President Obama Weighs His Economic Legacy by Andrew Ross Sorkin [The New York Times] Eight years after the financial crisis, unemployment is at 5 percent, deficits are down and G.D.P. is growing. Why do so many voters feel left behind? The president has a theory. [more inside]
Direct Primary Care: An Alternative to Conventional Health Insurance There are roughly 4,400 direct primary care physicians nationwide, up from 756 in 2010 and a mere 146 in 2005. [more inside]
According to the Urban Institute's Health Reform Monitoring Survey, "Though the Affordable Care Act [ObamaCare] has led to increased health insurance coverage for millions of nonelderly adults, and early signs indicate improvements in broad measures of access to care and affordability, we find that gaps in access to dental care remain even for insured adults and that low- and moderate-income adults in particular face challenges affording dental care." [more inside]
Kentucky counties with highest Medicaid rates backed Matt Bevin, who plans to cut Medicaid
Owsley County, one of the nation's poorest places [prev], neatly fit the trend. Nearly 1,000 of its 4,508 residents got health insurance after Democratic Gov. Steve Beshear established Kynect two years ago and expanded Medicaid to include people up to 138 percent of the poverty level, which is $16,105 a year for an individual. Newly insured people started to visit the Owsley County Medical Clinic on the outskirts of Booneville. They desperately needed medical care. Even by Kentucky's lax standards, Owsley has high rates of obesity, smoking and poor nutrition, and as a result, greater than normal incidences of cancer, heart disease and diabetes. Some patients wept with relief as longtime ailments finally were treated, clinic officials said. [...] The community's largest-circulation newspaper, the Three Forks Tradition in Beattyville, did not say much about Kynect ahead of the election. Instead, its editorials roasted Obama and Hillary Clinton, gay marriage, Islam, "liberal race peddlers," "liberal media," black criminals and "the radical Black Lives Matter movement."Owsley County voted for Bevin, a Tea Party businessman who vowed to dismantle Kynect, by a 70-25 margin. [more inside]
We Mapped the Uninsured. You'll Notice a Pattern. By Quoctrung Bui and Margot Sanger-Katz [The New York Times]
Two years into the health care law, clear regional patterns are emerging about who has health insurance in America and who still doesn’t. The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the Affordable Care Act’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans.[more inside]
The US Supreme Court upholds subsidies on the federal exchanges in King v. Burwell in a 6-3 ruling written by the Chief Justice Roberts. Rejecting Chevron deference, the court decided that Congress actually intended for the federal exchanges to work like the state exchanges.
Everyone is convinced that someone else is getting a better deal, that somewhere a horde of Kansans are gaming the system and preventing the truly needy from getting help. It’s a sentiment that Brownback eagerly exploits when attacking Medicaid expansion and other forms of public assistance. [more inside]
Health insurance companies are illegally charging for birth control, according to studies conducted by the National Women's Law Center. [more inside]
Obamacare turned 5 years old this week and the overall negative popular opinion on the legislation is starting to be replaced by positive experiences. GOP Congresswoman Cathy McMorris Rodgers (WA) found this out to her chagrin when she posted an image on her official Facebook page, slamming the Affordable Care Act and asking constituents to share their Obamacare nightmare stories. The response probably wasn't what she expected.
Last week the Supreme Court of the United States ruled (PDF) on the case of Yates v. United States, whether the captain of a fishing boat violated the Sarbanes-Oxley Act by throwing undersized red grouper overboard to avoid prosecution. [more inside]
The Affordable Care Act was "put together by a bunch of elitists who don't really fundamentally understand the American people," said former DNC chair Howard Dean. A few years ago, Democratic Gov. Ted Strickland voiced concerns about Democrats' "intellectual elitism" and hesitancy to "talk using populist language." Republicans have long used accusations of elitism against Democrats as an electoral tactic. Did elitism lose the Democrats the 2014 midterms?
