The New York Times: Economix: 'Premium Shock' and 'Premium Joy' Under the Affordable Care Act
Starting on Oct. 1, Americans can purchase individual health insurance in what is known as the nongroup market on the newly established electronic health-insurance exchanges that were called for in the Affordable Care Act of 2010. That coverage will take effect on Jan. 1. In the meantime, Americans will be bombarded with information on the premiums they will pay for coverage on the exchanges. Much of that information will be pure speculation, and a good part of it will be strategic misinformation (a topic that I will explore more fully in a future post). So let's review what the new arrangement seeks to accomplish (Uwe E. Reinhardt, 6/21).
The Wall Street Journal's Potomac Watch: John Kerry's ObamaCare Boondoggle
A bipartisan backlash is growing against another section of President Obama's health-care law. ... The change has allowed Massachusetts to raise its Medicare payout by $257 million, forcing cuts to hospitals in 40 other states. The National Rural Health Association and 20 state hospital associations in January sent a panicked letter to President Obama, noting that the Massachusetts manipulation of the program would hand that state $3.5 billion over the next 10 years at the expense of Medicare beneficiaries everywhere. They quoted Mr. Obama's former head of the Centers for Medicare and Medicaid Services, Donald Berwick, admitting that "What Massachusetts gets comes from everybody else" (Kimberley Strassel, 6/20).
Bloomberg: Obamacare Is For Republicans, Too
Three months from now, Americans will get their first look at whether Obamacare works. The answer will depend a lot on Republican governors and legislatures -- and they should want the law’s exchanges to be successful as much as the president does (6/20).
The Wall Street Journal: Here Comes ObamaCare's 'Workplace Wellness'
During the congressional debate over ObamaCare, few provisions stirred less controversy than an amendment providing incentives for companies to encourage their workers to stay healthy. It's a turbocharged version of "workplace wellness" programs: If employees fall short of their targets—on blood pressure or weight, for example—employers are allowed to make them contribute more to their health insurance. The idea is to rein in medical costs by reducing worker illness (Al Lewis and Vik Khanna, 6/20).
Politico: Competition Is Rx To Slow Health Costs
Three years into the Affordable Care Act, America's employers are still looking for the affordable part. Despite a recent slowdown, health care inflation remains two to three times the rate of general inflation. Health insurance is expected to cost a family $16,000 this year, double what it cost a decade ago. ... Congress must focus on cost containment, the unfinished business of health reform, as it works to tame entitlement spending and the deficit. Congress can tackle the cost issue head-on by making both public and private-sector payment for care dependent on delivering the high-quality care every hardworking American deserves (David Lansky and Sally Welborn, 6/19).
Detroit Free Press: Snyder Shows Leadership; Senate Shows Partisanship
On Thursday, Snyder was in rare form. The normally genial Snyder laid into his fellow Republicans, lambasting the GOP-led state Senate for its refusal to vote on the expansion before its summer recess. "Take a vote, not a vacation," Snyder told legislators. ... There was determination in Snyder's eyes as he urged the Senate to vote. Not voting is saying no, he said. It was clear the governor was on a mission, as he encouraged residents to tell their state senators to vote to expand Medicaid. It’s the right thing to do, and we’re heartened by his leadership on this issue (6/21).
Arizona Republic: Will Medicaid Referendum Make It?
Gov. Jan Brewer says that opponents to her Medicaid expansion won't get the signatures to refer it to the 2014 general election ballot. Her lawyers say that, even if they do, the courts will strike it down. Brewer has a much better chance of being right than her lawyers. The Arizona Constitution allows virtually any law passed by the Legislature, or any part of a law, to be referred. If enough signatures are gathered, the law doesn't go into effect until the electorate gets a chance to vote on it. Opponents are circulating petitions to refer both the expansion and the hospital assessment to pay for it and some of the state's existing Medicaid obligations (Robert Robb, 6/20).
Health Policy Solutions (a Colo. news service): The Pot Calling The Kettle Black On Obamacare
During the past month several reports have been published on cost variations in the health care system. Among medical providers, there is clear evidence of wide differences in costs and utilization both across geographic regions and institutions. When the Colorado 208 Commission studied the issue, it also found that there were great variations among what insurers, the government and individuals pay. And, recently, the Colorado Division of Insurance analyzed insurance proposals for the health exchange. Again, wide variations in insurance premiums are being proposed (Francis M. Miller, 6/20).
