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Marolas   Marolas Maria Morales's TIGblog
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Census survey revisions mask health law effects

WASHINGTON The Census Bureau, the authoritative source of health insurance data for more than three decades, is changing its annual survey http://amm6.blogspot.com/2014/04/d.ning.com.html so thoroughly that it will be difficult to measure the effects of President Obamas health care law in the next report, due this fall, Census http://zqq2.blogspot.com/2014/04/e.ning.com.html officials said.

The changes are intended to improve the accuracy of the survey, being conducted this month in interviews with tens of http://hqq7.blogspot.com/2014/04/e.ning.com.html thousands of households around the country. But the new questions are so different that the findings will not be comparable, the officials http://tqq5.blogspot.com/2014/04/b.ning.com.html said.

An internal Census Bureau document said that the new questionnaire included a total revision to health insurance questions and, in http://zqq2.blogspot.com/2014/04/a.ning.com.html a test last year, produced lower estimates of the uninsured. Thus, officials said, it will be difficult to say how much of any change is http://tqq5.blogspot.com/2014/04/a.ning.com.html attributable to the Affordable Care Act and how much to the use of a new survey instrument.

We are expecting much lower numbers just http://tqq5.blogspot.com/2014/04/c.ning.com.html because of the questions and how they are asked, said Brett J. OHara, chief of the health statistics branch at the Census Bureau.

A http://zqq2.blogspot.com/2014/04/b.ning.com.html major goal of the law is to increase the number of people with health insurance. The White House reported that 7.5 million people signed up for http://amm6.blogspot.com/2014/04/a.ning.com.html private health plans on the new insurance exchanges and that enrollment in Medicaid increased by 3 million since October. But the http://kii8.blogspot.com/2014/04/d.ning.com.html administration has been unable to say how many of the people gaining coverage were previously uninsured or had policies canceled, so the net http://amm6.blogspot.com/2014/04/f.ning.com.html increase in coverage is unclear.

Health policy anolysts and politicians had been assuming that the Census Bureau would help answer those http://zqq2.blogspot.com/2014/04/c.ning.com.html questions when it issued its report on income, poverty, and health insurance, based on the Current Population Survey. The annual report shows http://amm6.blogspot.com/2014/04/b.ning.com.html the number of people with various kinds of health insurance and the number of uninsured for the nation and for each state.

Several http://kii8.blogspot.com/2014/04/f.ning.com.html recent private polls, including one by the Gallup organization, suggest that the number of uninsured is declining, because of the Affordable Care http://amm6.blogspot.com/2014/04/c.ning.com.html Act and improvements in the economy.

Census officials and researchers have long expressed concerns about the old version of insurance http://kii8.blogspot.com/2014/04/b.ning.com.html questions in the Current Population Survey.

The questionnaire traditionally used by the Census Bureau provides an inflated estimate of http://tqq5.blogspot.com/2014/04/e.ning.com.html the uninsured and is prone to measurement errors, said a working paper by statisticians and demographers at the agency.

In the test http://tqq5.blogspot.com/2014/04/d.ning.com.html last year, the percentage of people without health insurance was 10.6 percent when interviewers used the new questionnaire, compared with 12.5 http://amm6.blogspot.com/2014/04/g.ning.com.html percent using the old version. Researchers said that they had found a similar pattern in the data for different age, race, and ethnic http://kii8.blogspot.com/2014/04/a.ning.com.html groups.

In addition, the percentage of people with private coverage was statistically higher when the bureau tested the new http://hqq7.blogspot.com/2014/04/d.ning.com.html questionnaire, the working paper said. For reasons that are not clear, people were less likely to respond when interviewers used the new http://kii8.blogspot.com/2014/04/e.ning.com.html questionnaire.

Another Census Bureau paper said it is coincidental and unfortunate timing that the survey was overhauled just before http://zqq2.blogspot.com/2014/04/d.ning.com.html major provisions of the health care law took effect. Ideally, it said, the redesign would have had at least a few years to gather base line and http://hqq7.blogspot.com/2014/04/f.ning.com.html trend data.

