Posted 11/12/12 on Medscape Connect’s Care & Cost Blog
The most striking aspect of the election was that it decisively clarified the philosophical preferences of most Americans. And because the outcome was largely determined by minorities, women, and the young, it appeared to be a much broader and more independently-minded vision than most pundits have given the electorate credit for. That unexpectedly portends big changes.
Peggy Noonan’s analysis in the Wall Street Journal quotes a brutal summation by conservative activist Heather Higgins:
A majority of the American people believe that the one good point about Republicans is they won’t raise taxes. However they also believe Republicans caused the economic mess in the first place and might do it again, cannot be trusted to care about cutting spending in a way that is remotely concerned about who it hurts, and are retrograde to the point of caricature on everything else.
Continue reading “Arriving at the Beginning”
Posted 5/2/12 on Managed Care Matters
When it comes to health reform, perhaps the only thing Congressional Republicans agree on is they hate ObamaCare.
There’s no agreement on a basic framework much less consensus on an actual bill. Moreover, there are parts of ObamaCare that enjoy solid support amongst many Republicans, complicating the GOP’s efforts to develop an alternative without conceding political ground.
Their dilemma is certainly understandable; as anyone who followed the tortuous path of the PPACA (aka Obamacare), there was precious little consensus among the Democrats who passed the bill. While most had serious issues with various bits and pieces, they held their noses and voted “aye” when pressed.
Continue reading “GOP Alternatives to ObamaCare”
Posted 4/25/12 on The Disease Management Care Blog
The Disease Management Care Blog agrees that if you want a peek at a potential future scenario for health care reform, look at what has happened in Massachusetts since 2006. That’s when the Bay State passed a law that, just like its cousin the Affordable Care Act (ACA), emphasized insurance reforms that included exchanges, subsidies and changes in Medicaid eligibility.
According to this recent New England Journal of Medicine article, the reforms resulted in both good and bad news. The good news is that 98% of Massachusetts’ citizens have insurance coverage; the bad news is that health care now consumes a whopping 54% of the state’s total budget.
In response, the state is now pursuing cost reforms. As the DMCB understands it, Massachusetts is banking on the principle of “global payment” to incent health care providers to work within a budget. If it works out, the providers will embrace “value” by delivering needed services and cutting waste. If it doesn’t work out, the providers could end up putting savings before patients by withholding medical care.
Continue reading “Cappers vs.Skinners in the Struggle To Control Costs”
Posted 4/26/12 on Health Care Policy and Marketplace Review
Today’s headline was, “Millions Expected To Receive Insurance Rebates Totaling $1.3 Billion.”
The Kaiser Family Foundation estimates that 3.4 million people in the individual market will receive $426 million in consumer rebates because of the Affordable Care Act’s new MLR rules. In the small group market 4.9 million enrollees will see $377 million in rebates, and 7.5 million people will get $540 million in the large group market.
Continue reading “The Medical Loss Ratio (MLR) Report—Just Fiddling While Rome is Burning”
Posted 4/12/12 on Common Sense Family Doctor
Regardless of whether or not the Supreme Court strikes down the individual mandate or the entire 2010 health reform law in June, state-based health insurance exchanges are a good idea and, if established, should benefit many working Americans who are too well-off to qualify for Medicaid but unable to otherwise afford health insurance coverage on their own. This post and two to follow over the next week are excerpts from an unpublished paper that I recently authored on this topic.
One of the key elements of the insurance coverage expansion contained in the Affordable Care Act (ACA) is the establishment of health benefits exchanges operated by individual states, groups of states, or the federal government, by January 1, 2014. These exchanges will offer competitive and/or subsidized insurance options for individuals whose employers do not provide insurance, as well as offer plans to small businesses (up to 100 employees) at reasonable rates. Prior to the ACA, Massachusetts and Utah had both operated state insurance exchanges with varying degrees of success. By outlining only basic requirements for the functions of the exchanges, the ACA left many important questions regarding their design unanswered. Some states appear to be pursuing a “wait and see” strategy, hoping that the U.S. Supreme Court will strike down the ACA prior to the January 2013 deadline for showing sufficient progress toward establishing an exchange or ceding control to the federal government. Others are at various stages of the planning process; as of January 2012, 13 states had formally established their exchanges through legislation or executive orders. Maryland and California are at the vanguard of this group.
Continue reading “My Take On State Health Insurance Exchanges – Part 1”
Posted 3/29/12 on Gooz News
This is what conservative justices will do if they strike down or cripple the health-care law … A court that gave us Bush v. Gore and Citizens United will prove conclusively that it sees no limits on its power, no need to defer to those elected to make our laws. A Supreme Court that is supposed to give us justice will instead deliver ideology. now – E.J. Dionne, The Washington Post
The insurance mandate was effectively reduced to a bumper sticker by the opponents in their constitutional challenge, and the entire law reduced to little more than an appendage to the mandate. . . The fate of the mandate should not determine the survival of the other elements of the law — like prohibiting insurers from denying coverage to people with pre-existing conditions or charging them higher fees — which can operate without the mandate. – New York Times editorial
Overturning the whole law would be an act of judicial restraint. – The Wall Street Journal editorial
Continue reading “Day Three – The Wrap Up”
C. Eugene Steuerle
Posted 3/23/12 on the The Government We Deserve
The Supreme Court will consider the constitutionality of the Affordable Care Act at the end of the month. We the public should be appalled.