The New York Times: My Abortion, At 23 Weeks
My world stopped. I loved being pregnant with twins and trying to figure out which one was where in my uterus. Sometimes it felt like a party in there, with eight limbs moving. The thought of losing one child was unbearable. The M.R.I., at Seattle Children's Hospital, confirmed our fears: the organs were pushed up into our boy’s chest and not developing properly. We were in the 22nd week. In Washington State, abortion is legal until the 24th week. After 10 more days of tests and meetings, we were in the 23rd week and had to make a decision. My husband is more conservative than I am. He also is a Catholic. I am an old-school liberal, and I am not religious. But from the start, and through this ordeal, we were in complete agreement. We desperately wanted this child and would do whatever we could to save him, if his hernia was fixable and he could have a good quality of life (Judy Nicastro, 6/20).
Bloomberg: Other Nations Don’t Compare To U.S. Health Care
It's a simple truism, often repeated, that other developed nations achieve better health outcomes than the U.S. does despite spending less money on care. … It's all so obvious, simple, widely agreed upon among health-care experts -- and completely irrelevant. (Economist Robert) Frank's comparison reflects a common misunderstanding of the real relationships between health, health care and government policy in the U.S (David Goldhill, 6/20).
Star Tribune: Move Forward On Medical Device Tracking
You may not yet depend on a pacemaker, defibrillator, stent, joint implant or any of the other life-changing, potentially lifesaving products made by the medical device industry. But chances are you or a family member will be a patient some day. The number of knee replacements performed annually is projected to soar 673 percent by 2030, for example, with hip replacements increasing by 174 percent in the same time frame. That’s why it isn't just the medical device industry that has a stake in the timely rollout of a long-overdue national system to better track the safety and whereabouts of devices once they're on the market or in use. The millions of people in Minnesota and elsewhere who already rely on medical devices, and the millions more who will do so in the future, deserve to have this important new public health protection in place as soon as possible (6/21).
Sacramento Bee: Physician Shortage Raises Questions
Right now, we simply don't have enough doctors to deliver high-quality primary care. Add to this the 25 million uninsured Americans who will have access to care in January when the Affordable Care Act goes into effect and we have the makings of a disaster. Medical schools across the country are doing an exceptionally poor job of addressing this shortage. Their press releases tout large numbers of medical students going into residencies that produce primary care doctors, yet these numbers are grossly misleading (Dr. Michael Wilkes, 6/20).
Kansas City Star: OK, Call Obesity A Sickness If It Leads To Wellness
Up until now, the medical establishment has described obesity as "a major public health problem." That's a soothingly impersonal way to put it. Collectively, too many obese people constitute a problem. But people don't normally wake up in the morning and think, "Hey, I am part of a major health problem." Now the ground has shifted. The American Medical Association this week officially recognized obesity as a disease. That strikes a lot closer to home. One could conceivably look in the mirror and say, "I have an illness." Would that help or harm? Obesity is a scourge (Barbara Shelly, 6/20).
Medpage Today: What’s Wrong With What We've Got Now?
Creating a Patient-Centered Medical Home within our existing system seems, at times, like a Herculean task. Getting all the pieces in place so that we can make the needed changes sometimes seems too vast to get it all right. We find ourselves asking: Why bother? Is our healthcare system that broken? Is the way we take care of patients now failing, satisfactory, or outstanding? If we just continue on the path we are on, is there anything wrong with that? Americans receive endless amounts of healthcare, but, we also have to ask, is it healthcare of endless value? (Dr. Fred Pelzman, 6/20).
Politico: Pathway Shouldn't Exclude Safety Net
The Congressional Budget Office estimates the (Senate immigration) bill will raise $451 billion of new revenue over 2014-2023 and another $1.5 trillion in the decade after that, mostly from income and payroll taxes paid by immigrants. Immigrants on the pathway to citizenship contribute to the funding of all federal programs with their tax dollars, but nearly all of them will be barred from using federal safety net programs for at least 13 years. ... The 13-year-long pathway to citizenship will be hard enough without these restrictions. Work hard to save up money not just for your kids’ school supplies, but to pay the penalties in the bill. Lose your job and you risk losing your legal status and being deported. The restrictions in the bill make the pathway even more treacherous. Pay your taxes, but don't get sick. Pay your taxes, but don't come to us for help (Sen. Mazie Hirono, D-Hawaii, 6/20).