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North Carolina Health News. News. Policy. Trends.

Irises Bloom in Raleigh

Photo credit: NAMI Wake County

Last Sunday, volunteers for the Wake County chapter of the National Alliance for Mental Illness placed hundreds of 45-inch-high irises with 14-inch blooms on a half-acre of the grounds of Rex Hospital at the corner of Blue Ridge Road and Lake Boone Trail in Raleigh.

The landscape-art installation is a re-creation of Vincent Van Gogh’s Irises, painted while the artist was in a mental institution, a year before his death in 1890.

The event was part of NAMI Wake’s eighth-annual Celebration of Hope. NAMI has adopted the iris as a “symbol of hope and courage.”

“Our goal is to raise awareness that mental illnesses are brain disorders,” NAMI Wake’s Ann Akland said in a release, “that with treatment there is hope, and that there is no reason for blame or shame.”

Lack of Funds Continues to Limit NC Abortion Clinic Inspections

This story first appeared in Carolina Public Press and is published by N.C. Health News through a content-sharing agreement.


Carolina Public Press

ASHEVILLE – In a new report, the N.C. Department of Health and Human Services says that funding shortfalls remain an obstacle to hiring needed inspectors for abortion clinics and other medical facilities.

The report, on “additional needs to survey abortion clinics,” was issued April 1 in response to the requirements of N.C.’s new abortion law, passed late last summer.

The law instructed DHHS to prepare new rules for how clinics are certified and to keep the N.C. General Assembly’s Joint Legislative Oversight Committee on Health and Human Services apprised of the process. Sen. Ralph Hise, a Republican from Spruce Pine, is one of the committee’s co-chairs. Hise represents Madison, McDowell, Mitchell, Polk, Rutherford and Yancey counties.

People protesting the Senate's plan to enact sweeping restrictions on abortion access outside the front of the legislative building in Raleigh.

People protesting the Senate’s plan to enact sweeping restrictions on abortion access outside the front of the legislative building in Raleigh in July 2013. Photo credit: Rose Hoban

The department’s “needs remain unchanged,” the report said. “Ten new positions will be needed.”

DHHS Secretary Aldona Wos told the legislature last summer that it will cost $1 million per year to fund 10 new inspector positions, doubling the department’s capacity. Those inspectors would survey not only abortion clinics but other acute care facilities as well, including dialysis centers and psychiatric hospitals.

In response, the General Assembly appropriated $100,000 for the potential new hires, and DHHS began seeking an additional $900,000 in federal funds from the Centers for Medicare & Medicaid Services.

But the federal funds have not come through, DHHS said in the new report. As a result, a key provision of the new abortion law remains in limbo.

DHHS addresses the holdup for new inspectors

The legislature’s directives regarding abortion clinics seemed relatively clear last summer: Do more inspections and write new rules. But neither objective has played out quickly.

“Money was appropriated by the General Assembly, but no matching funds were provided by the federal government,” DHHS spokesperson Kevin Howell said, after the new report on the continued need for more inspectors was issued. The department “performs inspections on behalf of (the Centers for Medicare & Medicaid Services), which is why federal funding is involved,” he added.

“CMS agreed to the need for these additional inspectors but did not have the funding available,” he said. “However, we will continue to work with CMS to identify and secure the funding necessary for these important positions.”

CMS has yet to comment on the matter. Requests for comment from Carolina Public Public were not answered.

Long process looms for proposed new abortion rules

The new law authorizes DHHS to “apply any requirement for the licensure of ambulatory surgical centers” to abortion clinics, while not “unduly restricting access” to abortion.

The department’s new update for the General Assembly followed a little-noticed interim report, issued Dec. 23, 2013, which was much more detailed.

It said that DHHS is beginning a rule-making process that will have to pass through a number of stages, and offered no predictions on when new restrictions might be enacted for abortion providers in North Carolina.

The process has been followed with particular attention in WNC, where the area’s sole provider of abortions, Femcare, was briefly suspended during last summer’s debate and is closing soon, while another clinic operated by Planned Parenthood is slated to open in Buncombe County.

Vidant/ Pungo Deal Will Keep Hospital Doors Open Until Summer

By Hyun Namkoong

The North Carolina chapter of the NAACP and Vidant Health announced on Thursday that they will sign an agreement to keep Vidant Pungo District Hospital in Belhaven open until at least July 1. The hospital’s doors had been slated to close on Tuesday.

