KBIA Radio, July 8, 2015

Financial disclosures aren’t just for political candidates. New data released by the Centers for Medicare and Medicaid Services shows that Missouri doctors received at least $71.9 million from medical device and drug companies in 2014 and the latter half of 2013. Illinois doctors pulled in $104 million during that same time period, many of whom hail from the Chicago area.

The statewide totals were compiled in a searchable database by ProPublica, a nonprofit data journalism center. The payments included fees for speaking engagements, drug samples, and travel. In other cases, doctors received royalty payments from companies for devices they had helped to develop, like orthopedic surgeon Dr. Lawrence Lenke.

Lenke received about $5.4 million from drug and medical device companies during the reporting period, the biggest amount for any doctor in the St. Louis area. The vast majority of the payments — about $5.2 million — were royalty fees for the Solera Spinal system, which he helped develop during his time at Washington University. Other payments included consulting, promotional speaking fees and food and beverage from medical device companies.

“It is not ideal that the payments are presented without any context of the work provided or separated out by the type of payment,” Lenke wrote in an e-mail. He moved his clinical practice for complex spinal deformity surgeries from St. Louis to New York City this summer.

“Hopefully in the future, more granularity can occur with this Open payment system, which I am in favor of in the context of full disclosure to the public and my patients,” Lenke wrote.

The long-time, but little known, practice of payments to doctors has drawn criticism from people who worry a doctor’s financial ties to a drug company could affect their judgment when writing prescriptions. On the other hand, some doctors argue the disclosures are inaccurate, misleading and create a “chilling effect” on their ability to seek information about drugs from manufacturers.

The payments are far from uncommon: According to the data, 607,000 physicians and 1,121 teaching hospitals received payments in 2014 and half of 2013. (The United States has only about 900,000 active physicians.)

Because the payments are so common and often involve the exchange of information, many doctors would reject the notion that industry relationships have any effect on how they conduct their practice, said Dr. Ed Weisbart, a board member for the Consumers Council of Missouri.

“You have this nice, attractive person coming into your office with food, who your staff adores, who’s dropping off little bits of information for you,” said Weisbart. “It becomes a name brand familiarity. So it does influence how we prescribe. How can it not?”

Dr. Michael Stadnyk, a radiologist and president of the St. Louis Metropolitan Medical Society, said he supports the transparency of the program but believes the data don’t tell the whole story.

Stadnyk, for example, received $68 worth of food last year during a meeting with Hologic Inc., in which they discussed a breast imaging system he is developing. He said the disclosures have created a chilling effect on industry relationships with doctors.

“There’s a good percentage of physicians interacting with these companies to try and better health care, to try and improve physician knowledge and come up with a better mousetrap. But that’s being hindered now.”

Because the payments are reported by companies, and often without confirmation from physicians, medical groups argue that the data are often misleading or inaccurate.

(In the interest of full disclosure, this reporter received a fellowship this year to attend a continuing education conference, which receives donations from multiple funders including the Missouri Foundation for Health.)

Regardless of the payments’ sway, they represent a significant investment by drug and medical device companies. The largest Missouri payer is Mallinckrodt Pharmaceuticals, an Irish drug company whose U.S. headquarters are in St. Louis. The company’s nearly 50,000 payments to physicians totaled around $3.4 million in 2014.

“Collaboration among physicians and industry helps drive innovation in patient care, contribute to the economic well-being of communities and provide resources for advancement of medical knowledge, to the ultimate benefit of patients,” Mallinckrodt wrote in a statement.

That collaboration includes supporting clinical trials conducted by individual physicians, payments for doctors who consult company reps on how they use a product in their practice and meals provided during an informational presentation, the statement said.

Where Stadnyk and Weisbart find common ground is in the data’s ability to flag doctors whose ties with the industry might be too close.

“If Dr. Smith has been taken out to dinner 42 times in the last month and a half by Company B, that would raise a red flag for me,” Stadnyk said. “It’s looking at the data … and making that conclusion for yourself. And if there’s ever any question, they need to contact their doctor and ask.”

