Lingering Health Law Questions Jon Stewart Wants Answered

By Georgia Feuer
Guest Contributor

Last week Jon Stewart hosted Secretary of Health and Human Services Kathleen Sebelius on The Daily Show. During the interview, he kept returning to the same question: Why was the piece of the Affordable Care Act that requires businesses to provide health insurance delayed for one year, but the piece requiring individuals to obtain health insurance (the “individual mandate”) was not delayed?

In her answer, Sebelius mentioned that there are subsidies and tax credits available to individuals starting in 2014 and also that the so-called “employer mandate” affects a very small number of businesses. The employer mandate only applies to businesses with 50 or more employees. Only 5% of businesses have 50 or more employees, and most of these companies already offer insurance.

Screen shot 2013-10-14 at 1.11.38 PMBut Jon Stewart was not satisfied with her answer, and that is because she did not give the whole answer. The real reason why the individual mandate cannot be delayed is that it is too crucial to the success of health care reform. To understand why, let’s suppose that getting health insurance was, in fact, voluntary. Then the people who would be most motivated to purchase health insurance are those who are sick. Continue reading

Commentary: A Not-So-Rosy View Of Mass. Health Reform

By Josh Archambault
Guest Contributor

Hundreds of healthcare journalists will be attending the Association of Health Care Journalists’ (AHCJ) conference in Boston this week to hear from many speakers with rose-colored ideas about both our Romneycare law and a brand new state cost-control law. Yet all is not well in the Commonwealth. State officials now predict “extreme premium increases” for many small businesses under Obamacare.

In a letter to federal regulators the day after Christmas 2012, a perfect day to bury news, Massachusetts officials floated the idea of obtaining a waiver from the Affordable Care Act (ACA) out of fear of the premium spikes. Yet, recently finalized federal regulations slammed the door on that flexibility. Many small companies justifiably feel sick over the decision.

Josh Archambault of the Pioneer Institute (Courtesy of JA)

Josh Archambault of the Pioneer Institute (Courtesy of JA)

The small business community has been paying more for health insurance since the commonwealth’s 2006 reform merged sicker individuals into the same risk pool. The legislature has also added to costs by passing 12 additional mandated benefits since then, a cost borne completely by small companies and individuals.

Now the future looks even bleaker for small business. Not only will their highest-in-the-nation premiums go up because of these new regulations, but they will be paying on average $8,000 per family, per plan more in taxes over the next ten years. That translates into employers and consumers in Massachusetts paying $213 million in 2014 and $3 billion more over the next decade.

Conference speakers will be sure to mention that the Connector was created to help small companies obtain competitively priced insurance, and other states will experience this benefit in the exchanges required under the federal law. Only one problem, the rhetoric doesn’t match reality in Massachusetts. Continue reading

What To Know About Massachusetts’ First-In-Nation Health Cost Law


Massachusetts Governor Deval Patrick, a Democrat and pal of President Obama, hasn’t signed the sweeping, 350-page health care cost-cutting bill yet — but he says he will soon. (Expect a celebratory, bells-and-whistles bash, a la Mitt Romney at Fanueil Hall in 2006, signing health insurance reform legislation that would become a model for Obama’s national health overhaul.)

When the new bill does become law, the Bay state will be the first in the country to attempt to slow rising health care costs through numerous strategies including tethering the growth in health care spending to the state’s overall economy, moving away from fee-for-service payments to doctors and more heavily managing and coordinating medical care.

After the bill passed earlier this week, Representative Steven M. Walsh, a Democrat and House Chair of the Joint Committee on Health Care Financing, who has shepherded the legislation, underscored the consumer’s perspective. “The passage of today’s bill is all about seeing our health care system through the eyes of the patient. We have the highest quality medical system in the nation and the highest percentage of health care coverage, yet it is a struggle for families to afford their health insurance premiums. This legislation focuses on increasing efficiency and cutting costs within our system, while enhancing the quality of care that our patients receive and empowering them to make the best personal health decisions.”

