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Hospitals worry as Obamacare repeal vote approaches

A heavyset man sits on a gurney pushed to the side of a hallway in the emergency room at Jefferson Health in Philadelphia. It’s not even 9 a.m, and already beds are filling up. CEO Dr. Stephen Klasko guides me to a fancy-looking IV pump. It can replace nearly half of someone’s blood after they got shot, stabbed or hurt in a car accident.

“In the old days, we would lose patients because we weren’t able to get that volume in quickly enough,” he said. “The difference between three minutes or seven minutes could be life and death.”

lasko is showing me around to make a simple point: It takes money to buy powerful equipment. And the bill to repeal Obamacare being voted on tonight in Congress threatens his revenue stream. Klasko estimates the legislation would move about 3 percent of his patients from the insured column to uninsured, which could cut annual revenue by $50 million to $100 million.

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GOP health care bill would send California’s costs skyrocketing
San Francisco Chronicle

The Republican-backed bill that would overhaul the Affordable Care Act would shift billions of dollars in health care costs from the federal government to states, with California on the hook for $6 billion in 2020 and growing to $24.3 billion by 2027, according to an analysis released Wednesday by Gov. Jerry Brown’s administration.

Nearly 14 million Californians, one in three adults and half the state’s children, are covered by Medi-Cal, the state’s version of the federal Medicaid program. Four-million residents enrolled through the Affordable Care Act. It’s unclear how the state would deal with the added costs under the bill — whether through new taxes, cuts to other state services or by dropping coverage or enrollees in the program.

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Doctor Turns Up Possible Treatment For Deadly Sepsis
National Public Radio

It’s hard not to get excited about news of a potentially effective treatment for sepsis, a condition that leads to multiple organ failure and kills more people in the hospital than any other disease.

But there have been so many false promises about this condition over the years, it’s also wise to treat announcements — like one published online by the journal, Chest — with caution.

The study, from Eastern Virginia Medical School in Norfolk, Va., reported some remarkable success in treating patients who were at high risk of sudden death.

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Understanding the Behavioral Health Crisis
Hospitals & Health Networks

Behavioral health and behavioral health care in America is in crisis. Nearly one in five U.S. adults has an active behavioral health condition, meaning that more than 40 million Americans — greater than the total population of New York and Florida combined — suffer from these diseases. In addition, nearly 4 percent of adults have serious thoughts of suicide, and more than 8 percent of youth have at least one major depressive episode yearly.

At the same time, behavioral health resources have been systematically reduced in the health care system. In North Carolina for example, nearly 70 percent of public inpatient psychiatric beds closed due to policy and reimbursement shifts from 1992 to 2012. And although there are signs of progress — such as requiring coverage of behavioral health services as an “essential health benefit” in the Affordable Care Act, the recent inclusion of significant behavioral health support in the 21st Century Cures Act and many private efforts in communities nationwide — our journey to an effective and just behavioral health system undoubtedly will be long and complicated.

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Health Care Plan Championed By Trump Hurts Counties That Voted For Him
National Public Radio

The Affordable Care Act replacement plan championed by President Trump would hurt low-income people in rural areas that voted heavily for the Republican last fall, according to an NPR analysis of data on proposed subsidy changes from the Kaiser Family Foundation.

The new changes in tax credits and subsidies for older Americans are a big reason many Republicans are hesitant to get behind the American Health Care Act, which is set for a vote in the House on Thursday.

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Why Trumpcare Is DOA: It Doesn’t Address Outrageous Healthcare Prices

Paul Ryan is “excited” that The American Health Care Act, as Republicans call their bill, will trim the federal budget by several hundred billion dollars over the next decade. The 24 million people who are expected to lose insurance under the AHCA aren’t excited about the bill, which will cut government spending at their expense, with potentially fatal consequences for those who go without timely medical care.

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GOP eyes eliminating benefit mandates in late scramble to pass ACA repeal
Modern Healthcare

The White House and U.S. House of Representatives’ ultra-conservatives reportedly were negotiating Wednesday night to repeal the Affordable Care Act’s insurance benefit rules in a last-minute effort to salvage House Republicans’ ACA replacement bill.