Through the mediation service of the U.S. Department of Justice, a “public-private partnership” model was used to create a representative community-based board that will assume the operating responsibilities of the hospital on July 1. Details of the agreement and transfer of ownership have yet to be finalized.

One concern cited by Vidant officials is the proximity of Pungo Hospital to the water's edge and a possibility of flooding.

Pungo Hospital, in Belhaven. Photo credit: Hyun Namkoong

“In these three months, we’re supposed to have some kind of resolution in which both sides can agree upon and go forth to see if salvaging the hospital will be possible,” said Charles Boyette, a long-time physician and former Belhaven mayor for 25 years.

“We don’t absolutely know all of the details,” he said.

The announcement that Vidant Health would close the hospital worried many Belhaven residents, not only because of the loss of health care but also due to the economic implications of losing the town’s biggest employer. The hospital brings in around $400,000 of revenue annually and has been instrumental in attracting retirees to the coastal town.

The hospital’s employees have been notified that they will remain in their positions until July and, according to the press release, the community-based board will make every attempt to avoid the elimination of any jobs.

Vidant Health announced plans to construct a multi-specialty clinic to replace the hospital. However, the lack of an emergency department caused a wave of anxiety and frustration in the community that prompted the NAACP to get involved in the town’s fight to save the hospital.

Many residents of Beaufort and Hyde counties worried that the 30-mile drive from Belhaven to Washington was too long in the event of an emergency.

Still Time For Some to Sign Up for Obamacare

By Rose Hoban

The deadline has now come and gone, but there are still options for signing up for Obamacare.

When the online exchanges first went live, the federal marketplace had multiple problems and glitches. As time went on, many of the bumps got ironed out; but in the meantime, many people got discouraged and stopped trying.

Even as the online registration process got easier, it still took consumers an average of six visits to complete their applications, spending between 20 and 30 minutes during each visit, according to Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services.

hammerdAnd on the last day, Monday, March 31, many people again found themselves locked out of the federal website as high demand crashed servers.

In North Carolina, if you attempted to sign up for health insurance through the exchange and got stymied, or could not finish before midnight Monday, there’s still time.

According to CMS, people who tried to enroll during the open enrollment period but did not complete the process by midnight March 31 will have a “limited amount” of additional time to finish up. Those whose paper applications are received by April 7 will be able to select a plan through April 30.

According to a blog maintained by CMS, consumers who had trouble finishing enrollment can log into their online Marketplace application and finish the enrollment process once they confirm online that they were still trying to enroll on March 31. The blog also said consumers can call to complete enrollment at 1-800-318-2596 and tell the person on the other end that they’ve been trying unsuccessfully to enroll.

In addition, people experiencing events that change their circumstances during the year, such as childbirth or job loss, may qualify for a special enrollment period outside of the annual open enrollment period (see list).

After the end of the open enrollment period, most consumers lacking health insurance coverage will be locked out of the individual insurance market until the beginning of the next open enrollment period, which starts on Nov. 15 and lasts through Feb. 15, 2015.

Those consumers will not be able to get effective coverage under a qualified health plan from the individual insurance market until Jan. 1, 2015 at the earliest.

Before that time, people needing insurance can still enroll in other kinds of insurance such as short-term or large group plans, as they have in the past.

However, short-term insurance plans do not qualify as creditable coverage, so short-term-plan enrollees will face a tax penalty for not being enrolled in a qualified health plan. That penalty can be hefty: It’s $95, or 1 percent of a person’s income, whichever amount is greater.

Qualifying life events that allow consumers to get insurance on the health insurance exchange outside of the annual enrollment period:

  • Marriage
  • Relocation to a new area that is outside the healthcare provider network of your current health insurance plan
  • Birth or adoption of a child/dependent
  • Losing existing health insurance coverage due to:
    • Job loss
    • Divorce
    • Changes in eligibility for Medicaid or Children’s Health Insurance Program (CHIP)
    • Expiration of COBRA coverage
    • Health plan being cancelled