Click here to look up payments received by your doctor.

Click here to see a chart about payments to Missouri doctors.

ST. LOUIS, Mo., May 19, 2015 — Consumers Council of Missouri has released it guide to helping Missourians review health insurance rates in order to make an important aspect of health care more transparent and accountable.  The state of Missouri has no law requiring health insurance companies to even file their rates much less have them reviewed or analyzed.

The federal Affordable Care Act provides that the Department of Health and Human Services do rate review in states that have no adequate rate review law.  Missouri is the only state that has no laws covering the topic.

Consumers Council produced the manual with funding from the Missouri Foundation for Health.  The foundation is also funding the council to perform health insurance rate review in Missouri for the first time ever when rates for coverage in Missouri through the ACA in 2016 become public around June 1.  

To download Health Insurance Rate Review for Missouri Consumers, click here.

Inside Health Policy, November 20, 2014

The executive director of the Missouri consumer advocacy group that had filed action against HHS for failing to provide information on issuers’ proposed rate increases called the department’s recent release of premium data too little too late, and said she remains disappointed with the department. HHS did release some of the information but did so in a non-user friendly manner, using spreadsheets instead of forms that are difficult to review and still did not include the needed data.

Advocates are “very disappointed” about the failure to include the detailed information, Joan Bray, executive director of the Consumer Council of Missouri, said in a Wednesday call with reporters. She said that while some data was available, HHS did not release the information in ‘Part 3” of the rate justifications in which issuers are supposed to explain the assumptions behind their proposals. Bray said that from what staff “can figure out so far,” after looking through the 135 columns and more than 65,000 rows of data, is that the rate increases in Missouri exceed the national average. She pointed out that a Blue Cross plan in Kansas City increased rates by 13 percent and a Coventry plan for HMOs has gone up by 23 percent.

The fundamental purpose of the the regulation was to enable the public to analyze and to comment on proposed increases, Bray said. Missouri does not have a regulator who is involved so it is critical for public interest groups to be able to see the proposed rates, figure out if they are justified and comment on them.

HHS is boasting about how transparent it is being and how the release enables academics to conduct research on the rates, but the point of the law is not about academic researchers it is about consumers, Bray argued.

Is it extremely important for Missouri, in particular, that HHS to comply with its own regulations since the state does nothing to enforce or even monitor compliance with the ACA due to state law. But HHS has “shirked” its responsibility, Bray said, adding that she is “very offended” that consumers in her view Missouri are treated as second class citizens when it comes to implementation of the law.

Although there may be no power to force plans with large proposed increases to come down, Bray said, HHS can and should hold public hearings in cases where they may be unjustified. In other states, when regulators shined the light on large increases the companies themselves backed off and returned with lower numbers, she pointed out.

Meanwhile, Bray said, open enrollment will go on and people will have to live with the rates. She said the group continues to study and prepare for next year since “we don’t want this to happen again.”

As far as the case itself, Bray said there is still no court date.

In September, former CMS insurance chief Jay Angoff had filed suit in the U.S. District Court in Eastern Missouri against HHS on behalf of the council. The lawsuit specifically deals with insurance rates in Missouri, which does not require insurers to file documentation with the state or make information public regarding proposed rates. The lawsuit says that, as a result, residents of the state are entirely dependent on HHS for information about insurance rates and insurers’ justifications for those increases. The suit says the consumer groups have a statutory right to obtain the information and HHS has no legal basis for failing to disclose those records.

CMS on Friday released the premiums for all states, but the agency did not include any analysis except to note that premiums were stable. Avalere Health offered an initial look of rates for federally facilitated exchange states, which includes Missouri.

According to Avalere’s analysis of Missouri plans, the lowest cost Bronze plan increased an average 9 percent, compared to a 3 percent for all FFM states, the lowest cost Silver plan increased 5 percent compared to the 4 percent FFM average, and the second lowest Silver plan increased by 7 percent in the state, compared to the 3 percent average for all FFM states.