The provision being discussed would erase the ACA’s minimum essential benefits requirement for fully insured plans in the individual and group markets. That requires all plans to cover benefits in 10 categories, with benefits determined by the states but comparable to the most common small-group plans.

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AMA urges Congress to vote no on amended ACA repeal bill
Modern Healthcare

The American Medical Association called on Congress to vote down the American Health Care Act despite Republican’s last-minute amendments to the bill, claiming millions will lose coverage if it becomes law. The trade group said in a letter to Congress Wednesday that it is still concerned about the law’s plan to roll back Medicaid expansion. AMA said the bill’s proposed tax credits are less generous than the Affordable Care Act’s cost-sharing subsides for low-income individuals.

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Health care reform calls for simplicity, catastrophic coverage
Orange County Register

At last in control of both houses of Congress and the presidency, Republicans wisely put a priority on additional health care reform.

Though hailed at the time as a triumph for liberals, Obamacare ultimately divided Democrats, some of whom had warned from the outset it would prove too cumbersome and unreliable for many Americans to navigate or support. But the GOP approach to fulfilling its promise of “repealing and replacing” Obamacare has gotten off to a shaky start.

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Guest Commentary: Benefits first, then cost considerations—getting ACA reform right
Modern Healthcare

Discussions about repealing and replacing the Affordable Care Act point to its shortcomings and how a new program will be better. However, the current process is repeating a fundamental error in crafting the ACA—it was implemented backwards.

The ACA, signed into law by President Barack Obama on March 23, 2010, contained many provisions for changing the limits on health insurance—for example, lifetime limits on expenditures for care and exclusion for pre-existing conditions were eliminated.

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Bills California says GOP health bill would cost state billions
Associated Press

The Republican health overhaul bill in Congress would cut federal payments for low-income health coverage in California by an estimated $6 billion in 2020 and more than $24 billion in a decade, Gov. Jerry Brown’s administration said Wednesday.

In their first detailed analysis of the bill’s impacts on Medi-Cal, state officials said lawmakers would eventually have to decide whether to spend additional money on the program that provides health coverage for the poor. They may have to cut costs by covering fewer people, reducing their benefits or paying less to doctors and hospitals.

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California Officials: State Will Lose $24 Billion by Decade’s End Under GOP Health Plan
KQED Radio

California would lose $24.3 billion in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to a new state analysis released Wednesday.

The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said.  The analysis, based on internal cost, utilization and enrollment data, was sent Tuesday to the state’s secretary of Health and Human Services.

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Jerry Brown sounds skeptical note on single-payer health care for California
Sacramento Bee

Gov. Jerry Brown, in Washington warning about the billions his state could lose on the eve of a Republican effort to repeal and replace Obamacare, strained Wednesday to understand the logic behind pushing another system like single-payer.

“Where do you get the extra money?” Brown asked in an extended chat with reporters. “This is the whole question. I don’t even get … how do you do that?”

Universal healthcare has gained in popularity, particularly among liberal groups in California, as an answer to what they see as the undermining of Obamacare.

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The Incredible Self-Destructing Healthcare Marketplace
The Health Care Blog

Too frequently what gets overlooked in policy making are the regulations that implement or update legislation. As Henry Mintzberg observed over 30 years ago policy is oftentimes formed without being formulated. For example, the Congress did not define the most important provision in MACRA. The Congress simply defined financial risk under an Alternative Payment Model (APM) as monetary losses in excess of a nominal amount. It was CMS that determined via regulatory rule making specific revenue and benchmark-based standards.

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CMS needs to alert docs as it overhauls Medicare ID cards
Modern Healthcare

As the CMS works to remove Social Security numbers from millions of Medicare ID cards, providers are calling on the agency to increase physician outreach efforts to alert them how billing under the program may change.

During a Wednesday meeting, HHS‘ Advisory Panel on Outreach and Education told the CMS that it needs to ensure that providers know they must update their electronic health record systems to accept new Medicare ID numbers created to curb fraud and abuse.