The Supreme Court has granted certiorari in King v. Burwell, invalidating subsidies through the federal healthcare exchanges, despite the lack of a Circuit split.
A Republican panel of the D.C. Circuit has ruled [.pdf opinion] in the case of Halbig v. Burwell that a drafting error in the Affordable Care Act provides subsidies exclusively to state-based exchanges and not to federally-facilitated ones, even while subjectively intending to provide subsidies in both cases. The ruling threatens to take away federal subsidies for insurance sold on Obamacare exchanges in 36 states.
V91.07xD Burn due to water-skis on fire, subsequent encounter I did not know water skis can catch on fire. Presumably, somebody's water skis did catch on fire, resulting in a trip to the hospital. [more inside]
How the U.S. Health Care System Compares Internationally - "The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity." [full report (pdf)] [more inside]
About half of countries who attempt to build single-payer systems fail. That’s Hsiao’s estimate after working with about 10 governments in the past two decades. Whether he’s in Taiwan, Cyprus, or Vermont, the process is roughly the same: meet with legislators, draw up a plan, write legislation. Only half of those bills actually become law. The part where it collapses is, inevitably, when the country has to pay for it.Ezra Klein's Vox Media looks at the financial and administrative mechanics of Governor Peter Shumlin's quest to bring single-payer health care to Vermont. Bonus: 12 questions about single-payer.
This morning, the Supreme Court heard arguments in Sebelius v. Hobby Lobby Stores, Inc. and Conestoga Wood Specialties Corp. v. Sebelius, two cases where private corporations have challenged the Affordable Care Act's contraception coverage mandate. Previously, and previously [more inside]
The US Office of Personnel Management's Retirement Operations Center is housed about 230 feet below the surface inside the caverns of an old limestone mine. The trucks full of paperwork come every day, turning off a country road north of Pittsburgh and descending through a gateway into the earth. Underground, they stop at a metal door decorated with an American flag. [more inside]
Six years ago, PBS's feature documentary program, Frontline, aired Sick Around the World, a documentary examining health care systems around the world -- and specifically how all those featured were generally superior to the American system. (2008 MeFi post) Today, the American Senate subcommittee on primary health and aging brought the debate over single-payer care to Washington. C-SPAN has a fine video of the hearing, which features seven witness representing health care systems and think tanks from around the US and the world. [more inside]
Inside the Nightmare Launch of HealthCare.Gov - "Unknown to a nation following the fiasco, McDonough's assignment from the President had boiled down to something more dire than how to fix the site. As the chief of staff remembers his mission, it was 'Can it be patched and improved to work, or does it need to be scrapped to start over? He wanted to know if this thing is salvageable.' Yes, on Oct. 17, the President was thinking of scrapping the whole thing and starting over." (previously) [more inside]
AOL chief cuts 401(k) benefits, blames Obamacare and two "distressed babies". "AOL chief executive Tim Armstrong Thursday offered a number of unusual explanations for why his company pulled back its 401(k) benefits for employees this year. The first reason: Obamacare. The second: two women at the company who had 'distressed babies' in 2012." [more inside]
As a result of new coverage under the ACA, many previously uninsured people in eastern Kentucky are giving the nation a glimpse of life under the new health care law.