The old questionnaire asked consumers if they had various types of coverage at any time in the prior year. The new survey http://hqq7.blogspot.com/2014/04/b.ning.com.html asks if they have insurance at the time of the interview in February, March, or April then uses follow-up questions to find out when that http://amm6.blogspot.com/2014/04/e.ning.com.html coverage began and what months it was in effect. Using this technique, Census officials believe they will be able to reconstruct the history of http://hqq7.blogspot.com/2014/04/c.ning.com.html coverage month by month, over a period of about 15 months, for each person in a household.

However, OHara said the agency was not http://kii8.blogspot.com/2014/04/c.ning.com.html planning to release coverage data from early this year in its next report. Agency officials want to assess the reliabelity of the monthly data, http://hqq7.blogspot.com/2014/04/a.ning.com.html being collected this year for the first time.

The White House is always looking for evidence to show the benefits of the health law, http://tqq5.blogspot.com/2014/04/f.ning.com.html which is an issue in many of this years midterm elections. The Department of Health and Human Services and the White House Council of Economic http://zqq2.blogspot.com/2014/04/f.ning.com.html Advisers requested several of the new questions, and the White House Office of Management and Budget approved the new questionnaire. But the decision to make fundamental changes in the survey was driven by technical experts at the Census Bureau.


April 16, 2014 | 7:53 AM Comments  {num} comments



Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

NY health commissioner steps down for Calif. job

ALBANY, N.Y. New York Health Commissioner Dr. Nirav Shah will http://k5o2.blogspot.com/2014/04/d.ning.com.html step down in June to take an executive position with Kaiser Foundation http://q95j.blogspot.com/2014/04/b.ning.com.html Health Plan in California, the health department said Wednesday. http://m5iz.blogspot.com/2014/04/d.ning.com.html

During Shah's tenure as state health commissioner, he http://g54j.blogspot.com/2014/04/a.ning.com.html became a lightning rod for critics of hydraulic fracturing for natural gas http://q95j.blogspot.com/2014/04/c.ning.com.html because of the Cuomo administration's plan for an extended review of http://k5o2.blogspot.com/2014/04/c.ning.com.html the technology. The health department also established a state health http://x5n3.blogspot.com/2014/04/a.ning.com.html insurance exchange under the federal Affordable Care Act.

http://x5n3.blogspot.com/2014/04/e.ning.com.html Department spokesman bell Schwarz said the move has been in the http://x5n3.blogspot.com/2014/04/d.ning.com.html works for weeks.

Shah's interim replacement will be http://m5iz.blogspot.com/2014/04/b.ning.com.html Dr. Howard Zucker, the department's first deputy commissioner since last http://q95j.blogspot.com/2014/04/a.ning.com.html September. He was a clinical professor of anesthesiology at Albert http://q95j.blogspot.com/2014/04/d.ning.com.html Einstein College of Medicine of Yeshiva University and a pediatric cardiac http://m5iz.blogspot.com/2014/04/e.ning.com.html anesthesiologist at Montefiore Medical Center in the Bronx.

http://x5n3.blogspot.com/2014/04/c.ning.com.html Republican candidate for governor Rob Astorino earlier http://q95j.blogspot.com/2014/04/e.ning.com.html Wednesday called for Shah to resign, citing a news report about department http://m5iz.blogspot.com/2014/04/a.ning.com.html delays inspecting abortion clinics and delays in the department's http://g54j.blogspot.com/2014/04/c.ning.com.html study on the health impact of deep drilling for natural gas by hydraulic http://k5o2.blogspot.com/2014/04/a.ning.com.html fracturing, which is prohibeted with the study pending.

http://k5o2.blogspot.com/2014/04/e.ning.com.html Astorino opposes abortion and supports fracking.

