Walgreen Stores Turning Away New Medicaid Patients

Walgreens: No New Medicaid Patients As of April 16, 2010


Effective April 16, Walgreens drugstores across the state won't take any new Medicaid patients, saying that filling their prescriptions is a money-losing proposition — the latest development in an ongoing dispute over Medicaid reimbursement.

The company, which operates 121 stores in the state, will continue filling Medicaid prescriptions for current patients.

In a news release, Walgreens said its decision to not take new Medicaid patients stemmed from a "continued reduction in reimbursement" under the state's Medicaid program, which reimburses it at less than the break-even point for 95 percent of brand-name medications dispensed to Medicaid patents.

Walgreens follows Bartell Drugs, which stopped taking new Medicaid patients last month at all 57 of its stores in Washington, though it still fills Medicaid prescriptions for existing customers at all but 15 of those stores.

Doug Porter, the state's director of Medicaid, said Medicaid recipients should be able to readily find another pharmacy because "we have many more pharmacy providers in our network than we need" for the state's 1 million Medicaid clients.

He said those who can't can contact the state's Medical Assistance Customer Service Center at 1-800-562-3022 for help in locating one.

Along with Walgreens and Bartell, the Ritzville Drug Company in Adams County announced in November that it would stop participating in Medicaid.

Fred Meyer and Safeway said their pharmacies would continue to serve existing Medicaid patients and to take new ones, though both expressed concern that the reimbursement rate is too low for pharmacies to make a profit.

The amount private insurers and Medicaid pay pharmacies for prescriptions isn't the actual cost of those drugs but rather is based on what's called the drug's estimated average wholesale price. But that figure is more like the sticker price on a car than its actual wholesale cost.

Washington was reimbursing pharmacies 86 percent of a drug's average wholesale price until July, when it began paying them just 84 percent. While pharmacies weren't happy about the reimbursement reduction, the Department of Social and Health Services said that move was expected to save the state about $10 million.

Then in September came another blow. The average wholesale price is calculated by a private company, which was accused in a Massachusetts lawsuit of fraudulently inflating its figures. The company did not admit wrongdoing but agreed in a court settlement to ratchet its figures down by about 4 percent.

That agreement took effect in September — and prompted a lawsuit by a group of pharmacies and trade associations that said Washington state didn't follow federal law in setting its reimbursement rate, and that that rate is too low. The lawsuit is pending.

"Washington state Medicaid is now reimbursing pharmacies less than their cost of participation," said Jeff Rochon, CEO of the Washington State Pharmacy Association.

Pharmacies that continue to fill Medicaid prescriptions at the current state reimbursement rate are "at risk of putting themselves out of business altogether," he said.




With Medicaid Cuts, Doctors & Patients To Drop Out



Carol Y. Vliet’s cancer returned with a fury last summer, the tumors metastasizing to her brain, liver, kidneys and throat.

As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years.

She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid.

Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room.

The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall.

“My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”

It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.

Mrs. Vliet, 53, who lives just outside Flint, has yet to find a replacement for Dr. Sahouri. “When you build a relationship, you want to stay with that doctor,” she said recently, her face gaunt from disease, and her head wrapped in a floral bandanna. “You don’t want to go from doctor to doctor to doctor and have strangers looking at you that don’t have a clue who you are.”

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.

In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.

As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it.

The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.

Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.

When Randy C. Smith showed up recently at a Hamilton Community Health Network clinic near Flint, complaining of a throbbing molar, Dr. Miriam L. Parker had to inform him that Medicaid no longer covered the root canal and crown he needed.

A landscaper who has been without work for 15 months, Mr. Smith, 46, said he could not afford the $2,000 cost. “I guess I’ll just take Tylenol or Motrin,” he said before leaving.

This year, Gov. Jennifer M. Granholm, a Democrat, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, she has warned, the state may have to reduce payments to health care providers by 11 percent.