  • Any of these problems encountered while attempting to enroll on the health insurance exchange qualify consumers for an extension:
    • Misinformation, misrepresentation, or inaction on the part of entities providing formal enrollment assistance
    • Enrollment errors due to technical issues
    • System errors related to immigration status
    • Display errors on marketplace websites
    • Delays in application transfers for consumers found ineligible for Medicaid or CHIP
    • Error messages
    • Unresolved casework
    • Misinformation about availability of premium tax credits for victims of domestic abuse who are married but not filing a joint tax return
    • Other system errors

Release: High-quality Early Intervention Brings Health Benefits 30 Years Later

Press release from UNC Chapel Hill News office, dated March 27

Children who received high-quality early care and education in UNC’s Frank Porter Graham Child Development Institute Abecedarian Project from birth until age 5 enjoy better physical health in their mid-30s than peers who did not attend the childcare-based program.

The findings, which appear in Science, have substantial implications for health care and prevention policy. The findings are the result of FPG’s collaboration with scientists from the University College London and the University of Chicago, where Nobel laureate James J. Heckman spearheaded an intricate statistical analysis of data from the Abecedarian Project.

Not only did FPG and Heckman’s team determine that people who had received high-quality early care and education in the 1970s through the project are healthier now, significant measures also indicate better health lies ahead for them.

Previous findings from the Abecedarian Project have been instrumental in demonstrating that high-quality early education and care for at-risk children can have positive, long-lasting effects on cognitive functioning and academic achievement that extend well into adulthood. However, the new study differs by examining physical measures of health.

“To our knowledge, this is the first time that actual biomarkers, as opposed to self-reports of illnesses, have been compared for adult individuals who took part in a randomized study of early childhood education,” said Frances Campbell, FPG senior scientist and principal investigator of the Abecedarian Project’s follow-up studies. “We analyzed actual blood samples, and a physician conducted examinations on all the participants, without knowing which people were in the control group.”

“This study breaks new ground in demonstrating the emergence of the relationship between education and health,” said Craig Ramey, the original principal investigator on the project, who now serves as a professor of pediatrics and a distinguished research scholar at the Virginia Tech Carilion Research Institute. “It broadens our understanding of the power of high-quality early experience to change lives for the better.”

The study determined that people who received early care with the Abecedarian program have lower rates of pre-hypertension in their mid-30s than those in the control group. They also have a significantly lower risk of experiencing total coronary heart disease (CHD), defined as both stable and unstable angina, myocardial infarction or CHD death, within the next 10 years.

Compared to the control group, males treated in the Abecedarian program have lower incidences of hypertension in their mid-30s. In addition, treated men less frequently exhibit combinations of both obesity and hypertension, and none exhibited the cluster of conditions known as “metabolic syndrome,” which is associated with greater risk of heart disease, stroke, and diabetes.

From the start, the Abecedarian Project represented a revolutionary approach to early childhood education by providing care from early infancy and exposing children to a high-quality center for five years, instead of the shorter durations typical of other programs. Children in the treated group benefited from stable early childhood environments, which included on-site health care and nutritious meals.

They also attended full days, five days a week, year round, and they learned under the “Abecedarian Approach,” an innovative curriculum that began in infancy.

“It is of particular significance that an early educational intervention produced long-term health effects,” said FPG senior scientist emeritus Joseph Sparling, who co-created the Abecedarian Approach. Sparling noted the importance of the curriculum’s educational content and five-year duration, which he and colleagues are now adapting and applying in Canada, Mexico, China and Australia.

Campbell, who has been with the project since it began in 1972, said many factors might have contributed to the sustained and substantial health benefits now seen for study participants: more intensive pediatric monitoring, improved nutrition, a predictable and less stressful early childcare experience and improved adult education. Even without pinpointing a single mechanism responsible for improved adult health, scientists involved in the Abecedarian effort agree that early childhood interventions are an encouraging avenue of health policy to explore.

“Good health is the bedrock upon which other lifetime accomplishments rest, and without it, other gains are compromised,” Campbell said. “Investing in early childhood programs has been shown to pay off in ways we did not anticipate forty years ago when the Abecedarian study was founded.”

Half Of Uninsured Not Planning On Getting Coverage, Poll Finds

By Jordan Rau

Kaiser Health News

Data courtesy Kaiser Family Foundation

Data courtesy Kaiser Family Foundation

With less than a week left for customers to apply for insurance through the health care marketplaces, a poll released Wednesday finds that half of the people still without health coverage intend to remain uninsured.

