Regulations posted today on Federal Register

title=”Regulations posted today on Federal Register”>Regulations posted today on Federal Register

Today regulations have been posted by the Health and Human Services Department providing guidance on the Essential Health Benefits, Health Insurance Exchange and other provisions of the the Affordable Care Act. 

Affordable Care Act, Health Insurance Exchange, Health Policy, Health Reform, Pennsylvania

Pennsylvania State-Operated Health Insurance Exchange- Not Happening

PA Will Miss Health Insurance Exchange Deadline

On Wednesday, October 17, Pennsylvania Health Insurance Commissioner, Michael Consedine stated that the Commonwealth will not be meeting its November 16th deadline to submit an Exchange Blueprint to the Health and Human Services (HHS) Department. Because of this, the State will not be able to establish its own state-based exchange but must instead either default to a Federally Facilitated Exchange (FFE) or partner with the federal government to establish a Partnership FFE.

Education, Health Disparities, Health Equity, Inequality, Medication, Social Determinants of Health

Using Medication to Treat Social Ills

The critical need for a social determinants approach to health care is illustrated in an article in today’s NY Times.  In “Attention Disorder or Not, Pills to Help in School” Atlanta doctor, Michael Anderson, explains that he prescribes Adderall to help even the educational “playing field” for low-income students.  Prescribing Attention Deficit Hyperactivity Disorder (ADHD) medication helps provide an edge to low-income students who are often struggling in schools that are under-resourced, yet are competing with students from higher-income families and schools for college admissions.  Dr. Anderson sees himself as employing his form of “social justice” noting, “I don’t have a whole lot of choice. We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

The possible short and long-term effects of prescribing stimulant ADHD medication to adolescents are discussed within the article, and some may find it shocking that parents and physicians would choose to prescribe medications in light of these risks.  However, a quick look at national disparities data shows that obtaining higher education is a matter of life or death.  According to the Robert Wood Johnson Foundation, college graduates are expected to live at least five years longer than those who do not graduate from college.  A mother’s education is also correlated with infant mortality; the lower her educational attainment the higher the risk for infant mortality.  Additionally, the higher one’s education the less likely they are to develop chronic diseases such as diabetes, heart disease, and obesity.  While Dr. Anderson’s clinical practices are certainly controversial and guaranteed to invite criticism, I applaud him for exposing such an important issue and calling for policies that address the true causes of health and social inequities.

Food Insecurity, Food Policy, Homelessness, Pennsylvania, Philadelphia

Philadelphia Outdoor Serving of Food Task Force Update

Outdoor Serving of Food Task Force members

In a recent post I called for more attention to be brought to Philadelphia Mayor, Michael Nutter’s Outdoor Serving of Food Task Force Report. This weekend I got what I wished for.

Philadelphia Inquirer reporter, Jennifer Lin reported on the fact that Mayor Nutter and outdoor food serving groups came to an agreement about the ban on outdoor serving of food. The two former adversaries agreed to put the litigation aside in order to focus on a long-term solution to end food insecurity and chronic homelessness in Philadelphia.

In a similar article, CBS reporter, Cherri Gregg also reported on the compromise. The Task Force’s recommendation to establish a neutral space that different food serving groups could utilize in order to increase capacity to serve was highlighted by Mayor Nutter’s press secretary, Mark McDonald.

Affordable Care Act, Essential Health Benefits, Health Reform, Pennsylvania

Pennsylvania’s Essential Health Benefits Package Progress (or lack thereof)

Previously, I provided information about the progress of Pennsylvania’s Health Insurance Exchange (HIX) implementation.  Today I received an email from Pennsylvania Insurance Department (PID) Commissioner, Michael Consedine, providing an update on the Commonwealth’s developments with the Essential Health Benefits (EHB) package and other health reform issues.

In his email, sent out through PAHealthOptions.com, the Insurance Commissioner provided links to three documents that should inform the reader of the “most recent activities of the department.”  The links included: 1. A report conducted by Deloitte on the EHB in Pennsylvania; 2. A letter to the HHS Secretary regarding the EHB; and 3. A letter to the HHS Secretary requesting more information about HIX implementation.  Following the links Commissioner Consedine assured the reader that, “We continue to be committed to pursuing health care reform solutions that work best for Pennsylvanians – but we are similarly committed to making sound, informed decisions – not just fast ones.”