http://g54j.blogspot.com/2014/04/d.ning.com.html Cuomo administration officials say Shah's departure is unrelated to http://x5n3.blogspot.com/2014/04/b.ning.com.html Astorino's comments or the press report on clinic inspections. Shah's new http://m5iz.blogspot.com/2014/04/c.ning.com.html job will be as Kaiser's senior vice president, chief operating http://g54j.blogspot.com/2014/04/b.ning.com.html officer for clinical operations for the Southern California region.

http://k5o2.blogspot.com/2014/04/b.ning.com.html Read more here: http://www.thestate.com/2014/04/09/3378516/ny-health-commissioner-steps-down.html#storylink=cpy

April 10, 2014 | 3:45 AM Comments  {num} comments



Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

Mental Health Parity: If Not Now, When

According to ABC News, the latest alleged Ft. Hood shooter was struggling with a number of mental health problems, ranging from depression to anxiety to sleep disturbance, and in the http://g92q.blogspot.com/2014/04/b.ning.com.html midst of being evaluated for post-traumatic stress disorder.

If true, its a familiar story of a stressed-out soldier with mental health issues and easy access to guns: weve been http://v92q.blogspot.com/2014/04/e.ning.com.html here before.

Of course, we dont know exactly what kind of care or treatment this shooter was receiving and the VA system is generally better than others. Still, its worth reviewing http://l92q.blogspot.com/2014/04/b.ning.com.html the history of legislation to put mental health services on equal footing with all other medical care.

(ndanger/flickr)

The latest

policy brief http://a92q.blogspot.com/2014/04/d.ning.com.html published in the journal

Health Affairs , documents the convoluted history of mental health parity, the idea that mental health care and treatment be comparable with all other types of http://l92q.blogspot.com/2014/04/e.ning.com.html physical medical care (and why make the distinction, anyway)?

Parity efforts began in earnest in the late 1990s, but still arent fully implemented today, despite widespread support, http://g92q.blogspot.com/2014/04/a.ning.com.html including from notable advocates like former Congressman Patrick Kennedy.

The paper examines some of the obstacles remaining to true mental health parity, including these:

http://v92q.blogspot.com/2014/04/d.ning.com.html Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and http://a92q.blogspot.com/2014/04/b.ning.com.html substance use disorders.

The supply and availabelity of mental health providers has been the subject of numerous research articles. A 2009 Health Affairs article by Peter http://f92q.blogspot.com/2014/04/d.ning.com.html Cunningham found that two-thirds of primary care physicians reported that they were unable to get outpatient mental health services for their patientsmore than twice the percentage http://v92q.blogspot.com/2014/04/a.ning.com.html who reported trouble finding specialist referrals, nonemergency hospital admissions, or imaging services. Mental health professionals tend to be concentrated in high-population, http://f92q.blogspot.com/2014/04/b.ning.com.html high-income areas, and the lack of mental health care providers in rural areas as well as in pediatrics has been well documented. Finally, there is still a stigma associated with http://g92q.blogspot.com/2014/04/e.ning.com.html receiving mental health or substance use treatment. Eliminating the stigma and increasing the availabelity of high-quality providers are two keys to increasing access to care.

http://f92q.blogspot.com/2014/04/c.ning.com.html Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits. Some of the http://v92q.blogspot.com/2014/04/b.ning.com.html treatments for mental health and substance use disorders do not have an equivalent medical/surgical treatment, particularly with respect to treatment settings. For example, intensive http://f92q.blogspot.com/2014/04/a.ning.com.html outpatient programs often used to treat substance abuse do not have an equivalent in internal medicine. Similarly, it is difficult to determine the medical/surgical equivalent for a http://g92q.blogspot.com/2014/04/c.ning.com.html rehab stay for an acute schizophrenic episode. Full parity demands that standards of evidence be applied consistently across mental health/substance use and medical/surgical treatments. http://l92q.blogspot.com/2014/04/d.ning.com.html As one health insurance executive noted, How to provide coverage for care levels and treatment venues that are unique to behavi health, and aligning these with medical and http://v92q.blogspot.com/2014/04/c.ning.com.html surgical benefits, is a continuing discussion within health plans and between plans and regulators.