In Flint, the birthplace of General Motors, the collapse of automobile manufacturing has melded with the recession to drive unemployment to a staggering 27 percent. About one in four non-elderly residents of Genesee County are uninsured, and one in five depends on Medicaid. The county’s Medicaid rolls have grown by 37 percent since 2001, and the program now pays for half of all childbirths.

But surveys show the share of doctors accepting new Medicaid patients is declining. Waits for an appointment at the city’s federally subsidized health clinic, where most patients have Medicaid, have lengthened to four months from six weeks in 2008. Parents like Rebecca and Jeoffrey Curtis, who had brought their 2-year-old son, Brian, to the clinic, say they have struggled to find a pediatrician.

“I called four or five doctors and asked if they accepted our Medicaid plan,” said Ms. Curtis, a 21-year-old waitress. “It would always be, ‘No, I’m sorry.’ It kind of makes us feel like second-class citizens.”

As physicians limit their Medicaid practices, emergency rooms are seeing more patients who do not need acute care.

At Genesys Regional Medical Center, one of three area hospitals, Medicaid volume is up 14 percent over last year. At Hurley Medical Center, the city’s safety net hospital, Dr. Michael Jaggi detects the difference when advising emergency room patients to seek follow-up treatment.

“We get met with the blank stare of ‘Where do I go from here?’ ” said Dr. Jaggi, the chief of emergency medicine.

New doctors, with their mountains of medical school debt, are fleeing the state because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.

Access to care can be even more challenging in remote parts of the state. The MidMichigan Medical Center in Clare, about 90 miles northwest of Flint, closed its obstetrics unit last year because Medicaid reimbursements covered only 65 percent of actual costs. Two other hospitals in the region might follow suit, potentially leaving 16 contiguous counties without obstetrics.

Medicaid enrollees in Michigan’s midsection have grown accustomed to long journeys for care. This month, Shannon M. Brown of Winn skipped work to drive her 8-year-old son more than two hours for a five-minute consultation with Dr. Mukkamala. Her pediatrician could not find a specialist any closer who would take Medicaid, she said.

Later this month, she will take the predawn drive again so Dr. Mukkamala can remove her son’s tonsils and adenoids. “He’s going to have to sit in the car for three hours after his surgery,” Mrs. Brown said. “I’m not looking forward to that one.”

Sources: NY Times, Walgreens, Fox News, Seattle Times, Youtube

Health Care Reform Now Rests On Harry Reid's Shoulders...Poor Guy

What to watch for in today's Health Care Reform debate



Nancy Pelosi did it. Can Harry Reid?

Two Saturdays ago, Pelosi passed health reform on a squeaker of a House vote. Today, Reid can’t spare a single Democrat as the Senate decides whether to start debate. If not, President Barack Obama’s reform hopes suffer immeasurable harm.

That said, things were looking good at daybreak, as Reid can be reasonably confident of 59 votes, with Sen. Ben Nelson (D-Neb.) a yes vote and Sen. Mary Landrieu (D-La.) leaning yes. The holdout: Sen. Blanche Lincoln (D-Ark.), who has been a fan of reform generally but faces a tough 2010 re-election fight.

In theory, Reid’s job should actually be easier than Pelosi’s. The House voted on final passage. Reid is just asking the Senate to begin debate. But the vote is more than that – it’s a test lab for the ideas, arguments and battle tactics that both sides will carry into an epic showdown over health reform next month.

The debate runs all day with the vote scheduled for 8 p.m. To cut through all the speechifying and straight to what matters, POLITICO offers these things to watch.

Harry Reid’s three-step.

The Patient Protection and Affordable Care Act is now a fully owned subsidiary of the Senate Majority Leader’s office and its fate and the political fortunes of its author are intimately intertwined. Reid needs to deliver reform.

“His entire political future is predicated on a campaign that ‘I get things done and I can get things done for this nation and Nevada,’” said Nevada political analyst and columnist Jon Ralston. “It really undermines that campaign if he can’t get it done.”

Reid’s decision to include a public insurance option was largely viewed as a political move to satisfy the labor unions and progressive activists he’ll need to campaign for him when he runs for re-election next year. That’s Harry Reid, the endangered Senate candidate.

