Tag: Health Brief

July 3, 2024

Two Rival Hospitals Want To Join Forces. Will Patients Lose?

In Terre Haute, Ind., two rival hospitals want to merge, a move that supporters say will save patients money and help people live longer.

But similar hospital consolidations in Tennessee, Virginia and North Carolina have resulted in government reports documenting diminished care.

In more than a dozen states, certificates of public advantage (COPAs) permit deals like the one on the table in Indiana, even though the Federal Trade Commission otherwise considers them illegal because they reduce competition. As a result, the FTC has warned states to avoid COPAs and the mergers they create.

In Terre Haute, state regulators will decide whether to allow Union Hospital to purchase the surrounding county’s only other acute care facility, Terre Haute Regional Hospital. The merger would be the first deal under the state’s 2021 COPA law. Aside from the FTC’s concerns about the anti-competitive nature of these deals, there’s another, potentially bigger question: Does allowing hospitals to combine forces improve patient care?

The largest COPA-created hospital system in the country, Tennessee-based Ballad Health, has reported that the time patients spend in its ERs in Virginia and Tennessee before being hospitalized has more than tripled, reaching nearly 11 hours, in the six years since that monopoly of 20 hospitals formed.

The FTC has been closely examining the effects mergers have on prices, quality and even employee wages. In 2019, the FTC ordered multiple insurers and COPA-created health systems, including Ballad, to turn over information. The FTC declined to provide an update on the status of its findings.

To mitigate the negative effects of a monopoly, merged hospitals typically agree to conditions imposed by state regulators. Still, Tennessee has awarded Ballad top marks even when certain quality metrics, including its ER speed, fall below its established benchmarks.

Ballad Health spokesperson Molly Luton said the system’s performance has improved since statistics were collected for its 2023 fiscal year, which ended June 30, 2023, and that ER wait times have shortened.

COPA arrangements have also led to fallout in nearby North Carolina. When the state repealed its 2015 COPA law, it removed state oversight of Asheville’s Mission Health system, which was required as part of the merger. That meant the local monopoly remained but none of the COPA’s conditions applied when a subsidiary of HCA Healthcare bought the system for $1.5 billion in 2019.

Last year, government inspectors found “deficiencies” at Mission Health that contributed to four patient deaths and posed an “immediate jeopardy” to patients’ health and safety, according to the 384-page federal inspection report.

North Carolina Attorney General Joshua Stein sued HCA’s subsidiary, alleging that the ER was “significantly degraded” and that the company did not maintain certain critical services, including oncology care, a violation of a purchase agreement Stein’s office negotiated because the company acquired a nonprofit.

HCA said it promptly addressed the issues found in the inspections and denied Stein’s allegations in its response to the ongoing lawsuit, arguing that it has expanded services. HCA also contended the agreement is silent about maintaining the quality of care.

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

June 28, 2024

Abortion Ballot Measures Won’t Automatically Undo Existing Laws

On Tuesday, a judge in Michigan blocked some of the state’s lingering restrictions on abortion access, including a mandatory 24-hour waiting period. The ruling comes 19 months after voters added abortion rights to the state constitution in November 2022.

Michigan was one of the first states to protect abortion access at the ballot box after the Supreme Court overturned federal abortion protections in Dobbs v. Jackson Women’s Health Organization in 2022. But the amount of time some abortion restrictions in the state have remained on the books serves as a caution to other states holding similar votes. Election results may not be as clear-cut as you might think.

This year, voters in as many as 12 more states, including Missouri, could weigh in on abortion. Here, as in most of those states, a likely ballot measure would add abortion protections to the state constitution.

Abortions in Missouri have been banned in nearly every circumstance since the Dobbs ruling. But the procedure was largely halted here years earlier by a series of laws designed to make abortions scarce. These laws are sometimes called “targeted regulation of abortion providers,” or TRAP, laws.

By 2021, the last full year before Dobbs opened the door for Missouri’s ban, the state recorded only 150 abortions, down from 5,772 in 2011.

Even if Missouri voters enshrine abortion protections in the state constitution this year, state regulations such as a 72-hour waiting period and minimum dimensions for procedure rooms and hallways in clinics that provide abortions would remain on the books.

Such laws likely wouldn’t be overturned legislatively under a Republican-controlled legislature and governor’s office. But they will surely face legal challenges, which could take a while.

The lawsuit that led to Tuesday’s ruling in Michigan, for example, was filed 15 months after voters added abortion protections to the state’s constitution.

The delay had a purpose, according to Elisabeth Smith, state policy and advocacy director at the Center for Reproductive Rights, which filed the lawsuit: It afforded the Democratic-led legislature time to act. It’s often more effective to change laws through the legislature than through litigation because the courts can only strike down a law, not replace one.

Michigan did pass an abortion rights package that was signed into law by the state’s Democratic governor, Gretchen Whitmer, in December. But the package left some regulations intact, including the mandatory waiting period, mandatory counseling and a ban on abortions by non-doctor clinicians, such as nurse practitioners and midwives.

Abortion opponents such as Katie Daniel, state policy director for Susan B. Anthony Pro-Life America, are critical of the Michigan lawsuit and such policy unwinding efforts.

“The litigation proves these amendments go farther than they will ever admit in a 30-second commercial,” Daniel said.

Of the seven states that have voted on abortion since Dobbs, Ohio may be the most politically similar to Missouri.

Last year, Ohio Attorney General Dave Yost, an antiabortion Republican, said passing an amendment to protect abortion rights would upend at least 10 state laws limiting abortions.