Five million people have signed up for insurance since the marketplaces created by the federal health law opened  in October. The official deadline to sign up without facing a financial penalty is March 31, although federal officials told news organizations Tuesday that consumers who begin the process before then and have had trouble with the technology will an extension of several weeks to finish the process. The Congressional Budget Office estimates by the year’s end, 6 million people will have obtained insurance on the marketplaces.

The Kaiser Family Foundation’s latest poll, conducted in mid-March, found that 50 percent of adults under age 65 who still lack coverage plan to remain without insurance, while 40 percent aim to sign up by the deadline at month’s end. (KHN is an editorially independent program of the foundation.) The other 10 percent said they did not know what they would do or refused to talk about it.

Of the uninsured, two out of three said they have not tried to get coverage yet. The rest said they attempted to get it through an online marketplace such as, the state-federal Medicaid program, their employer or a private insurance company.

Only four in 10 of the uninsured knew the March 31 deadline to sign up for coverage, the poll found. A third of the uninsured didn’t know they are subject to a fine if they don’t obtain coverage, absent a few permitted exclusions such as financial hardship. The poll found that direct outreach efforts have had limited success: only 11 percent of uninsured people said they had been contacted about the health law by phone call, email, text message or a home visit.

According to the poll, the majority of the public still holds unfavorable views of the health care law, although that gap has narrowed from the beginning of the year. Forty-six percent of people said they disliked the law, while 38 percent approved. That gap of eight percentage points is half of what it was in November and January. The views of people without insurance also have improved since earlier this year and now essentially mirror the overall public’s opinion. The pollsters noted that it is tricky to compare the views of the uninsured over time since the composition of that group changes as more people get coverage.

A majority of the public, 53 percent, is tired of hearing fights over the health law. Forty-two percent believe the debate should continue.

The poll was conducted among 1,504 adults between March 11 through March 17. The margin of error for questions of the overall public is +/- 3 percentage points. The margin of error for questions of just the uninsured population is +/- 9 percentage points.

This story originally appeared in Kaiser Health News an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Budget for Child Care, Early Ed Looks Thin for Coming Year

By Rose Hoban

In the past three budget years, North Carolina’s various early-childhood education programs – Head Start, NC Pre-K and Smart Start – have seen almost $70 million trimmed from their state allocations. Advocates for early-childhood programs say that the prospects for the budget coming out of the legislative short session that begins in mid-May don’t look much better.

“Last year, we were trying to stop the hemorrhaging and make sure early education remained a priority in the budget,” said Michelle Rivest, executive director of the NC Child Care Coalition, a statewide advocacy group.

“There are many ways that all of these programs have been underfunded, but the reality is that we’re not going to make a push for a budget increase because there’s not much indication that it would be supported.”

Health and Human Services Secretary Aldona Wos spoke to child care experts at last week's obesity symposium.

Health and Human Services Sec. Aldona Wos spoke to child-care experts at last week’s obesity symposium. Photo credit: Rose Hoban

There are about 100,000 4-year-olds in the state, about 45,000 of whom qualify for subsidies to participate in the N.C. Pre-K program, according to Rivest. But currently, there’s only funding to support 26,000 kids in the program per year.

“So we’re clearly not serving all the children who are eligible,” she said.

Rivest pointed out that the rates paid to child-care centers as part of the state-funded child-care subsidy have not increased since 2007. That’s resulting in some child-care centers closing and frozen teacher salaries.

“We know that 41 percent of the child-care workforce was on some form of public assistance,” Rivest said. “They’re grossly underpaid.”

Data from the 2012 workforce survey compiled by the N.C. Child Care Services Association found median income for the highest-paid teachers in child-care centers was only $12 per hour, even in 4- and 5-star facilities. The vast majority of centers do not pay for health or retirement benefits. Rivest said it’s no surprise that centers experience about 20 percent turnover annually, and, according to the survey, about one in five teachers leaves the field after three years.

Last week, when asked whether the Department of Health and Human Services would be advocating for increased early-education budgets, Sec. Aldona Wos said that her department is getting “far, far smarter in how we use the one cent we have available to us.”

“There’s only a certain amount of times you can take that pie and slice it,” Wos told child-care leaders gathered at a meeting on reducing childhood obesity .

“So we don’t work on … one person works on one part of the equation, two people double it on another and the third person doesn’t have any resources to work on something else,” Wos continued.

“We maximize federal resources and we have funding from the child-care development fund; we work to maximize the number of kids that we can serve with those dollars,” Rob Kindsvatter, head of the Division of Child Development and Early Education, told the group when Wos asked him to elaborate.

Attempts to reach DHHS officials for further clarification of what changes were being made or what savings have been achieved were unsuccessful at the time of publication.

Rivest said one of the challenges for early-childhood education advocates in the past several years is educating new lawmakers about how much bang for the buck the state can derive from early-intervention efforts. She said older legislators who helped champion programs early on are gone and many lawmakers in the General Assembly are freshmen or sophomores who’ve not heard the message before.

“It surprises our coalition members when we say that many legislators don’t know about the value of early education,” she said.

So even as the economy slowly improves, Rivest and others say early-intervention advocates should be focusing on holding steady, not expanding.

“While the need remains great and there’s never been more evidence to prove the effectiveness of early education, it still remains significantly underfunded,” she said.

State Agency Denies Politics Played Role in Suspending Asheville Women’s Clinic

This story first appeared in Carolina Public Press and is published by N.C. Health News through a content-sharing agreement.

By Jon Elliston

Carolina Public Press

Carolina Public Press’ recent report on state government documents regarding last summer’s suspension of Femcare, Western North Carolina’s only abortion clinic, drew a response from the state’s Department of Health and Human Services yesterday. In it, a DHHS spokesperson again denied that political motives were behind the suspension.

The March 13 article, “Documents disclose political, PR pressures surrounding Asheville abortion clinic’s suspension,” detailed findings in internal records from both DHHS and the office of Gov. Pat McCrory. It showed how key legislators involved in new state legislation tightening restrictions on abortions pressed the department for details about Femcare’s inspection history. It also showed how the McCrory administration mounted a publicity push surrounding the suspension.

State health officials have given Femcare, an abortion clinic in Asheville, 10 days to show is it has met, or plans to meet, licensing requirements. The facility was ordered to close by Wednesday afternoon. Jon Elliston/Carolina Public Press

State health officials have given Femcare, an abortion clinic in Asheville, 10 days to show is it has met, or plans to meet, licensing requirements. The facility was ordered to close by Wednesday afternoon. Jon Elliston/Carolina Public Press

Last week, state Rep. Susan Fisher, a Buncombe County Democrat, told WLOS that CPP’s report on the documents “solidifies my belief that politics were at play in the closure of Femcare.”

“The documents exposed [last] week confirm that the laws passed this summer had nothing to do with women’s health and safety — everything to do with restricting access to safe and legal abortion care,” said Suzanne Buckley, executive director with NARAL NC, as reported by the (Raleigh) News & Observer’s state politics blog. “To put it simply, Governor McCrory and the extreme lawmakers in Raleigh are playing politics with women’s lives.”

DHHS spokesperson Kevin Howell took exception to that interpretation of Femcare’s suspension.

Regarding state legislators’ inquiries about Femcare and the clinic’s subsequent suspension, he said in a statement: “Legislators routinely seek information about facilities regulated by DHHS, and we provide them with information accordingly. This is part of a normal process. Nothing about the (Femcare) inspection was politically motivated.”

As for the department’s media outreach before and after Femcare’s suspension, he wrote: “At the time, the governor was being wrongly accused by his political opponents of restricting access to abortions. Even after last year’s survey of Femcare found egregious rules violations, some of the governor’s opponents chose to ignore the potential medical consequences that necessitated the inspections in favor of inciting political passions. Patient care and safety has always been and always will be the primary concern of Governor McCrory and (DHHS) Secretary Aldona Wos.”

According to a news release sent out by the agency last year about Femcare, inspectors found that the women’s health clinic had, among 23 rules violations, failed “to maintain anesthesia (nitrous oxide gas) delivery systems in good working condition, with torn masks and tubing held together with tape.” Read the entire inspection report here.

As Carolina Public Press first reported yesterday, Femcare is now for sale and is slated to close. The Raleigh-based Planned Parenthood Health Systems says it is preparing to provide abortion services in WNC.

Clarification: Carolina Public Press edited the headline to more accurately reflect the range of services provided by Femcare.