But Reid comes to the chamber in two other roles. As Senate ringmaster, he’s trying to keep his diverse constituency safe and away from too-tough votes. But as White House point man, he’s trying to deliver Obama-style reform, on an Obama-style schedule, before the end of the year.

Those roles can conflict on the Senate floor. Already, the White House has signaled a preference for the “trigger” on a public option but Reid picked the plan with a state opt-out, arguably a more liberal version that could cause him trouble with moderates.

Listening to Lincoln

Look for Lincoln, Landrieu, Nelson and fellow centrists to go to great lengths to explain how their vote is not a vote for reform, but simply an OK to talk about reform.

“If you don’t like the bill, then why would you block your own opportunity to amend it?” Nelson said earlier this week.

Aside from the obligatory nods to small-d democracy, the real clue to Harry Reid’s future headaches is what else they say. Expect to hear Nelson’s concerns about federal funding for abortions, Sen. Joe Lieberman’s stiff opposition to a public insurance plan and Landrieu’s worries about how the plan will affect small businesses.

Already, Lieberman and Nelson have said they’ll join Republicans in blocking the bill if their concerns aren’t met. Watch to see if any other moderates go that far Saturday.

And listen for how forcefully the centrists make their demands. Landrieu spoke up and got an extra $100 million in Medicaid funding sent to Louisiana.

But what will Lincoln say? She’s been cagey for months and has tried to calibrate her remarks – particularly on the public option – to avoid upsetting either side of the debate. Today’s her day to speak up and lay down the must-haves – part of the maze of moderate demands Reid must navigate before he can pass a bill.

The future Republican TV ads

In many ways, Saturday’s vote is the real kickoff to Campaign 2010 for the Senate. Republicans will begin sharpening their attacks into what will become familiar refrains over the next year should reform pass.

First off, Republicans will push back hard against Democrats “procedural” argument and call the vote an implicit endorsement of Reid’s bill. And they’ll say it greases reform’s path to final passage. A Congressional Research Service report found that over the past decade, 97 percent of the bills subject to a 60-vote threshold to begin debate eventually passed.

But health care reform plays into the larger GOP narrative of an Obama White House bent on wrapping its fingers around every industry and taxpayer until it has plucked every ounce of capitalism from the economy. So look for Republicans to cast the bill as a government takeover of health care that raises taxes and premiums on Americans while endangering seniors with drastic Medicare cuts.

“It's a quarter- trillion in Medicare cuts; between $400 billion and $500 billion in new taxes; and higher insurance premiums for 85 percent of the American people who already have health insurance. That's the core of the bill,” Senate Minority Leader Mitch McConnell said Friday.

One problem for Democrats – polls show a lot of the American people are worried about just that. So naturally, they’ll be highlighting the other parts of the bill that are surefire winners, like ending denials of coverage for pre-existing conditions.

Hot-button pushing

They are some of the debate’s most familiar and much-debated issues. The public option: government takeover of health care, or honest competitor to the private sector? Rationing: is it in the bill, or not?

Each issue has flared and then cooled in almost regular cycles throughout the year and a floor debate may spark any one of them again. Federal funding for abortions almost derailed reform in the House two weeks ago. So keep an eye out for new developments that could reignite these always-smoldering issues.

Charges of health-care rationing are likely to get a lot of play Saturday, as Republicans seize on confusing new guidelines for mammograms and pap smears to raise questions about government interference in health care.

And if there’s a contender in the Senate bill for a surprise last-minute fight, it could be immigration reform, as Reid put in tough language that bars illegal immigrants from buying health insurance in the exchange and bars legal immigrants from government health services for five years, measures that Hispanic Democrats oppose.

The Mainers

Don’t forget the two GOP senators from Maine who Democrats see as their best opportunity to bring a splash of Republican red to a very blue bill.

The spotlight has largely subsided since Sen. Olympia Snowe endorsed the Senate Finance Committee bill last month. But Reid and President Obama continue talking to Snowe and her colleague Sen. Susan Collins.