Voters passed the measure with nearly 57 percent of the vote, but most of those state laws — including a 24-hour waiting period and a 20-week abortion ban — continue to govern Ohio health providers.

June 26, 2024

Federal Budget Constraints May Hurt Older Americans With HIV

Researchers say that by the end of the decade, 70 percent of people in the United States living with HIV will be older than 50. Thanks to advances in medicine, the diagnosis is no longer a death sentence.

“I’ve been fortunate to take care of some people with HIV for over 30 years,” said Melanie Thompson, a physician in Atlanta who said she is frequently told by patients, “You’re my longest relationship.”

But there’s a catch: People living with HIV are at increased risk for other health problems, such as diabetes, depression and heart disease.

As their health needs increase, more is required of the Ryan White HIV/AIDS Program, the comprehensive federal system that provides HIV primary medical care, medications and essential support services for low-income people living with the virus.

But core funding for the national network of clinics hasn’t changed much in the past decade.

According to a KFF analysis, inflation-adjusted spending has dropped from a peak in the early 2000s, despite the program serving tens of thousands of new patients.

Laura Cheever, who oversees the Ryan White program, said budget constraints make it hard to prioritize the needs of older people with HIV, especially when many people with the virus haven’t been diagnosed or aren’t receiving services at all.

“When a lot of people aren’t getting care, how do you decide where that next dollar is spent?” Cheever said.

President Biden’s budget request for fiscal 2025 asks for a funding bump of less than 1 percent for the program.

The latest infusion of funding for Ryan White — about $466 million since 2019 — came as part of a federal initiative to end the HIV epidemic by 2030.

But that program, launched by the Trump administration in 2019, was targeted by House Republicans last year in their push to slash the budget of the Centers for Disease Control and Prevention.

Their argument? The initiative, launched just a year before the global coronavirus pandemic drew resources and attention from other public health priorities, wasn’t meeting its goal to cut new HIV infections dramatically by 2030.

Around the same time, Republicans were threatening a different HIV program from a different GOP administration: the President’s Emergency Plan for AIDS Relief, or PEPFAR, launched by George W. Bush.

Republicans held up reauthorizing the program, which has helped millions around the world, over rumors its dollars funded abortions.

Advocates worry these cases signal a larger erosion in bipartisan support for HIV prevention and treatment that threatens to undermine years of progress lowering transmission and mortality rates — especially if older people with the virus don’t get adequate care.

“It’s tragic and shameful that elderly people with HIV have to go through what they’re going through without getting the proper attention that they deserve,” said Jules Levin, executive director of the National AIDS Treatment Advocacy Project, who, at age 74, has been living with HIV since the 1980s.

“This will be a disaster soon without a solution.”

June 20, 2024

How Two States Reveal a Deeper Divide on Insuring Kids’ Health

Arizona and Florida lawmakers saw trouble ahead for children in 2023, with states slated — as the covid-19 pandemic waned — to resume disenrolling ineligible people from Medicaid.

So, legislators in both states voted to expand a safety net known as the Children’s Health Insurance Program, or CHIP, which covers those 18 and younger in families that earn too much for Medicaid.

Florida Gov. Ron DeSantis (R) and Arizona Gov. Katie Hobbs (D) signed the bills into law last year, giving their state Medicaid agencies the green light to apply to federal regulators to raise the family income limit for CHIP eligibility.

But while Arizona’s plan hewed to Biden administration policies, such as keeping eligible children enrolled in CHIP even with unpaid premiums, Florida’s proposal ignored those coverage protections; the state has removed at least 22,000 children from CHIP for unpaid premiums since the rule banning such disenrollments took effect Jan. 1.

Clearly, there is a divide, said Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured. “It simply may be between the policies of the Trump administration and the Biden administration.”

These differences are also evident in the context of the 2024 presidential election. Former president Donald Trump has suggested he is open to cutting federal assistance programs if elected to a second term, while the Biden administration has taken steps to make it easier for low-income Americans to keep their health coverage.

The flexibility for states to design different CHIP programs is a big reason Republicans and Democrats have supported the federal initiative since 1997, when it was signed into law, Tolbert said.

But how Arizona and Florida have handled CHIP premiums underscores key ideological differences on the government’s role in subsidizing health insurance for children.

The Sunshine State ultimately sued the Biden administration over its unpaid premium policy, but U.S. District Judge William Jung dismissed the case May 31, saying the matter was up to federal regulators to decide.

Sara Lonardo, a spokesperson for the federal Department of Health and Human Services, said in an email that the Biden administration says the law requires states to give children in CHIP the same coverage protection as kids in Medicaid — continuous enrollment for 12 months, even if the premium is not paid.

“No eligible child should face barriers to enrolling in CHIP or be at risk of losing the coverage they rely on to stay healthy,” Lonardo said.

However, Florida officials have said on social media and in legal filings that the state’s CHIP plan is “a bridge from Medicaid to private insurance,” intended to get families used to premiums, cost sharing and the risk of losing coverage when they miss a payment.

Research shows the cost of premiums can block many families from obtaining and maintaining CHIP coverage even when the cost is low.

“Premiums are more about an ideological belief that families need to have skin in the game, rather than any practical means of paying money to support the program,” said Matt Jewett, director of health policy for the Children’s Action Alliance of Arizona, a nonprofit that promotes health insurance coverage for kids.

DeSantis’s office, Florida’s Medicaid agency and Florida Attorney General Ashley Moody’s office did not respond to questions about CHIP — or if Florida will appeal the court decision.

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