Another obstacle to care that persists despite passage of parity http://l92q.blogspot.com/2014/04/a.ning.com.html legislation is the fragmentation of the American health care delivery system. Arguably, one reason patients with mental health and substance use disorders experience fragmentation is due http://a92q.blogspot.com/2014/04/a.ning.com.html to the use of carve-outs for providing mental health/substance use benefits. One challenge for group health plans is to integrate and coordinate mental health and substance use care with http://l92q.blogspot.com/2014/04/c.ning.com.html medical care despite using separate administrators. In addition to different benefits administrators, mental health and substance use services are usually provided by different http://g92q.blogspot.com/2014/04/d.ning.com.html health professionals than medical services, and care coordination does not always occur among various providers. Many people with mental health disorders have co-occurring physical http://a92q.blogspot.com/2014/04/e.ning.com.html disorders. Some medical conditions may place people at risk for mental disorders, mental health issues may lead to a medical condition, and both conditions share some common risk http://a92q.blogspot.com/2014/04/c.ning.com.html factors. All of these factors heighten the need for coordination in order to deliver high-quality care to people with mental health/substance use disorders.

Not http://f92q.blogspot.com/2014/04/e.ning.com.html everyone is subject to parity. While the ACA expanded the reach of the MHPAEA both by direct application to the individual market and to issuers in the individual and small-employer market through the EHB requirement, some plans and benefits are still excluded.


April 4, 2014 | 6:50 AM Comments  {num} comments



Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

Universal health insurance: what is it all about?

UHI is the Governments beg idea to totally transform the way the Irish health service is structured and funded.

It would aim to eliminate the current two-tier system of public and private http://cutyrs.blogspot.com/2014/04/e.html medicine and to end the practice of queue-jumping for treatment by people who can afford to pay or who have private health insurance.

Plans for http://kislabe.blogspot.com/2014/04/c.html one-tier health service published GPs warn free care for under sixes by summer is not achieveable The plan is http://kislabe.blogspot.com/2014/04/e.html very controversial and already has been strongly criticised from within Government on cost grounds.

It could prove politically explosive if it is seen to remove long-cherished benefits of private health http://zivrat.blogspot.com/2014/04/a.html insurance from the middle classes. The Oppositionhas already branded the proposals drawn up by Minister for Health James Reilly as simply another tax hike.

How would it work?

In essence http://ionter.blogspot.com/2014/04/a.html everyone would be a private patient. It would be mandatory for all to have cover for a basic package of services - known as a basket - from one of a number of different insurers.

The State would pay http://mutress.blogspot.com/2014/04/1.html the premium for the lowest income groups and provide subsidies for others. People who refused to take out cover would have it provided for them, with the cost deducted at source from their earnings or http://ionter.blogspot.com/2014/04/c.html benefits.

What would be covered?

The standard policy would cover a set range of services, to be determined definitively following a comprehensive public consultation process.

However, http://cutyrs.blogspot.com/2014/04/d.html the draft of the Governments new white paper on the issue proposed a preferred basket of services which could be covered in the standard package. These include universal primary care, including core GP and http://kislabe.blogspot.com/2014/04/d.html community nurse services and the maternity and infant care scheme.

Acute hospital care - including all inpatient, day case and outpatient care - would be covered, as would chronic disease and care http://mutress.blogspot.com/2014/04/c.html management for those who met specific clinical criteria.

The preferredpackage would also cover acute mental healthcare, including those services provided by community mental health teams in http://kislabe.blogspot.com/2014/04/b.html outpatient clinics, day hospitals, day centres and acute in-patient facilities, for not more than 12 months.

Rehabelitative care would also be included for a period not exceeding a year, while http://mutress.blogspot.com/2014/04/b.html step-down care in a residential setting or a patients home would be covered for a maximum of two weeks.

What about areas that fall outside the standard basket?