“The conversations have to translate into something specific,” Snowe said on Thursday, illustrating her frustration that the reform has only moved further left since October.

Democrats may get a better sense of just how much those talks have swayed the senators – if at all – should they take the mike today. Their comments over the past few days suggest it’s going to be a tough sell.

“When Americans understandably are so upset about the high cost of health care and when health insurance premiums are going up by double digits, making it so difficult for most Americans to afford health insurance, the last thing we should be doing is to make the situation worse,” Collins said in a Friday floor speech.

But here’s the twist – Obama has hinted to his fellow Democrats that he’s in favor of one thing that’s not in the Reid bill, a public option “trigger” that only kicks in if the private sector fails to expand coverage enough. It's a provision Snowe supports. If Reid can’t muster the votes for his version of a public option, the trigger could make a reappearance, and with it, the hunt for even a single GOP vote.





US House passes historic Health Care Reform bill


The House of Representatives passed legislation for the first time Saturday night that would provide health coverage to almost every American after nearly a century of false starts and un-kept campaign promises.

The final vote was 220-215. In all, 219 Democrats voted to approve the measure in a largely party-line vote, with 39 Democrats voting no. One Republican supported the bill, Rep. Joseph Cao (R-La.).

The bill has a steep cost – both in dollars, $1.2 trillion, and political capital – but Democrats hailed its passage as the next chapter in a governing legacy that produced Medicare and Social Security.

“Oh what a night,” Speaker Nancy Pelosi said moments after the vote, after fielding a congratulatory call from President Barack Obama. “Without President Obama in the White House, this victory would not have been possible. He provided the vision and the momentum for us to get the job done for the American people.”

Obama has made health care reform his signature legislative priority — and he put his personal prestige on the line Saturday by traveling to the Capitol to rally Democrats, telling them to “answer the call of history” by passing the bill.

In a written statement after the vote, Obama hailed the House bill as one that would “make real the promise of quality affordable health care for the American people.”

But Republicans were equally sweeping in their condemnation of the bill. “This is perhaps the worst bill I have seen come to the floor in my 11 years in Congress,” said Wisconsin Rep. Paul Ryan.

The bill includes fundamental changes to the American health care system – creating a public health insurance option to compete with private insurers and for the first time, requiring employers to offer health insurance.

The path ahead remains shaky – for the bill and for many of the Democrats who voted to approve it. Party leaders need to mend the bruised feelings that will linger from this debate before they can address whatever legislation the Senate can produce.

And in the Senate, Majority Leader Harry Reid is still struggling to find 60 votes for Senate legislation and made clear he might not meet the White House’s Christmas deadline to pass a bill. Obama said in his statement, however, that he expects to sign a bill this year.

Fights over abortion, immigration and the size of the federal government exposed long-standing cultural and regional divides within the disparate Democratic caucus. A last-minute abortion fight left a particularly bitter taste in the mouth of Democratic women who spent the early part of their careers fighting for reproductive rights.

“People are furious,” said Colorado Rep. Diana DeGette.

After hours of negotiations with a group of abortion opponents, led by Indiana Rep. Brad Ellsworth, and the United States Conference of Catholic Bishops, Pelosi made a final painful sacrifice to pick up crucial support, allowing a vote on an amendment sponsored by Ellsworth and Michigan Rep. Bart Stupak that would bar any insurance company participating in the exchange program from covering the procedure.

Stupak’s amendment passed with a vote of 240 -194-1. Republican Rep. John Shadegg of Arizona was the one present vote.

On abortion, the two sides engaged in a fevered debate on the House floor hours before the House approved the overarching health care bill, with DeGette calling the amendment “a wolf in sheep’s clothing” and Connecticut Rep. Rosa DeLauro, a Pelosi ally, saying, “It attempts an unprecedented overreach.”

But in the end, Democrats, like DeGette, subverted their political prerogatives and personal anger for a bigger goal – providing health care to 96 percent of the country.