St. Louis Post-Dispatch, October 6, 2014

As part of their guerrilla war on Obamacare, Missouri lawmakers not only have failed to pass Medicaid expansion, but have forbidden state insurance regulators from reviewing proposed prices and other details about health plans on the federal health exchange.

That means thousands of Missourians must shop for coverage without the information they need to make informed decisions.

What a terribly cynical and mean-spirited thing to do in the name of serving the public.

Missouri is one of only a few states that does not reviewhealth insurance rates. Potential health care customers here don’t know which companies are offering plans in their areas, what benefit options are available to them or how much it will all cost.

The Consumers Council of Missouri, an advocacy group, has now sued the federal government to try to force public disclosure of health insurance rate information ahead of the upcoming enrollment period beginning Nov. 15.

The group made a Freedom of Information Act request for the rate filings, which was denied by the U.S. Department of Health and Human Services. The council told the Post-Dispatch’s Jordan Shapiro that it wants information about pricing and explanations for why insurers changed rates.

In many states, consumers don’t need federal help to get rate information because the details are made public by state insurance regulators who have authority to review an insurer’s proposed prices for health plans.

The consumer group says Obamacare requires federal officials to make rate information public so consumers can challenge the price of health insurance before they begin online shopping. The Health and Human Services Department division that runs the online marketplace has yet to release information about proposed rates or the identity of insurers who have applied to offer plans in Missouri.

A spokesman for HHS told Mr. Shapiro that the department is preparing the information and plans to release it, but did not say when.

Polls, surveys and statistics from independent research organizations, including the Commonwealth Fund, Gallup, the Rand Corp., the Kaiser Foundation and the Urban Institute, show that the federal health care plan is meeting many of its goals. Among them:

• More people have health insurance.

• People with health insurance are better off, with less financial distress and fitter mental health.

• Many people paid less for insurance this year than last year.

• Marketplace premiums are barely rising, and employer-sponsored premiums rose about 3 percent this year, similar to past years.

• Overall health care costs are rising at historically low rates.

• The federal deficit is down because money spent on health care has been offset either by new revenue or new spending cuts.

• The law exposed the nearly $3.5 billion in incentives that drug and medical device companies paid doctors and hospitals for part of last year. An initiative called Open Payments spotlights potential ethical conflicts. Consumer groups say such incentives can influence prescribing decisions, the use of high-tech tests and types of surgeries performed.

Missouri lawmakers must stop treating the poor and working poor like second-class citizens — or worse. All Americans are entitled to the information they need to make informed and critical decisions about health care. Hiding it won’t hide the truth: President Barack Obama’s signature health care achievement is working.

St. Lous Post-Dispatch, April 2, 2014

WASHINGTON (AP) — It’s not too late to get covered. A few routes remain open for those who missed the health care law’s big enrollment deadline.

Millions may be eligible for a second chance to sign up for subsidized insurance this year. And people who get coverage after the deadline can still avoid, or at least reduce, the fine for going uninsured.

Here are five options for those still without insurance:

___

1. TAKE ADVANTAGE OF THE GRACE PERIOD

This special break was created for anyone who began enrolling in an insurance marketplace by Monday’s deadline but didn’t finish. That includes people stymied by website outages or overwhelmed phone lines, missing information on applications, and other problems or confusion.

Those who started an application on HealthCare.gov by March 31 should log on and finish it as soon as possible. Federal officials say they will take what time is necessary to work through cases pending.

People applying online will have until April 15 to finish, administration spokesman Aaron Albright said Tuesday. Paper applications will be accepted until April 7.

Consumers will have to attest that they had tried to enroll by March 31.

Rules vary in the 14 states running their own insurance marketplaces.

For most people, going through a marketplace opens the door to lower costs. Those who use the grace period will get coverage starting May 1 and won’t owe a fine.