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GOP Health Plan Aims To Curb Medicaid, Expand State Options
Kaiser Health News

For all its populist design, the House GOP’s latest proposal to overhaul federal Medicaid funding creates financial risks for states and could leave some enrollees worse off.

Dramatic changes in Medicaid are a big part of the House bill to partially repeal the Affordable Care Act that’s steaming toward a floor vote scheduled for Thursday.

Big revisions were made to the legislation this week to appeal to conservatives pushing to reduce federal Medicaid spending and shift more power to states.

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Medi-Cal faces major funding cuts
Capitol Weekly

Billions of dollars for California’s health care system serving 13 million poor and young people would be slashed under a proposal in Congress backed by House Majority Leader Kevin McCarthy and other top Republicans.

The plan, called the Affordable Health Care Act, is expected to come up for a House vote on Thursday. It contains the biggest potential change to California’s system since its inception more than 50 years ago.

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Mental health agencies say they’ve saved state billions under Medicaid
Modern Healthcare

A new report by advocates for Michigan’s public Medicaid behavioral health system estimates it has saved the state $5.3 billion over the past 18 years and would save an additional $7.4 billion through 2024 using their patient-centered and integrated care model.

They also contend rate increases for behavioral health systems were lower than Medicaid HMOs and state Medicaid programs during that period.

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Repair damage from Obamacare: Opposing view
USA Today

For decades, the National Federation of Independent Business (NFIB) has asked small business owners to rank the top challenges. For more than 30 years, their No. 1 problem has been the high cost of health care.

Obamacare turned this concern into a crisis for small businesses. It fails to deliver on its main promise to make health care more affordable. For small business owners, the law has made insurance more complicated, more restrictive and more expensive.

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Breast Implants Linked To Rare Blood Cancer In Small Proportion Of Women
National Public Radio

The Food and Drug Administration says at least nine women have died of a rare blood cancer after receiving breast implants, and that the agency is officially acknowledging an association between the implants and the disease.

On Tuesday, the agency announced that as of Feb. 1, it had received 359 breast implant-associated reports of a rare type of non-Hodgkin’s lymphoma called anaplastic large cell lymphoma, or ALCL. The cancers were more common in women who had implants with textured, rather than smooth, surfaces.

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California Gov. Jerry Brown on paying for universal healthcare: ‘How do you do that?’
Los Angeles Times

Gov. Jerry Brown stuck to his skeptical view on matters of broad healthcare reform on Wednesday, dismissing the idea of a universal healthcare system as something akin to a financial impossibility.

“Where do you get the extra money? This is the whole question,” Brown said in an interview after wrapping up a day’s worth of events and meetings in Washington.

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Southern California Republicans face a dilemma on health care vote
San Bernardino Sun

The American Health Care Act could prove hazardous to the political well-being of Southern California’s House Republicans.

GOP members of Congress who vote for the bill to repeal and replace the Affordable Care Act, commonly known as Obamacare, may end up energizing opposition groups and providing a talking point for Democrats determined to oust them.

But if they vote “no” and the GOP effort fails, Republicans in Congress could embarrass their party and party leaders.

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Kaweah Delta ER to undergo expansion
Visialia Times-Delta

Kaweah Delta’s Emergency Department sees upward of 93,000 patients each year. That’s roughly 254 patients each day, or 10 patients every hour.

With only 33 beds, the department has struggled to keep up with the daily number of incoming patients, said Dr. Jerry Jacobson, emergency department medical director.

“Our current emergency department is designed for an annual volume of between 40,000 and 50,000 patients,” Jacobson said. “We have such an impasse with patients coming into a department that is designed for only half of the patients we see.”

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St. Helena Hospital Napa Valley to close rehab program
North Bay Business Journal

St. Helena Hospital Napa Valley plans to close its four-decade-old drug and alcohol rehabilitation center this spring.

The unit had been operating at a financial loss for many years, due to decreasing insurance coverage and low reimbursement rates for addiction services, hospital officials said. The Deer Park facility will close the 28-day residential program on April 8.

However, medical detoxification services will still be provided, said Jill Kinney, Adventist Health spokesperson.