It’s not that each side can’t come up with some good constitutional arguments. It’s that the suit is totally unnecessary, caused largely by the unwillingness of the major political parties to work together on anything. Like a divorce between two parties more invested in their fight than in the effect on those around them, it belongs in a domestic relations court that would refer the parties to a mediator.
Continue reading “Health Reform: An Amicus Brief for the Court of Public Opinion”
Brian Klepper and Shannon Brownlee
Published 3/29/12 in the New York Daily News
Obamacare had its days in the Supreme Court this week, and the justices’ decision could have sweeping consequences for the individual mandate provision in the Patient Protection and Affordable Care Act, and maybe even for the fate of the law itself.
Yet whatever the court decides, we will still be stuck with a problem that this contentious law was not likely to solve on its own: an out of control health care industry that threatens the stability of the U.S. economy and the federal government’s ability to deal with our long-term debt.
Continue reading “The Right Rx for Better Health Care: Rise Up to Challenge the Industry’s Lobbying Power”
Posted 3/28/12 on Health Policy and Marketplace Review
First, trying to predict how the Court will rule is at best just speculation. I know what Justice Kennedy said both today and yesterday and it certainly doesn’t look good for the Obama administration and upholding at least the mandate.
But I will remind everyone, based upon oral arguments, most Court watchers expected a ruling in favor of the biotech industry on a recent case involving health care patents. “Surprisingly,” the Court ruled against the industry.
Continue reading “If the Supreme Court Overturns the Individual Mandate”
Posted 3/24/12 on Gooz News
Opponents of health care reform, whose case will be heard next week by the Supreme Court, base their complaint against the Obama administration’s signature domestic achievement on the claim that its individual mandate to purchase health insurance is unconstitutional.
Challengers, including state attorneys general and governors in a majority of states, say it represents an unwarranted extension of the constitution’s commerce clause into the personal realm of individual choice. If people do not want to buy a particular product – in this case health insurance – the government has no right to make them.
Continue reading “The Mandate May Fall, But Not Reform”
Posted 3/25/12 on The Hospitalist Leader
To get a sense of why this case is different and will dominate the news cycle now until the decision in June, appreciate this fact: the time allotted for arguments—the period in which plaintiffs and defendants present their views to the justices—is six, instead of the usual one. Moreover, the proceedings will transpire not just in one day, but three. This is substantial.
There are several issues under debate, but the most significant, and the one you have likely heard about, is the individual mandate. This is the requirement in the Affordable Care Act that all individuals without insurance must purchase it. The alternative is paying a penalty (but not a tax)–and this is important. Nevertheless I will revisit that below. For most people, the mandate is not applicable, as folks with Medicare or Medicaid, or receiving insurance from their employer meet the necessary waiver requirements.
Continue reading “Health Care and the Supreme Court: Prepare Your News Dial”
Posted 2/22/12 on Managed Care Matters
Will the health reform bill kill jobs? Devastate small businesses? Push us back into recession?
According to several organizations and and anti-reform politicians, it’s the worst thing to hit the economy since the Depression.
But it turns out those doomsayers are mostly wrong.
Here’s what FactCheck.com says about these claims:
“this is health-care hooey, aimed at exploiting public concern over continuing high unemployment, with little basis in fact.
Continue reading “ObamaCare and Jobs”
Posted 2/9/12 on Health Care Policy and Marketplace Review
I have no idea which way the Supreme Court will rule this year on the Affordable Care Act. Let me go out on a limb and predict a 5-4 vote on the question of whether the individual mandate is Constitutional. Just don’t ask me which way the vote goes.
I found the recent Obama administration brief submitted to the Court on the mandate question somewhat ironic. Not surprisingly, the Obama Justice Department argued that a finding by the Court that the individual mandate is unconstitutional should not jeopardize the vast majority of the new health law.
Continue reading “Dismantling the Affordable Care Act: The Obama Supreme Court Argument + 51 Republican Senators”
Posted 2/6/12 on Health Policy and Marketplace Review
Medicare Advantage would appear to be a fantastic success—senior premiums are dropping and enrollment is increasing.
Listening to Health and Human Services Secretary Sebelius last week, you would think private Medicare plans were a Democratic idea and this is their success. Many industry observers, including me, have worried that Medicare Advantage benefits would shrink and premiums would rise because the new health care law reduced federal payments to the plans by $136 billion over the next decade.
Continue reading “Medicare Advantage Premiums Drop an Average of 7% and Enrollment Is Up 10%—That Must Make Republicans Just Want to Cry”
Posted 1/31/12 on Forbes
Seems to me we always have a few big breaking healthcare stories early in the year. I remember last year when Mary Meeker released her stunning report – USA, Inc. For the first time, it gave us a detailed view into the health of our country – as if it were a Corporation using balance sheet accounting. That report is truly outstanding. If you haven’t read it – I can’t recommend it highly enough. In some ways I think it’s “table stakes” for any intelligent discussion around the health (and healthcare) of our Country. In that report are two charts that graphically illustrate the size of our healthcare spending (as reported through 2009) – and then the results of our healthcare system. This was the first one: