Opportunity for news stories: New federal rules mean all nonprofit hospitals must do a community health needs assessment

It's long been the rule that nonprofit hospitals have had to provide charitable benefits to their community in order to keep their nonprofit status. That's no small matter, given that 60 percent of the nation's almost 3,000 hospitals are nonprofits and those tax benefits equal $12.6 billion annually. The benefits those hospitals provide have usually come in form of care for those unable to afford it, but it's unclear how, and how much, hospitals spend on community benefits has led to increased oversight by the Internal Revenue Service and Congress.

This year, there's a new kink for nonprofit hospitals and one that is important to every community those hospitals serve -- and a golden opportunity for every news outlet that reports on them. The Patient Protection and Affordable Care Act requires each nonprofit hospital to conduct a community health needs assessment, which must include a wide variety of community stakeholder input, prioritize needs, and eventually, when completed, be made widely available to the public. As explained by the Robert Wood Johnson Foundation, the assessment does more. It "offers an opportunity for the entire community to work together to collectively improve health." Participants can include health systems, health departments and other government agencies, community organizations, employers, the faith community, the United Way and other non-profits, local funding organizations, academic institutions, and other community leaders.

To read the issue brief and find more resources about the benefit and programs associated with it, go here.

Experts disagree on whether states will choose to expand Medicaid

Experts disagree on whether states will choose to expand Medicaid, a crucial, but voluntary, part of the federal health-care reform law. Yesterday, the Supreme Court ruled the federal government could not force states to expand the system for the poor and disabled, but that the expansion itself is constitutional.

Yesterday, both Gov. Steve Beshear and Senate President David Williams both indicated they are researching how Kentucky should proceed.

U.S. Sen. Lamar Alexander, R-Tenn., said "many states, maybe most, will decide that they simply cannot afford to choose to expand Medicaid." Though the federal government will pay for the newly eligible enrollees for several years after the law takes effect in 2014, states will eventually have to pay 10 percent of the cost.

Despite the expected cost, Sara Rosenbaum, a professor of health law and policy at George Washington University, predicts that "only a small number of states" will pass up the opportunity to expand, given the federal government's generous offer, reports Robert Pear for The New York Times.

The Medicaid expansion is central to the health care law, since about 17 million of the 30 million Americans who will newly qualify for health insurance will do so under Medicaid. In Kentucky, that translates to 280,000 more people enrolling in the program.

Senior administration officials said they feel sure states will choose to expand Medicaid, but Republican governors like Mitch Daniels in Indiana and Bob McDonnell in Virginia would not commit either way. Daniels said the expansion would cost Indiana $2 billion in the next 10 years.

And though U.S. Sen. Max Baucus, D-Mont., is one of the authors of the new law, he was not sure his own state would opt to expand. He did call the offer of federal assistance "a big juicy carrot." (Read more)

Useful list helps explain health care law and Supreme Court ruling

To learn more about the U.S. Supreme Court ruling on the federal health-care reform law, as well as the Affordable Care Act itself, the Detroit Free Press has put together a list of helpful websites that elucidate the issues.

The list would be helpful to reporters interested in localizing the impact of the law.

Click here for the list, compiled by reporter Pat Anstett.

What will high court do on health law? 4 most possible scenarios

Last week, U.S. Supreme Court justices heard arguments about the constitutionality of the federal health-care reform law. At the center of the debate is whether the government can force people to buy health insurance, a provision often referred to as the individual mandate. There are four likely scenarios that will be the outcome of the justices' decisions, asserts Jennifer Haberkorn for Politico, all of which come with their own problems.

Scenario 1: The individual mandate is struck down, as well as insurance reforms: If these parts of the Affordable Care Act are scrapped, "Insurance companies will still be able to deny coverage based on customers' costly pre-existing conditions and charge more to older and sicker — or female patients," Haberkorn reports.

If that happens, the Obama administration and Democrats would likely blame Republicans for promoting a lawsuit that puts insurance companies in charge again. If reaction from the public is strong, Republicans may feel obligated to enact insurance reforms without an individual mandate. Ideas for doing this include "charging more if a person buys insurance at the last minute, tax incentives and a promise that if a person buys coverage, that person wouldn't lose it if he or she were to get sick and need it," Haberkorn reports.