NC One of Ten States Critical To Obamacare Enrollment Goals

North Carolina is one of the key states being targeted by leaders in the Obama administration for enrollment in the online health exchanges created under the Affordable Care Act.

By Phil Galewitz
Kaiser Health News

Ten states – seven of them controlled by Republicans – hold the key to whether the Obama administration succeeds at signing up 6 million people by the deadline of March 31.

Those large states account for nearly 30 million uninsured – almost two-thirds of the nation’s 47 million uninsured.

That’s why the Obama administration and advocates have focused so much attention on California, Texas, Florida, New York, Georgia, Illinois, North Carolina, Ohio, Pennsylvania and New Jersey.

“It’s like what Willie Sutton said when they asked him why he robbed banks. ‘That’s where the money is,’” said Jonathan Oberlander, health policy professor at the University of North Carolina-Chapel Hill. “The national figures are really being driven by just a handful of large states.”

exchanges states target 300Reaching 6 million – the number projected by the Congressional Budget Office earlier this year – has both practical and political significance. The more enrollees there are, the more likely the exchanges will have enough younger and healthier people to spread insurance risks and hold down premiums in future years, say experts.

And it also gives Democrats potential bragging rights – or another headache – heading into the November elections.

Signups have been stronger than average in California, New York, Florida and North Carolina, where there have been vigorous outreach efforts by states and voluntary groups, but have flagged in many other places.

“We are very happy,” said Diego Ricon, 51, who signed up with his wife Saturday at Good Samaritan Medical Center in West Palm Beach, Fla., where nearly a dozen patient navigators with laptops filled a conference room and spilled into a hallway.

California, Texas take different tacks

Of the 10 big states, only California and New York have set up state-based insurance marketplaces for people without employer-based coverage. Those two states received millions in additional federal money for marketing and consumer assistance because they built their own exchanges.

California, with nearly 7 million uninsured – the highest number in the country – had enrolled 1 million people as of March 17, more than 30 percent of those eligible for the marketplace plans in that state.

But in Texas, where 6.2 million people are uninsured, almost a quarter of the state’s residents, the state declined to participate in the marketplace. As in most Southern states, officials have been openly hostile to the law. Fewer than 10 percent of those eligible for the plans had enrolled as of March 1, according to the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

While several small states, including Maryland, Oregon, Massachusetts and Hawaii, have faced continuing problems with state-run websites that have hampered enrollment, they will have little effect on whether the CBO’s 6 million projection is reached, policy experts say. The CBO had previously predicted that 7 million would enroll in 2014 but scaled that back after October’s rocky rollout.

Nationally, about 5 million people had enrolled in Obamacare plans as of March 17, according to a blog post by CMS Administrator Marilyn Tavenner. Millions more had started the application process but not chosen a plan.

Among both large and small states, those with their own insurance exchanges are generally faring better than those relying on the federal marketplace because of the additional funding they received for marketing and consumer assistance.

But enrollment has varied even among the 36 states participating in the federal exchange. For instance, North Carolina has enrolled nearly 19 percent of those eligible for the marketplaces compared to less than 10 percent in Texas and Ohio, according to the Kaiser numbers.

The pool of potential enrollees is calculated to include everyone who is uninsured or has individual coverage and has an income above the level to qualify for Medicaid (which varies depending on whether the state is expanding Medicaid).

North Carolina has done comparatively well because it set up a centralized system for residents to schedule appointments for in-person assistance, Oberlander said.

But he added, “We still have a long way to go to cover all the uninsured.”

‘Negative environment’ takes toll

Enrollment efforts in Ohio, with almost 1.5 million uninsured residents, have been hurt by negative comments about the law by Republican politicians, among them, House Speaker John Boehner, whose district is in suburban Cincinnati, said Kathleen Gmeiner, project director for Universal Health Care Action Network of Ohio, an advocacy group.

“That negative environment has taken a toll,” she said. “We run into people all the time who say, ‘I thought the law had been repealed,’ because all they hear is their congressman has voted for the 50th time to repeal the ACA.”

Boehner’s office declined to comment.

Another factor hurting enrollment is that Ohio state lawmakers imposed restrictions on the groups that received federal funding to help consumers buy coverage in the online marketplaces, including barring participation from any group that got funds from a health plan, such as hospitals and clinics. Children’s Hospital Medical Center in Cincinnati was one of two organizations in that state that returned grants and dropped out.