"Obamacare horror stories" where innocent citizens are losing their insurance and being forced to pay astronomical costs for new plans on the exchanges are being reported by some media outlets. The problem is that most of these stories don't survive further scrutiny. [more inside]
That lack of expertise explains why in building healthcare.gov, the government turned to industry contractors; in particular, to CGI Federal, a subsidiary of CGI Group, a Canadian company. To those uninitiated in the dark art of government contracting, it seems scandalous that CGI, a company most Americans had never heard of, a company that is not located in Silicon Valley (where President Obama has plenty of Internet superstar friends who could have formed a dazzling brain trust to implement his signature legislation) but rather in Montreal, could be chosen as the lead contractor for the administration’s most important initiative. While right-wing news outlets have focused on the possible relationship between Toni Townes-Whitley, senior vice president for civilian-agency programs at CGI Federal, and Michelle Obama, both of whom were 1985 Princeton graduates, CGI’s selection is probably more an example of a dysfunctional system than it is a scandal. “A lot of the companies in Silicon Valley don’t do business with the government at that level [the level required for federal contracting],” explains Soloway. “It is very burdensome, and the rules make it very unattractive.” Indeed, government contractors have to meet a whole host of requirements contained in a foot-thick book, including cost accounting and excessive auditing, to prove that they are not profiting too much off the American taxpayer. Hence, there tends to be a relatively small, specialized group of companies that compete for this work, even on such critical matters as healthcare.gov. - Accounting for Obamacare
In real (or at least our preferred) life, we do have other, better things to do. We have books to read, children to raise, friends to meet, loved ones to care for, amusements to enjoy, drinks to drink, walks to take, webs to surf, couches to lie on, games to play, movies to see, protests to make, movements to build, marches to march, and more. Most days, we don’t have time to do any of that. We’re working way too many hours for too little pay, and in the remaining few hours (minutes) we have, after the kids are asleep, the dishes are washed, and the laundry is done, we have to haggle with insurance companies about doctor’s bills, deal with school officials needing forms signed, and more.
The conventional wisdom about the origins of the Affordable Care Act is that it is a reformulated plan from the Clinton era, one that right-wingers like Newt Gingrich and the Heritage Foundation created. How true is it? [more inside]
It's time for Americans to gather around the dinner table, eat too much, and argue about politics! A new genre of Thanksgiving-themed web pages seems to be taking off this year, that being the "How to argue with your [opposite political party] family members at Thanksgiving" genre. From the left side of the political spectrum, the Democratic National Committee has launched "The Democrat's Guide to Talking Politics with Your Republican Uncle", and The Huffington Post chimed in with "Here's Every Argument You'll Need To Win Your Obamacare Debate This Thanksgiving". Not to be outdone, conservatives have responded with cheat sheets of their own, including RedState.com's "Thanksgiving dinner with your liberal relatives" and The Washington Examiner's "The Thanksgiving guide to making conservative arguments liberals can understand". [more inside]
John Hodgman posted about the ACA, which led his followers to tweet him about the various health problems they had encountered and the effect insurance or a lack thereof had to their lives. Hodgman retweeted many of the stories from people in their 20's and then posted 17 reasons for young people to get insured to his blog.
Forbes provides a list of 5 major scams that have popped out of the woodwork with the beginning of deployment of the Affordable Care Act (AKA Obamacare). Be on the lookout! [more inside]
Happy Political Clusterf*ck Day (U.S.)! In one corner: the first federal government shutdown since 1996, born of the House GOP/Tea Party faction's crusade to delay, defund, and destroy Obamacare (and the Democratic Senate and President's resolve to not do that). "Continuing resolutions" have ping-ponged between the two houses, fighting over language to cancel healthcare reform (plus a few other items, such as the implementation of Mitt Romney's entire economic agenda). National parks are closed, contractors are hamstrung, and 800,000 federal workers furloughed until Speaker Boehner drops the "Hastert Rule" and passes a bill the other branches can agree to. In the other corner, heedless of the chaos (though not without glitches of its own): the official rollout of the Affordable Care Act and its state insurance exchanges. The portal at Healthcare.gov is your one-stop shop for browsing, comparing, and purchasing standardized, regulated insurance coverage with premium rebates, guaranteed coverage, and expanded Medicaid for the poor (in some states). A crazy day, overall -- but peanuts compared to what might happen if the debt ceiling is breached in 16 days. [more inside]
- “It is strange, in my opinion, that the insurance market has evolved so, that so few individuals understand the fundamentals of the medical insurance plans they are insured under."
- Among the 19% polled who are uninsured, nearly four in 10 don't realize the law requires them to get health insurance next year. Among young people, whose participation is seen as crucial for the exchanges to work, just 56% realize there's a mandate to be insured or face a fine.