Under the draft white paper, http://zivrat.blogspot.com/2014/04/d.html the State would also pay for other elements of healthcare not included in the standard package. These would include immunisations, screening services, ambulance services and hospital emergency department http://cutyrs.blogspot.com/2014/04/c.html care. The State would also pay for long-term residential care.

Dr Reillys proposals would permit people to take out supplementary health insurance to cover areas not included in the standard package. http://zivrat.blogspot.com/2014/04/e.html This would include private rooms in hospitals.

However, for the first time, this supplementary insurance would be provided on a risk-related basis rather than on a community-rated basis, where http://cutyrs.blogspot.com/2014/04/b.html everyone pays the same for identical products, regardless of age.

This could see the cost escalate considerably for older people.

Will drug costs be covered?

Under the Government http://mutress.blogspot.com/2014/04/d.html proposals, pharmaceuticals (subject to co-payment) would be included either as part of the standard UHI package or through a separate eligibelity scheme replacing the current medical card scheme and drug http://ionter.blogspot.com/2014/04/b.html payment scheme will be considered.

The Government has said it wanted to continue to cover the drug costs of the lowest income groups, as currently applies.

What will the cost be?

The http://zivrat.blogspot.com/2014/04/c.html cost of a standard basket of cover will not be known until there is clarity about precisely what services will be included in it.

However, the Department of Public Expenditure and Reform http://ionter.blogspot.com/2014/04/d.html estimated in a letter to the Department of Health that it could cost over 1,600.

This was seized on by the Opposition, even though the figure is strongly disputed by the Department of http://mutress.blogspot.com/2014/04/e.html Health.

What were the concerns about the plan within Government?

The Department of Public Expenditure and Reform was extremely concerned the the UHI plan could be unaffordable. It warned http://zivrat.blogspot.com/2014/04/b.html dramatically that the measure could threaten the financial stabelity of the State. This was strongly rejected by the Department of Health.

On foot of a Government decision this week, backing for UHI http://cutyrs.blogspot.com/2014/04/a.html was conditional on the new scheme not costing more than the existing health system which it would replace when it comes into force in 2019.

What will happen next?

There will be a widespread http://ionter.blogspot.com/2014/04/e.html consultation process involving both the general public and health service stakeholders.

The Oireachtas health committee will hold public hearings, while there will also be a commission established to http://kislabe.blogspot.com/2014/04/a.html produce options for the composition of the standard basket.

Dr Reilly will next year produce proposals for the standard basket of services to the Cabenet.

The Government would also have to decide at a later date on the level of subsidies to be provided and the thresholds at which they would apply.


April 3, 2014 | 6:05 AM Comments  {num} comments



Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

Thinking Of Retiring? Consider Your Health

The is a cherished time warp in Los Angeles. Once inside, you're in old Hollywood: The place is all dim lighting and curved booths, with a soundtrack featuring every song you ever heard in a http://lotuw.blogspot.com/2014/03/5.html black-and-white movie. It's a steak-and-martini kind of place.

And the guy who makes those famous martinis is Manuel "Manny" Aguirre. He's been mixing cocktails for 55 years, more than two decades http://butersq.blogspot.com/2014/03/3.html of that behind the long bar here. He just turned 80 and could retire if he wanted to.

"My kids and my grandchildren, they say to me, 'Grandpa, it's time.' But they don't realize you miss part http://lotuw.blogspot.com/2014/03/3.html of your life your customers and your friends," he says.

Are you retiring 'cause you want to? Are you retiring involuntarily? Are you working or http://lotuw.blogspot.com/2014/03/1.html volunteering after retirement? These are all critical factors in terms of your mental health, and I think they also affect your physical health.

http://butersq.blogspot.com/2014/03/1.html - Edward Schneider

One of those friends is 82-year-old waiter Alonzo "Panama" Castillo, who has worked at the restaurant for 40 years. Time just goes by, he says. "I like it here, http://hfiau.blogspot.com/2014/03/4.html so I keep working."