Scenario 2: The mandate is struck down, but insurance reforms stay intact: Part of the reason why insurance companies agreed to stop denying coverage based on pre-existing conditions is they could offset the losses because the law would enlarge their insurance pool by 30 million people — the number of Americans who lack coverage.

If insurance companies are still required to stop denying coverage based on pre-existing conditions but the individual mandate is struck down "They could start a mini revolt over having to cover expensive patients without the mandate," Haberkorn reports.

Scenario 3: The entire law, or the majority of it, is axed: That would mean unpopular parts of the law would be trashed, but so would popular ones, including the pre-existing conditions piece as well as a provision that allows young adults to stay on their parents' health insurance until the age of 26.

In 2010, 26 provisions took effect and another 17 did last year. Nine new provisions are taking place this year. "Lawmakers designed the phase-in, in part, with the thought that the public would become more supportive of the law once certain provisions began to take hold," report Michael Doyle and David Lightman for McClatchy Newspapers.

Scrapping the law entirely could cause the most political fallout. "Republicans would try to move quickly to enact a small-scale health reform legislation aimed at restoring some of the popular pieces of the health law," Haberkorn reports. "But Democrats won't want to support something far less comprehensive than the Affordable Care Act, not with some 50 million Americans uninsured."

Scenario 4: The law stands: Though this is the hope of the Obama administration, "The mandate is considered relatively weak: The penalty for not obeying it starts at $95 in 2014 — that's nothing compared with the cost of insurance premiums," Haberkorn reports. The amount increases to $695 by 2016.

As for what the justices will do, "at least some of the court's conservatives seem prepared to kill the whole bill," report Doyle and Lightman. "My approach would be, if you take the heart out of the statue, the statute is gone," Justice Antonin Scalia said.

Justice Elena Kagan countered, "Half a loaf is better than no loaf," while Justice Ruth Bader Ginsburg suggested, "It's a question between a wrecking operation and a salvage job."

Some justices said the whole bill should be sacked, "on the theory that members of Congress would not have voted for it without the mandate," Adam Liptak reports for The New York Times. But Justice Sonia Sotomayor said killing the whole law "would be too broad an assertion of judicial power," Liptak notes. Justice Anthony Kennedy, the likely swing vote, said "We would be exercising the judicial power, if one provision was stricken and the others remained, to impose a risk on insurance companies that Congress had never intended."

The justices probably decided the future of the law Friday morning, reports Mark Sherman for The Associated Press. Typically, an initial vote is "followed soon after by the assignment of a single justice to write a majority opinion, or in a case this complex, perhaps two or more justices to tackle different issues. That's where the hard work begins, with the clock ticking toward the end of the court's work in early summer," Sherman writes.

In Kentucky, health advocates and officials are watching closely to see what happens. "I think the entire health-care sector and insurance sector are watching this closely because it has significant implications on both industries," said Stephen Williams, chief executive officer of Norton Healthcare. "This is very far-reaching."

In Kentucky, the law extends coverage for 35,000 young adults, reports Laura Ungar for The Courier-Journal. (Read more)

What would solve primary-care crisis, create jobs and help banks? Building community health centers, writer contends

The federal health-care reform law will mean a glut of new patients who will be newly insured and bog down the primary-care system. Thousands of construction workers are out of jobs as the economy remains stagnant. And the banking sector is still reluctant to lend. The answer to all three problems? Build more community health centers, writes Jeffrey Leonard in an opinion piece in The Washington Monthly. (Photo: Vista, Calif., Community Clinic)

"The way to meet the flood of new patients coming down the pike is to expand the nation's existing network of community health centers — nonprofit clinics that offer primary care to the medically under-served, often in rural areas or inner cities," writes Leonard, CEO of the Global Environment Fund and chairman of the magazine's board of directors. "But to get this done, there's no need to appropriate billions more in direct government spending. Rather, there is a way to lure skittish banks in lending private capital to finance a health-center construction boom in all 50 states, simply by tweaking the language of an existing federal lending program."

Though community health centers generally have difficulty raising their own funds to expand or build facilities, in part because they serve uninsured, low-income patients who can't donate to building projects, they are sound investments, Leonard contends, pointing out only "one or two" of the 1,200 community health centers in America today have ever defaulted on a loan.

