>> Closing nursing homes will create a shortage of beds just as the Boomer generation will need care. The number of nursing homes in Florida has declined as the business changes. Medicaid payments for home health care or less expensive alternatives (such as assisted living) have cut the demand for nursing homes even as the elderly population has continued to grow. Today only about one-third of patients are those needing long-term care. Another third need a few weeks of rehabilitation after a hospital stay, and the rest are very sick patients who stay only a short time. But a growing number of aging Boomers will end up on waiting lists for the beds that remain after Florida’s decade-long moratorium on facility expansion and the closing of older, struggling nursing homes, often in low-income and minority neighborhoods. “The baby boomers are going to need long-term care services,” predicts one nursing home executive, “that there isn’t capacity to meet.” -- >> Successful court challenges to the individual mandate provision of health-care reform could spell the end of private health insurance in The U.S. If conservative judges make the private market unfixable by removing the most effective way to deal with the adverse selection problem, the only alternative to rising cost pressures will be the single payer approach. --See Washington Post: Judicial rulings could have unintended consequences for Republicans. (Ezra Klein), 13Dec2010 >> Florida will pay a heavy penalty for its long-running stinginess toward the medically uninsured. Once state-imposed enrollment restrictions are removed by the health reform act, 2 million previously eligible but uninsured people could sign up for free coverage (bringing Florida more in line with other states). Because those enrollees will get only a partial federal subsidy, Florida will need to raise billions of dollars for the program -- additional charges that could have been avoided if the Legislature’s tightfistedness had not kept more than half the eligible people off the Medicaid roles in the past. -- See: Salon: Why don’t more Americans use their free health insurance? (Darshak Sanghavi), 14Dec2010 >> Overbuilding medical research capacity In Florida (and elsewhere in the U.S.) will produce a bubble-like expansion of lab facilities that will outstrip the government’s ability to fund. Many universities and research institutions expanded “on spec”, borrowing money in expectation that they will win enough research grants and contracts to pay for the new labs. But the gamble unrealistically assumed a steady increase in government research spending. As budgets are frozen, or even cut, scientists will devote less time to doing research and more time to writing grant applications with prospects not much better than a lottery. The bursting of the medical research bubble will end the heavy reliance of universities and research organizations on government funding. Forced to come up with the money for new projects, retrenchment will be more common than expansion. -- Science: Overbuilding research capacity (Bruce Alberts), 10Sept2010; Washington Post: Biotech grants stretched thin among many projects (Steven Overly), 08Nov2010 >> About 36 million people who now lack health insurance will obtain it from the exchange marketplaces set up by Florida and the other states over the next five years. Many will work for very small businesses (10 employees or less) that will be able to obtain insurance because of lower rates available on the exchanges. According to a forecast by the Rand Corporation, most workers (about 126 million) will stay in traditional employer-sponsored plans, while 18 million will continue to lack coverage. Without the exchanges the number of uninsured in the country would be 52 million. Florida has asked for a grant from the U.S. Department of Health and Human Services to start planning the state’s insurance exchange. – Rand Corp.: Establishing state health insurance exchanges – implications for health insurance enrollment, spending and small businesses. (Christine Eibner and others), 29Aug2010 >> GOP governors and legislatures will proceed with setting up health care exchanges in compliance with the health reform bill, but emphasize private sector providers and loose regulation. The worst-case scenario is that a state sets up an exchange in a way that makes it certain to fail. But many policy analysts predict that Republican governors and state legislators, despite their posturing against the law, will have a strong incentive to work with the Obama administration behind the scenes to avoid political embarrassment. Voters will expect more than obstructionism and angry rhetoric. -- Washington Post: New GOP governors will affect health law (N.C. Aizenman), 09Nov2010 |
Health Care Trends and Issues |