- Health policy is an extremely personal and complicated topic... Observing historical patterns of attempted healthcare reform and backlash towards these reforms, we may begin to understand what is keeping such a prominent and promising nation from enlisting a social contract of health.
More than half the population of small, rural Madras, Oregon (population: ~6059) and its surrounding community is served by one clinic: Madras Medical. At the beginning of 2006, the clinic's doctors and nurses decided to ban pharmaceutical reps from visiting their practice. No more free lunches. No more free drug samples. No more gifts. And yet.... "It's made us better doctors." (Via) [more inside]
A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare. The man is impressed. "This beats Obamacare I hope," he mutters to one of the workers. “Do I burst his bubble?” wonders Reina Diaz-Dempsey, overseeing the operation. She doesn't. If he signs up, it's a win-win, whether he knows he's been ensnared by Obamacare or not.
The Department of Justice filed a lawsuit yesterday (after a long investigation) against the state of Florida alleging the state is in violation of the Americans with Disabilities Act (ADA) in its administration of its service system for children with significant medical needs. [more inside]
The Oregon Health Insurance Experiment, an outgrowth of Oregon's 2008 lottery to allocate Medicaid slots to eligible residents, has released their second year of results (Previous discussions on the lottery and the experiment). The gist of the results are that they found statisitically significant reductions in catastrophic health care expenditures, improvements in the incidences of depression, and increased use of health care services. They found minimal (and not statistically significant) improvements in the rates of physical health indicators (diabetes and hypertension) they tracked. Because of ethical concerns, there are no other randomized controlled tests on this scale that study the effects of Medicaid and few on the effects of health insurance in general (the only significant one being a RAND study released 30 years ago). Because of the small amount of information available on the topic and the impending Medicaid expansion offered by Affordable Care Act, this study has drawn a lot of attention from political commentators. This will presumably be the last year these results will be published, as the state of Oregon was able to find extra money in 2010 in order cover the rest of its Medicaid-eligible population. [more inside]
Three excerpts from David Goldhill's new book on American health care:
Part One: Focus on Health-Care Costs Causes More Spending
Part Two: Obamacare Math Doesn't Add Up to a Healthier U.S.
Part Three: To Fix Health Care, Turn Patients Into Customers [more inside]
Part One: Focus on Health-Care Costs Causes More Spending
Part Two: Obamacare Math Doesn't Add Up to a Healthier U.S.
Part Three: To Fix Health Care, Turn Patients Into Customers [more inside]
But it is already too late. CNN has been carefully orchestrating its transformation into a shockingly efficient news distribution company. They have been planning to saturate every screen in reach with this story as fast as possible, and the producer’s initial go-ahead pulled the trigger. On the air, Wolf Blitzer is sending the coverage to the Courthouse steps. And as planned the reporter is putting her phone down to go on the air, which cuts herself off from the only CNN employee with access to the opinion. We’re getting wildly differing assessments: SCOTUSblog compiles first-hand accounts of the minutes between 10:06 and 10:15am on June 28, when CNN and FOX misreported and retracted that the mandate had been struck down.
What's Obamacare? A studious Reddit user has read the mammoth 955-page Patient Protection and Affordable Care Act, and outlined the important points of what the new law actually does, with specific citations. While the recently-upheld law itself remains unpopular, most individual components of the bill enjoy widespread popularity among republican politicians and the public, despite the fact that both groups remain largely unaware of the bill's actual provisions. [more inside]
Obamacare: One Less Reason to Get Married. Erin Gloria Ryan of Jezebel writes: Insurance Marriages had become to the 21st century what shotgun weddings were to jokes about hillbillies. Back in 2004, the LA Times wrote about couples that married for insurance, couples who for varying reasons had not wanted to marry, but who had been driven to marriage by financial necessity. ABC News posted its own roundup of With This Policy, I Thee Wed-style couples in 2008, as did the New York Times. In 2008, 7% of couples who married reported doing so primarily for the insurance benefits. [more inside]
In less than an hour, the Supreme Court will hand down its final judgment in what has become one of the most crucial legal battles of our time: the constitutionality of President Obama's landmark health care reform law. The product of a strict party line vote following a
year century of debate, disinformation, and tense legislative wrangling, the Affordable Care Act would (among other popular reforms) require all Americans to buy insurance coverage by 2014, broadening the risk pool for the benefit of those with pre-existing conditions.