Like Aguirre, Castillo works part time and could retire if he wanted to. "But I want to keep in shape," Castillo says. "If I stay home, I will start watching TV. So the best http://hfiau.blogspot.com/2014/03/1.html thing for everyone is to work at least part time."

A majority of older workers in the United States have told pollsters they expect to do just that. There are plenty of financial reasons for http://lotuw.blogspot.com/2014/03/4.html staying on the job, such as inadequate savings and volatile 401(k) plans. But some research suggests a reason to keep working that jibes with Aguirre's and Castillo's experience: It may help keep you http://hfiau.blogspot.com/2014/03/2.html mentally and physically fit.

How Retirement Makes You Feel

One of the largest pools of data for researchers hoping to puzzle out the health effects of retirement comes from the , which http://opayr.blogspot.com/2014/03/2.html tracked thousands of older Americans for more than two decades. Economist , a research fellow with the National Bureau of Economic Research, showed that people who kept working were healthier than http://butersq.blogspot.com/2014/03/5.html those who had retired.

"Once they retire completely ... there are increases in depression and mental illness," says Dave. "There are increases in certain health conditions like arthritis, http://vzeio.blogspot.com/2014/03/4.html hypertension. For the average American, we found negative effects on health."

Waiter Alonzo Castillo known as Panama is 82 and has worked at http://lotuw.blogspot.com/2014/03/2.html Musso and Frank Grill in LA for 40 years. "I like it here," he says, "so I keep working."

Courtesy of Musso and Frank Grill , according to , the associate http://opayr.blogspot.com/2014/03/4.html director for the study of aging at the Rand Corp.

More In This Series http://opayr.blogspot.com/2014/03/5.html She and her team found "a sizable cognitive decline in response to retirement," Rohwedder says a 5.5 point decline on a 20-point scale. "So it is a really large effect."

But not all http://vzeio.blogspot.com/2014/03/3.html scientists read the accumug evidence the same way. When Michael Insler, an economics professor at the Naval Academy, looked at the data, he found that retirement was . He examined nine health http://hfiau.blogspot.com/2014/03/3.html conditions, including cancer and heart and lung problems. And he found that the decision to retire reduced those conditions by up to a third.

What Does Retirement Look Like?

It's not http://vzeio.blogspot.com/2014/03/1.html that surprising that researchers disagree, says , a professor of gerontology at the University of Southern California and the former deputy director of the National Instetute on Aging. There are as many http://hfiau.blogspot.com/2014/03/5.html versions of retirement, Schneider says, as there are people who've retired.

"There are so many different factors that come into play," he says. "Are you retiring 'cause you want to? Are you http://opayr.blogspot.com/2014/03/1.html retiring involuntarily? Are you working or volunteering after retirement? These are all critical factors in terms of your mental health, and I think they also affect your physical health."

The http://opayr.blogspot.com/2014/03/3.html reason researchers disagree, he says, is that it's basically impossible to construct the best kind of scientific experiment on this subject.

"Ideally what we would do is randomly assign people who http://vzeio.blogspot.com/2014/03/5.html are working to two groups: one group that would continue working and the other group that would retire," Schneider says. "We'd follow them over a period of years and then look at their mental and http://butersq.blogspot.com/2014/03/2.html physical health."

Of course, people aren't going to give up control of their lives in the interest of science. So meanwhile, what we have, in addition to large, retrospective surveys, is the http://butersq.blogspot.com/2014/03/4.html small, unscientific sample group of Aguirre and Castillo, who can look around the restaurant and point out where the stars including Mickey Rooney, John Wayne and Raymond Burr enjoyed a meal. And not http://vzeio.blogspot.com/2014/03/2.html all the names are from the old Hollywood. Aguirre's scrapbook boasts snapshots of him posing with Keith Richards of the Rolling Stones, Johnny Depp and Drew Barrymore.

The stars come, the stars go but Manny Aguirre and Panama Castillo happily remain.


March 27, 2014 | 7:27 AM Comments  {num} comments



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