississippi law requires the state to hire a private contractor.) The state would also be required to explore joining a multi-state cooperative to identify individuals enrolled in other states.

Under the model, the state, not the contractor, would make the final decision about whether someone continues to receive benefits. And the amount the state saves by removing people from the rolls must exceed that spent to pay the contractors — a provision that could mean outside firms lose their state contract if they don’t flag enough ineligible recipients.

Mitchell said the bills are wrongly targeted at welfare recipients when they should be targeted at health care providers, such as doctors and pharmacists, who often commit fraud.

In general, states are already doing most of what is outlined in the bills, said Stacy Dean, vice president for food assistance policy at the Center on Budget and Policy Priorities. But, in instances where they aren’t, Dean and others say that hiring staff or updating computer systems would help, more than hiring an outside firm.

The bills are predicated, she said, on “the false narrative that SNAP and Medicaid are in crisis, that state administrators are bad at their job, and that low-income people are committing fraud.”

When states do start to check with more frequency, it increases the amount of churn, Dean said, and that can be costly to states. One national study found that administering agencies spend between $400 and $600 per person who is removed from the rolls and then re-enrolled.

Flagging Fraud

States that look more closely to ensure that people receiving benefits are eligible often find erroneous payments, as Minnesota did.

On average, about 4.8 percent of assistance payments by federal and state government agencies were made in error in 2015, according to a 2016 GAO report. The error rate for SNAP was estimated at about 3.7 percent and for Medicaid at about 9.8 percent.

States are particularly concerned with erroneous Medicaid payments because the program is expensive, at nearly $300 billion in 2015, and because states pay for part of it — about 37 percent in 2016. The federal government pays for SNAP.

The Foundation for Government Accountability says that by passing its model bill, states will save millions by canceling benefits for those who are dead, who don’t qualify, or who are committing fraud. If every state adopted the practices it advocates, the total savings could be up to $8 billion annually, the group said in a press release.

While Illinois did see savings in at least the first year of its new system, that was mostly because the state was catching up, said Anne Irving, director of public policy for AFSCME Council 31, the union that represents the state’s workers. The union estimated that having state employees do the work, rather than hiring a private contractor, would have saved the state an additional $18 million a year.

Faced with a grievance from the union related to its collective bargaining agreement, the state in 2013 reduced the amount of work it was paying the contractor to do. The contractor still flags discrepancies in the system, but it no longer makes recommendations on what the state should do about them.

In Mississippi, Equifax, the company that many states already contract with for up-to-date information, lobbied for the new law. The company wanted to educate lawmakers about the tools available in the private sector that can help them better determine eligibility, said Robert Purser of Equifax.

Under the new law, the state will now issue a request for proposals for a third-party company, and Purser said Equifax may apply. “The legislation is a step in the right direction,” he said. “It gives states the tools they need to determine eligibility.”

But it’s unclear what exactly will change under Mississippi’s new law. The law is not specific, and state officials say it’s too soon to tell how often eligibility checks will happen or whether the state will collect more information about recipients.

This story was produced by Stateline, an initiative of The Pew Charitable Trusts. You can view the original report on its website.

The post What happens when states go hunting for Medicaid fraud appeared first on PBS NewsHour.