The fate of this "individual mandate," bitterly opposed by Republicans despite its similarity to past plans touted by conservatives (including presidential contender Mitt Romney) is the central question facing the justices today. If the conservative majority takes the dramatic step of striking down the mandate, the law will be toothless, and in danger of wholesale reversal, rendering millions uninsured, dealing a crippling blow to the president's re-election hopes, and possibly endangering the federal regulatory state.
But despite the pessimism of bettors, some believe the Court will demur, wary of damaging its already-fragile reputation with another partisan 5-4 decision. But those who know don't talk, and those who talk don't know. Watch the SCOTUSblog liveblog for updates, Q&A, and analysis as the truth finally comes out shortly after 10 a.m. EST.
Judge Jerry Smith (R) of the U.S. Fifth Circuit Court of Appeals has ordered the Department of Justice to do an unusual homework assignment: present him with a three-page single spaced letter specifically addressing the position of the Attorney General and DOJ the authority of the federal courts to conduct judicial review. The "tantrum" or "brave take on the left" depending upon your viewpoint, has legal scholars scratching their heads as to whether DOJ would have to comply. So far, Attorney General Holder has indicated that DOJ will "respond appropriately."
Deep vein thrombosis is generally a topic that comes up with regards to airline seating and other periods of prolonged immobility (previously). Anna Brown was a homeless woman and constantly on the move, so doctors in the emergency room thought that her complaints of leg pain were just drug-seeking behavior. Unfortunately, drug seeking is a major problem in ERs in the United States. [more inside]
This morning marked day two of marathon proceedings in what's likely the most momentous and politically-charged Supreme Court case since Bush v. Gore: the effort to strike down President Obama's landmark health care reform law. While yesterday was a sleepy affair of obscure technical debate, today's hearings targeted the heart of the law -- the individual mandate that requires most Americans to purchase insurance by 2014. With lower courts delivering a split decision before today, administration lawyers held some hope that at least one conservative justice could be persuaded to uphold the provision, which amortizes the risk that makes universal coverage possible. But after a day of deeply skeptical questioning by swing justice Anthony Kennedy and his fellow conservatives [transcript - audio], the mandate looks to be in grave trouble, with CNN legal analyst Jeffrey Toobin going as far as calling the day "a train wreck" for the administration. But it's far from a done deal, with a third day of hearings tomorrow and a final decision not expected until June.
Yesterday, the Supreme court granted certiorari to several of the challenges to the constitutionality of the Affordable Care Act. Here's a great roundup of several news stories. I like the NPR story for a quick summary of the issues. The Court will hear a total of 5.5 hours of oral argument, and a decision is expected by the end of the current term, in June.
"The Justices all sit in high-backed leather swivel chairs, and Thomas has set his so that he can recline so far that he appears almost to be lying down. He stares at the ceiling. He rubs his face. He does not appear to be listening. He closes his eyes and sometimes appears to be asleep. The over-all effect is rude, if not contemptuous." The New Yorker profiles Justice Clarence Thomas, his wife Ginni's Tea Party connections and what they might mean for the inevitable SCOTUS ruling on Obama's Patient Protection and Affordable Care Act, and looks back on his confirmation hearings. Previously, Justice Thomas and Ginni; Obama and healthcare; SCOTUS.
The Senate votes to bring health care bill (text in an amendment) to floor, 60-39. Major concessions extracted by holdout senators. Other analysis here and here. Differences between this and the House bill.