The Deloitte study analyzed the Commonwealth’s choices of existing plans within the state to operate as the EHB as provided by HHS.  These include: 1. The largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market; 2. One of the three largest State employee health benefit plans by enrollment; 3. One of the three largest federal employee insurer options; or 4. The largest HMO plan offered in the State’s commercial market.

Deloitte found that there was only a one percent difference between the total value or cost between the highest and lowest options; however coverage differences did exist among the plans, most notably for dental and specialized services including behavioral health. The study also found that all ten of the existing plans analyzed would need to be supplemented in order to meet requirements under the Affordable Care Act (ACA).

So, the question is: Which health plan will Pennsylvania choose as its Essential Health Benefits package? Like the letter to HHS about the Health Insurance Exchange, Commissioner Consedine, provides a similar answer. The Commissioner states, “Given what we believe to be the clear statutory obligation on HHS to define EHBs and the lack of any rulemaking that would allow Pennsylvania to make an informed and consequential decision by September 30th, we are simply providing the study conducted by the Commonwealth at this time.”  Commissioner Consedine also stated in his letter that he will be “directing interested parties to submit their comments and recommendations to you [HHS] for your consideration. . . ..”

In an ironic attempt to subvert a “one-sized fits all” Washington D.C. policy on the State of Pennsylvania, the Insurance Department has chosen to defer to Washington D.C. to craft the EHB package and will most likely default to a Federally-Facilitated Exchange (FFE) or a Partnership FFE.


Mayor’s Task Force on Outdoor Serving of Food

Mayor’s Task Force on Outdoor Serving of Food

This year, Philadelphia Mayor, Michael Nutter’s controversial ban on outdoor serving of food garnered nationwide attention; however, efforts to propose comprehensive solutions to address Philadelphia’s critical food insecurity issues were largely left unnoticed.

The outdoor serving of food ban was implemented through two regulations:  one promulgated through the City’s Board of Health and the other through the Department of Parks and Recreation.  In short, the Board of Health regulation required outdoor servers of food to obtain food safety and handling training and the Department of Parks and Recreation regulation prohibited the serving of food to three or more members of the public within a City park without acquiring a special event permit prior to the distribution.  While the regulations applied to all parks within the City, it disproportionately impacted individuals who served food along the Ben Franklin Parkway, since that is where many homeless individuals gathered for meals.

Plaintiff food servers brought suit against the Mayor and the City claiming that the regulations violated their constitutional right of Freedom of Religion.  The plaintiffs claimed that serving food to individuals in need was a religious calling and often part of a religious ceremony or practice.  Judge Yohn, who presided over the case, ruled in favor of the plaintiffs and granted an injunction for the Parks and Recreation regulation; however, he allowed enforcement of the Board of Health regulation.  In his ruling the Judge cited to a need for a long term solution in Philadelphia for food insecurity.

While the regulations and the suit that followed received much attention from the national and local press, another effort by Mayor Nutter to address food insecurity went largely left unmentioned.  Following the implementation of the regulations and prior to Judge Yohn’s decision, Mayor Nutter convened a Task Force on  Outdoor Serving of Food comprised of indoor and outdoor food servers, individuals who have previously sought free food services, and representation from City government.  The task force was led by Dr. Arthur Evans, Commissioner of Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS).

As an assistant to the project, I personally witnessed the Task Force work diligently over a three-month period to analyze the complex situation, including the reasons why individuals sought outdoor food services and the motivation of groups to serve food outdoors.  The Task Force collected data from both those in need and those that provided services and identified key core issues and proposed comprehensive recommendations to the issues.   The Mayor accepted the Task Force’s report with a commitment to implement some of the recommendations. Specifically, the Mayor stated that he would identify leadership within his office to lead efforts aimed at reducing food insecurity in the City.

Certainly, policies that risk impeding on individuals’ rights should continue to be vetted publicly and through the judicial system.  However, the spotlight should not be diverted away from issues and efforts that lack a certain level of “controversy” but may present feasible solutions to those issues that are being disputed.