___

2. USE A SPECIAL ENROLLMENT PERIOD

The government also is offering special extensions for a host of problems that might have prevented people from signing up through a marketplace: Natural disasters. Domestic abuse. A serious illness. Mistakes by application counselors. Errors by insurance companies.

To seek a “special enrollment period,” contact the federal call center, at 1-800-318-2596, or your state marketplace and explain what went wrong. It’s on the honor system. If the extension is approved, that brings another 60 days to enroll.

Also, at any time during the year, certain life events — such as changing jobs, getting married or divorced, or becoming a parent — open a 60-day window to sign up for marketplace coverage.

___

3. SIGN UP FOR MEDICAID

Those who qualify can still enroll in Medicaid — there’s no deadline. Eligibility is based on income and varies from state to state. About half the states expanded their Medicaid programs. The main beneficiaries of the change are adults earning up to about $16,100 per year, with no children living at home. Previously, Medicaid was limited mostly to poor children and their parents and people with disabilities.

___

4. BUY INSURANCE OUTSIDE THE MARKETPLACES

Buyers can always go directly to an insurance company, but it may be expensive. Plans bought outside the marketplaces don’t come with government subsidies that hold down the cost for people with low or mid-level incomes. But they do include the law’s consumer protections. For example, insurers can’t turn down customers because of pre-existing medical conditions.

Even after the deadline, buying a plan that meets the law’s essential coverage standard reduces the penalty owed, which is based on the number of months without coverage.

The fine for going uninsured all year is the greater of two formulas: about 1 percent of household income above the tax-filing threshold of $10,150 or $95 per adult and $47.50 per child under 18, up to $285 per family. It’s due to the IRS in April 2015.

___

5. GET READY FOR NEXT TIME

Open enrollment for 2015 is coming later this year. It’s scheduled to begin Nov. 15 and run just three months. That’s another chance to get covered or switch into a plan with subsidies.

Supporters of the law are calling on President Barack Obama to make things easier next time around.

The advocacy group Families USA suggested a bunch of improvements Tuesday, including more face-to-face sign-ups, coordinating enrollment with tax-filing season so people better understand the fines, and improving coordination with Medicaid programs.

Something to think about: The uninsured penalty next year rises to 2 percent of income or $325 per adult and $162.50 per child.

You Are Invited:

Health Care Finance
Beyond the Affordable Care Act:
Missouri and Single Payer

Thursday, March 6, 2014
6:30 – 8:30 PM
Central Reform Congregation
5020 Waterman Boulevard
St. Louis MO 63108

Despite the ACA’s many vital reforms of the health insurance industry, fundamental problems remain.  Professor Gerald Friedman, Ph.D., will discuss the merits and limits of the ACA, the problems going forward, and how single payer is the only way to control costs and provide affordable coverage for all Americans.  He will present estimates of how a single-payer system could work in Missouri, the savings it would achieve and potential financing methods.

Friedman, Professor of Economics at the University of Massachusetts – Amherst, focuses on economic history, labor history and economics, and the history of economic thought.  He has been a regular media correspondent on the international financial crisis.  Friedman earned his doctorate in economics at Harvard. He is the author of several books and scholarly articles.

RSVP requested but not required.  Email pnhpMO@gmail.com
Light refreshments will be served.
Admission is free but donations are welcome.

Hosted by:
Physicians for a NationalHealth Program www.pnhpMO.org
Consumers Council of Missouri www.MOconsumers.org
Missouriansfor Single Payer Health Care for All www.mosp.us

Think Progress, January 23, 2014

A federal district court judge in Jefferson City has temporarily blocked enforcement of a state law that puts restrictions on individuals and organizations trying to help people sign up for health coverage under Obamacare.

Obamacare uses so-called state navigators and enrollment counselors to assist Americans who are looking to buy health plans. These navigators include doctors, nonprofit organizations, social workers, and community groups. They’re required by federal law to reach out to uninsured residents about different marketplace plans, spread the word about potential premium subsidies or Medicaid eligibility, and explain other pertinent enrollment details.