Still, they have trouble getting loans from banks, even once they have been able to raise a chunk of funds, in large part because centers "in an economically distressed inner-city neighborhood serving a mixture of Medicaid patients and the uninsured, or one in a depressed heartland town where real estate prices are spiraling downward" are seen as a risk, Leonard explains.

Leonard suggests the centers be eligible for the Small Business Administration's 504 loan program, in which a small business asks a non-profit lender to issue "low-interest, fixed-rate, government-backed bonds to finance up to 40 percent of the project," Leonard writes. As of now, the loan program is only open to some for-profit businesses. But Congress could change that, thus opening up possibilities. Moreover, the loan program is "routine and efficient to process" and the "interest rates are among the lowest on the market," Leonard contends.

Another option would be for construction companies and real estate developers to put up the equity themselves, build the facilities and then rent them out to nonprofits "on a long-term lease or through various lease-to-own arrangements." "Indeed, hungry developers and construction firms would find any number of ways to get the hammers swinging," Leonard writes.

Overall, it's a win-win, Leonard argues."It's hard to imagine Congress appropriating any more direct spending to fuel the construction of health centers," he writes. "But there's no good reason why they shouldn't change a few words in a statute to achieve the same end. Not only would it quickly create much-needed jobs in the construction trades, it would also spark economic activity over the long run in some of the places in America that need it most." (Read more)

Teens are misinformed about risks of tanning beds, and are not being warned at salons

With swimsuit season just around the corner, the American Academy of Dermatology has found that more than 40 percent of people who tan have never heard from tanning salon employees about the dangers of tanning beds. This comes days after the Tanning Bed Cancer Control Act was introduced by U.S. Reps. Carolyn Maloney (D-N.Y.) and Charlie Dent (R-Pa.). It calls on the Food and Drug Administration to reclassify indoor tanning beds and require warning labels on the equipment about the dangers of ultraviolet light.

"Studies have found that UV radiation from indoor tanning beds increases a person's risk of developing melanoma by 75 percent," said dermatologist Dr. Ronald L. Moy, president of the dermatology academy. "Contributing to this problem is the fact that tanning bed facilities currently are not required to verbally warn patrons of the known health risks of ultraviolet radiation and, in some cases, they may be misleading the public by falsely promoting artificial UV light as safer than natural sunlight."

The report found tanning bed users from 14 to 17 are "more than twice as likely to think tanning beds are safer than the sun than older tanners age 18 to 22 ... and more than three times as likely to think that tanning beds do not cause skin cancer," the research-reporting service Newswise reports.

"The FDA currently ranks tanning beds as a Class I medical device, which provides a minimal level of regulation and oversight similar to bandages, tongue depressors, gauze and crutches," Moy said. "That is why it's important that the FDA change the classification of indoor tanning devices to reflect the significant health risks that they pose." (Read more)

Earlier this year in the Kentucky General Assembly, state Rep. David Watkins of Henderson introduced a bill that would prevent children under 14 from using tanning booths. The bill, which was backed by the Kentucky Medical Association and the American Cancer Society, cleared the House's Health and Welfare Committee but went no further.

Rogers, Florida colleague file measure to crack down on 'pill mills'

U.S. Rep. Harold "Hal" Rogers of Eastern Kentucky's 5th District continues to pressure the White House for more action to crack down on "crook doctors operating these pill mills," the Lexington Herald-Leader's Halimah Abdullah reports. (H-L photo by David Perry)

Along with U.S. Rep. Vern Buchanen, R-Fla., Rogers has filed a measure that would support state-based prescription drug monitoring efforts; use seized profits from the drug trade to support rehabilitation treatment; tighten prescription standards for some pain drugs; and make prison terms more lengthy and fines more expensive.

The Obama administration says it is doing its part and "is the first to publicly call the prescription abuse problem an epidemic," Abdullah reports. White House officials contend the administration has increased drug busts and has already poured millions into state-operated prescription monitoring programs. "We've been laser-focused on this issue since day one," said Rafael Lemaitre, a spokesman for the Office of National Drug Control Policy. (Read more)