Texas Gov. Rick Perry also placed restrictions on navigators, which advocates and health providers say has hampered enrollment.

Changing a culture

Sara Rosenbaum, a health policy professor at George Washington University, said that enrollment has also varied because insurers have been more active in some states than others. And states in the Midwest and Northeast also have a culture where people are expected to carry insurance, whereas others do not, she said.

Over the next two weeks, Obamacare supporters have hundreds of enrollment events planned in the 10 states, and top administration officials, including the president and first lady, are expected to make more trips to Florida, Texas and Ohio to talk up enrollment.

State exchange directors, for their part, are trying to put things in perspective.

“This is about changing a culture that for too many low-income people is a culture of coping rather than a culture of coverage,” said Peter Lee, who runs the California exchange. “And that doesn’t change on a dime.”

Marketplace Enrollment
As A Share of Potential Marketplace Population As Of March 1, 2014
State Marketplace Type Estimated Number Of Potential Marketplace Enrollees Number Of Individuals Who Have Selected A Marketplace Plan Percent Of Potential Marketplace Population Enrolled
California* State-based 3,291,000 868,936 26.4%
Texas Federally-facilitated 3,143,000 295,025 9.4%
Florida Federally-facilitated 2,545,000 442,087 17.4%
Pennsylvania Federally-facilitated 1,276,000 159,821 12.5%
New York** State-based 1,264,000 244,618 19.4%
North Carolina Federally-facilitated 1,073,000 200,546 18.7%
Georgia Federally-facilitated 1,063,000 139,371 13.1%
Illinois Partnership 937,000 113,733 12.1%
Virginia Federally-facilitated 823,000 102,815 12.5%
Ohio Federally-facilitated 812,000 78,925 9.7%
U.S. total 28,605,000 4,242,325 14.8%
Source: Kaiser Family Foundation (as of March 1, 2014)

*The California marketplace announced Monday that as of March 17, 1,000,000 individuals have selected a marketplace plan (30.4 percent of potential population)
**The New York marketplace announced Tuesday that as of March 18, 327,020 individuals have selected a marketplace plan (25.9 percent of potential population)

This story originally appeared in Kaiser Health News an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

UNC Develops First Flowchart for Alcohol-related Hospital Admissions

By Stephanie Soucheray

Alcohol-related hospitalizations can cost about $5.1 billion annually in health care spending. Considering that alcohol consumption is the third-highest cause of preventable death in the United States, that number isn’t surprising.

But it is high for a condition for which hospital admittance protocols aren’t agreed upon by institutions, doctors or nurses.

“Some of us would admit these patients, while some of us would send them home,” said John Stephens.

Stephens, a professor of medicine at UNC-Chapel Hill, recently published a new protocol – a medical flowchart, if you will – that helps standardize the approach to hospital admissions of alcohol-related diagnoses.

“This population had a subset with a lot of readmissions,” he said. “Many would get better, we’d send them home and then they’d be readmitted in the same month.”

Stephens said that a protocol could potentially help admit fewer of these people into the hospital, which would cut down on the “excessive utilization of resources.” In other words, admitting fewer patients and guiding them towards outpatient care can save hospitals a lot of money.

In order to create the one-page flowchart for physician use, Stephens created a task force with three doctors, a nurse practitioner and a case manager at UNC Hospitals. The group met several times to look at the medical literature on alcohol-related diagnoses before crafting their recommendations.

The protocol and the results of an 18-month follow-up on its implementation at UNC Hospitals show some promising trends: alcohol-related admissions per month dropped from about 19 to 16 patients. According to the study, that translates into a cost savings of $315,000 per year.

Stephens said the flowchart, however, did little to influence re-admittance rates.

“The best thing from our perspective is that we can standardize care,” he said. “When we’re called into the ER, then we can say, ‘We need to use this approach.’”

Stephens said the flowchart is part of a broader trend in medicine partially based on The Checklist Manifesto by Atul Gawande. Gawande’s book argues for the use of flowcharts and checklists to help medical professionals streamline decision-making.

UNC Alcohol detox protocol and checklist.

UNC Alcohol detox protocol and checklist. Image courtesy: UNC Healthcare

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