Although navigators have to be federally certified, the health law allows states to impose additional requirements they must comply with. At least 19 states generally opposed to the Affordable Care Act have passed such laws — and some states’ navigator requirements are so stringent that advocates say they prevent counselors from fulfilling their very purpose and speaking candidly with Americans seeking assistance.

For instance, Missouri’s navigator law, the Health Insurance Marketplace Innovation Act (HIMIA), prohibits federally certified navigators from discussing specific marketplace plans unless they also become state-licensed insurance brokers. Any organization found violating that rule would be subject to thousands of dollars in fines, and the burden of those requirements spurred Missouri nonprofit groups like St. Louis Effort for AIDS and Planned Parenthood of St. Louis to file suit against the state.

“Missouri has placed groups like St. Louis Effort for AIDS in an untenable situation,” said plaintiff’s counsel and former Missouri insurance commissioner Jay Angoff when he filed the lawsuit last winter. “If they comply with the Missouri statutes, they can’t perform the duties the Affordable Care Act requires them to perform, but if they comply with the ACA and do perform those duties, they violate the Missouri law and are subject to thousands of dollars in penalties for doing so. Those conflicts have created a culture of fear among the very people charged with helping Missourians comply with the new law.”

Judge Ortrie Smith agreed with that assessment. “The Court concludes HIMIA’s requirement that federally approved/licensed individuals and entities must also comply with additional licensing requirements constitutes an impermissible obstacle,” wrote Smith in his ruling. “[T]he suggestion that those designated to operate the [Obamacare marketplace] can do so only if they are also licensed as insurance agents demonstrates that the state law obstructs the federal purpose.”

A federal judge in Tennessee temporarily blocked a similar law in that state in October.

Missouri is likely to appeal the new ruling, which may eventually have broad ramifications for how well states can sign up residents for Obamacare. A recent study by George Washington University found that patients who go to clinics in states with strict navigator laws are significantly less likely to get information about the health law or find an insurance plan that’s right for them.

After opening three weeks ago, the new Missouri Health Insurance Marketplace website is steadily improving.  Missourians are starting to enroll in new, quality, affordable health insurance, many with financial help.  The website has experienced some difficulties, so please be patient and keep trying.

Give it a try — shop the Marketplace at www.healthcare.gov and make your way to Missouri.

We know lots of people still have questions: What does it mean? How does it work? How can my family or business benefit? How can I get information to people who are uninsured? What’s the latest news? Please join us for any of the following programs to get your questions answered. And, please spread the word.

Marketplace Launch Conference Calls
Join us to get updates on the new Marketplace.
Thursdays, 12:00 noon: October 24, and October 31. For call-in information, RSVP tomohealthcareforall@gmail.com.

Community Education Forums: Understanding the Health Insurance Marketplace in Missouri

Get your questions answered about the new Health Insurance Marketplace at any of the following programs. All are free and open to the public.

Missouri Health Care for All provides speakers to all types of organizations. If your organization or congregation would like to host a speaker, please contact us atmohealthcareforall@gmail.com.

Programs are being added frequently. If you don’t see a program near you, please watch the “Events” page at http://mohealthcareforall.org/events, and don’t forget you can sign up for our weekly October conference calls.

St. Louis County (Ladue) Wednesday, October 23, 7:00 pm
Congregation Shaare Emeth 11645 Ladue Road, St. Louis, Missouri 63141

St. Louis City Thursday, October 24 Two sessions: 12:00 pm and 7:00 pm
Central Baptist Church 2842 Washington Ave, St Louis, MO 63103

Jefferson City Monday, October 28 Two sessions: 6:00-7:15 pm and 7:30-8:45 pm
Lincoln University – Ballroom Jefferson City, MO Navigators will be available to help with enrollment following each presentation.