Even if you don’t live in Massachusetts, many of these changes — in some form or another — will likely be coming to your state or doctor’s office too. We’re still digesting all the details and implications. But here’s an early snapshot of five things you might like to know:

1. Try Not To Get Sick In The First Place

Prevention and wellness are a priority in the new Massachusetts cost-cutting plan. If you lead a healthy lifestyle and try to care for your body through diet, exercise, not smoking, good attitude (when possible) etc. you can spend more time away from the doctor and out of the hospital thus saving the system money and just generally making life better. Under the Mass. plan, there’s $60 million for a prevention and wellness trust fund to boost such efforts. There are also tax credits for small businesses that run wellness programs.

2. The Cost Of Care

Speaking of budgeting, there will now be even greater pressure on your doctor, hospital or hospital system to save money. That means you will have to start thinking much more about how much your health care costs. Under the Mass. plan, hospitals and doctors will have to cut their rate of growth by about half. You, as the patient, may experience this in various ways, for instance, fewer non-critical tests, procedures and imaging Continue reading

She’s Gotta Have It: 8 ‘No-Cost’ Women’s Health Services Now Available

Alan O’Rourke/flickr

Liz Pugh, 23, is a recent college graduate with a job at a nonprofit AIDS advocacy group and financial independence for the first time in her life. Every month she shells out $15 or so of her modest salary for a co-pay on her birth control pills. But no more. The next time she runs out to the pharmacy to resupply, there will be no additional cost. “I am relieved,” she said. “to see that $15 co-pay gone.”

On August 1, insurers for the first time in history were required to start providing women with a set of basic preventive health services — not just birth control — for no extra fee. Though contraception and some of the other newly covered services, such as breast feeding support and equipment, have received most of the media and political attention, the new coverage spans a range of screening, counseling and other health services for women of all ages.

The new provisions fall under the federal Affordable Care Act and, according to Dr. Paula Johnson, Chief of the Division of Women’s Health at Brigham and Women’s Hospital in Boston, “represent a paradigm shift from a health care system built on diagnostic treatment of disease toward a foundation of disease prevention and wellness promotion.”

Johnson is a member of the Institute of Medicine Committee on Women’s Health Preventive Services — the group that recommended the new services be covered — and Executive Director of the Connors Center for Women’s Health and Gender Biology at the Brigham. She says that “cost has been a significant barrier for women” in accessing these basic medical services, and the new requirements “will allow women to get the preventive care that they need without the financial worry.” Moreover Johnson says, having these eight new services covered by insurers “raises the bar for preventive care for women,” and will ultimately strengthen the bond between doctors and patients.

Here, Johnson summarizes the 8 services women with private health insurance will now have access to without cost-sharing, and why these tests and services are vital for overall health:

1. Well-woman visits: Half of women delay or avoid well-woman preventive services due to cost barriers. Continue reading

Heavyweights Propose Top Health Care Cost-Saving Strategies

(Tax Credits/flickr)

Frankly, I’d prefer crashing a dinner party with these guys to reading their insightful, timely (but, let’s face it, a little dry) paper in the August 1 issue of The New England Journal of Medicine titled “A Systematic Approach To Containing Health Care Spending.”

Still, the piece by these health policy luminaries (including Ezekiel Emanuel, M.D., Ph.D., Stuart Altman, Ph.D., Donald Berwick, M.D., M.P.P., David Cutler, Ph.D., Tom Daschle, B.A., Arnold Milstein, M.D., M.P.H., John D. Podesta, J.D., Uwe Reinhardt, Ph.D., Meredith Rosenthal, Ph.D., Joshua Sharfstein, M.D., and Peter R. Orszag, Ph.D., among others) is worth reading, as it lays out numerous smart strategies for cost-saving and quality improvement as part of the medical journal’s election 2012 coverage. The piece also comes, coincidentally, as Massachusetts approves its own first-in-the-nation health cost savings plan, with many similar strategies. Continue reading

I'll Have What She's Having: ‘No-Cost’ Women’s Health Services Start Today

By Dr. Paula Johnson
Guest Contributor

August 1, 2012 marks the first time in history that insurers will be required to provide women with a set of core women’s health preventive services without cost-sharing. These services are part of the Affordable Care Act’s (ACA) robust plan of preventive care for women across the lifespan and represent a paradigm shift from a health care system built on diagnostic treatment of disease toward a foundation of disease prevention and wellness promotion.

Dr. Paula Johnson, