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Burwell: ACA focus will be on quality, not quantity


U.S. Health and Human Services Secretary Sylvia Burwell says that the Obama administration will focus on improving quality over quantity in the nation’s healthcare system in the ongoing implementation  of the Affordable Care Act.

As part of this, she says,  the administration plans  to push further on a patient-centered approach.

“Our vision is paying providers for what works, and incentivizes quality over quantity.”

She also emphasized the importance that the administration puts on enlisting states that do not currently accept federal funds for for the Affordable Care Act’s Medicaid expansion. With the recent Supreme Court ruling on ACA subsidies, it seems likely that all or most of the states now refusing to expand Medicaid will do so within the next year or so.



FQHC’s get busier despite the ACA


Editor’s note: Cambridge Management Group has done much work with Federally Qualified Health Centers so we follow stories such as this closely.

This article is part of a reporting partnership with NPR, WFAE and Kaiser Health News.



Nurse practitioner Martha Brinsko helps a lot of patients manage their diabetes at the Charlotte Community Health Clinic, in North Carolina.

“Most mornings when you check your sugar, what would you say kind of the average is?” Brinsko asked patient Diana Coble.

Coble hesitated before explaining she ran out of the supplies she needs to check her blood sugar levels, and she didn’t have the gas money to get back to the clinic sooner. Brinsko helped Coble stock up again.
Coble, who is unemployed, lives with her sister and can’t afford insurance even now that the health law is in place, relies on the clinic for healthcare.“If you need to get more than one box, get more than one box,” Brinsko said. “But you need to check them every morning so that we can adjust things.”

“They do a great job with everything,” Coble said. “I couldn’t do without them.”

Nancy Hudson was the clinic’s director as the Affordable Care Act was rolled out and  she now consults for the clinic. She expected the insurance exchange, or marketplace, established under the ACA would reduce the number of uninsured patients the clinic sees. The opposite happened, she says.

“What we found within our patient population and within the community is that a lot of the advertisement and information about the marketplace brought people [in who] didn’t know anything about free clinics and did not qualify for any of the programs within the ACA marketplace,” Hudson says.

And now they get free or low-cost care at the clinic, which is designated by the government as a Federally Qualified Health Center.

The health law was designed to cover the poorest people by expanding Medicaid, the federal-state program for low-income people. But the Supreme Court made that optional. The result in states that didn’t expand Medicaid is a gap, where some people make too much money to qualify for Medicaid but not enough to qualify for insurance subsidies. In North Carolina, about 319,000 people, like Coble, fall into the Medicaid gap.

“Over half of the people that we see would’ve been eligible for Medicaid expansion had the state elected to exercise that option,” says Ben Money, president of the association that represents North Carolina’s community health centers.

North Carolina is among the 21 states, including many in the South, currently saying no to Medicaid expansion. Louisiana is another.

Gary Wiltz,  M.D., the CEO of 10 community health centers in  southwestern Louisiana, says demand has surged. “We’ve gone from 10,000 patients to 20,000 in the last six or seven years, so we’ve doubled,” he says.

Wiltz says other things are at play, too. The economic recovery hasn’t reached many of the poorest people, and some who do qualify for ACA subsidies say their options are still too expensive.

“The need keeps increasing, and I think that’s reflected throughout all the states,” he says.

Wiltz, who also heads the board of directors for the National Association of Community Health Centers, says clinics are packed even in states that expanded Medicaid. After all, most of the clinics treat Medicaid patients too.

The Charlotte clinic’s Nancy Hudson says there’s another part of the health law helping fuel the growth: additional funding for community health centers.

Hudson found out last week her clinic is getting about $700,000 to expand in partnership with Goodwill.

“Many of their clients did not have any access to healthcare,” she says. “They can’t train and sustain a job if they don’t have the basic needs taken care of, and healthcare is one of them.”

Nationwide, the federal government estimates  that its latest round of funding will lead to about 650,000 people getting better access to healthcare.

This story is part of a reporting partnership with NPR, WFAE and Kaiser Health News.

Nervous GOP legislators split on tax credits


With a U.S. Supreme Court decision on the Affordable Care Acts’s healthcare subsidies coming in the next few weeks, congressional Republicans remain split over whether to extend the law’s tax credits if the court voids them in most of the country. Some GOP leaders fear a firestorm of public anger if the Republican-dominated court and the anti-ACA House are blamed f0r taking away what many patients have come to like and depend on.

If the Supremes throw out the credits, we’d guess that many anxious  Republican lawmakers will  vote to extend the credits to buy the GOP time  to enact a broader overhaul of health law the party has long opposed.

Much of ACA would survive anti-subsidies ruling


Here’s a look at how much of the Affordable Care Act would survive a Supreme Court ruling against subsidies.

Hospitals somewhat sanguine on subsidies case


Reuters reports that hospital executives are ”optimistic they will avoid the toughest consequences of a U.S. Supreme Court decision on whether millions of Americans can continue to purchase subsidized health benefits under Obamacare.”

“Investors interpreted commentary by Justice Anthony Kennedy, a potential swing vote among the nine judges, as favorable to the Obama administration’s defense of the subsidies that help consumers in more than 30 states.”

“I am hopeful that the court will recognize and uphold the intent of Congress, which was to expand coverage as broadly as possible,” Bill Carpenter, chief executive of LifePoint Hospitals, said in an interview.

If the court rules against  federal subsidies, Carpenter and other executives interviewed by Reuters said they expected the justices ”would allow for a transition period before patients lose access to healthcare.”

”Alan Miller, CEO of hospital chain Universal Health Services, expects the Obama administration would reach an agreement with Republican opponents of the law to keep subsidies in place through the end of 2015. He believes that is enough time to create a workaround to the Supreme Court ruling.”




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