West Plains Tuesday, October 29 Two sessions: 3:00 pm and 6:00 pm
Missouri State University – West Plains, Melton Hall – Room M112 129 Garfield Avenue, West Plains, MO 65775

Lake St. Louis Sunday, November 3, 2:00 pm
Transfiguration Episcopal Church 1860 Lake St. Louis Blvd., Lake St. Louis, MO 63367

Jefferson County (Dittmer) Monday, November 4, 7:00 pm
St. Martin’s UCC 7890 Dittmer Ridge Rd., Dittmer, MO 63023

St. Louis County (Kirkwood) Tuesday, November 5, 7:00 pm
Kirkwood Baptist Church 211 North Woodlawn Ave., Kirkwood, MO 63122

St. Louis Post-Dispatch, October 9, 2013

By Joan Bray, Executive Director of Consumers Council of Missouri

Nearly 500,000 uninsured Missourians got the opportunity, beginning last week, to do something extraordinary — get health insurance through the Affordable Care Act. Now they can add security and comfort to their lives, knowing they finally have medical care they can afford.

And they will get it at reasonable cost because individuals and families earning incomes up to 400 percent of poverty will be assisted by subsidies or tax credits. Consumers can go to www.healthcare.gov, click through to Missouri, choose from among 17 insurance plans and determine the cost to their budgets.

Unfortunately, opponents of the ACA in Missouri’s Legislature have spent the past three years obstructing this opportunity.

In August 2010, the Legislature put Proposition C on the ballot, aimed at Missourians opting out of a major requirement of the federal law — obtain insurance or pay a penalty. The measure passed, but the outcome was only symbolic because federal law generally trumps state law. The result serves primarily to cloud the atmosphere.

In November 2012, Proposition E became law, largely barring state workers from assisting Missourians in taking advantage of the ACA and making them liable for lawsuits if they do. The federal law establishes a marketplace in each state, an online destination where consumers compare insurance options in plain language. Prop E decreed that no state employee may participate in designing or implementing the marketplace unless it has been established in Missouri law — which the Legislature refused to do.

As a result, nonprofit organizations such as the Missouri Foundation for Health and the Missouri Hospital Association are picking up the slack to provide enrollment assistance. They know that healthier Missourians are more productive and happier Missourians.

As if lawmakers hadn’t done enough damage through ballot measures, this past legislative session they passed another attempt to safeguard the state’s dubious distinctions of ranking 42nd in health status among the states and having the second-highest growth rate of uninsured people over the past 13 years.

The ACA provides for people and organizations, “navigators,” to help consumers choose and enroll in insurance plans. It makes sense. Selecting insurance is stressful, even for those who enroll annually under employer plans.

But Senate Bill 262 makes it difficult for navigators to function. The Missouri law:

• Imposes a fine on anyone who is unlicensed as a navigator but is helping someone find insurance in the marketplace. It requires private individuals who talk to other private individuals about insurance to either obtain a navigator license or pay a fine. This has a chilling effect on community and public interest organizations that are filling the gap in state involvement caused by Prop E.

• Bars navigators from providing advice about “the benefits, terms, and features” of a plan. So much for navigators being helpful. Such language prevents navigators from meeting the federal law’s requirements to “distribute fair and impartial information concerning enrollment in qualified health plans” and “facilitate selection of a qualified health plan.” But Missouri keeps a navigator from advising a consumer that one plan is better than another and disclosing plan details.

• Doesn’t allow navigators to tell consumers about plans or other insurance products not offered in the marketplace. Qualified health plans will also be sold outside the marketplace. But a navigator in Missouri has to pretend they don’t exist.

• Mandates that a navigator encountering a person who has insurance obtained from an insurance agent not advise that person but refer her instead to the private market.

A majority of the highly partisan Missouri Legislature has made the ACA much less attainable for the people they are sworn to serve, 13 percent of whom are uninsured. These lawmakers have spent the past three years demonizing and complicating the most socially beneficial federal legislation since Congress passed Medicare and Medicaid in 1965.

Missourians must draw on our deep-seated Midwestern grit and perseverance to get past the negative rhetoric and destructive policies calculated to diminish us before we can finally provide a healthier, happier future for ourselves and our families. We can do it.