“I don't believe any of us believe we can hold up what we've been fighting for ... and that's health care," said Rules Committee Chairwoman Louise Slaughter (D-N.Y.), who left her own chamber when the panel granted Stupak his vote.

The bill would expand coverage to 36 million uninsured Americans through a mix of subsidies and incentives and mandates on individuals and businesses. Under the plan, individuals would have to secure insurance through their employers or through an insurance exchange established by the bill. Authors set aside subsidies to help lower- and middle-income Americans who don’t qualify for Medicaid pay for that insurance.

In an effort to lower premiums across the marketplace, House Democrats would create a government insurance option to compete with private insurers that would operate in the exchange. And businesses with more than $500,000 in annual payroll would be required to cover their employees or pay a penalty of as much as 8 percent of the combined salaries.

Republicans oppose almost every aspect of the bill, from the cost to the requirements on individuals and small businesses. They characterized the creation of a so-called public plan as a “government takeover of the health care system.” And members of the minority malign the president and his congressional allies for failing to make a genuine effort at bipartisanship.

Republican Leader John Boehner called the requirement that individuals purchase insure "the most unconstitutional thing I've seen in my life."

The GOP is also gambling that voters will reward them for their unified opposition to the package. For months, Republicans have been chomping at the bit to hang this vote around the necks of vulnerable Democrats. The National Republican Congressional Committee chastised those who were on the fence and tore into anyone who publicly supported it. Throughout the floor debate Saturday night, Republicans referred to the bill as “The Pelosi Plan,” in a bid to tar the legislation with her label.

The vote amounts to a big win for Pelosi and her leadership team. Her No. 2, Majority Leader Steny Hoyer (D-Md.), spent much of the year patiently working the caucus, and a roster of supporting players ushered the bill through three committees of jurisdiction and two turbulent months of internal negotiations that produced the final bill.

Pelosi and her team got a big push Saturday morning from Obama, who steered clear of legislative details to focus on the historic impact of the vote, comparing the reform push to the establishment of Social Security and Medicare – and reminding Democrats that both were criticized by those who predicted they would eventually lead to the country's collapse.

Obama also reminded them that voting no on the health care bill wouldn’t insulate them from Republican attacks anyway.

“Remember why you got into politics in the first place and when you do, remember we can’t afford to let this moment pass,” Obama told Democrats during a 30-minute speech in the Cannon Caucus Room Saturday morning, according to the notes of one attendee. “When I’m in the Rose Garden signing a piece of legislation to give health care to all Americans, we’ll look back and say that was our finest moment.”

Congressional Democrats echoed their president all day Saturday by highlighting the historic context of this vote.

Michigan Rep. John Dingell, who presided over Medicare’s passage in 1965 and whose father first introduced universal health care in 1943, presided over debate again from the speaker’s chair. Pelosi and others invoked Ted Kennedy’s name repeatedly. And Democrats were quick to remind each other that Saturday was the third anniversary of the 2006 election, when they bounced Republicans from power for the first time in 12 years.

When Dingell closed, he hobbled from the podium back to his seat as his colleagues rose in applause. He then exchanged a hug with Pelosi, and Hoyer came from his seat to shake his hand.

But the day belonged to Pelosi. The speaker spent months leaning on her members to iron out their issues. And the ever-practical former whip abandoned her own priorities when the votes weren’t there on abortion and a stronger version of government-sponsored insurance.

The speaker, in resplendent red, got a surprise Saturday when her grandkids made an unexpected visit to the Capitol as she scrambled to corral the final votes she needs for this historic bill. Her two grandsons ran through the hallways of her office as she called wavering Democrats, an aide said. At least one member could hear them in the background as Pelosi tried to secure that lawmaker’s vote.

“For nearly a century, leaders of every party and political philosophy – as far back as Teddy Roosevelt - have called for health care for the American people,” Pelosi said. “For generations, the American people have called for affordable, quality health care for their families. Today, the call will be answered.”



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Sources: Politico, Google Maps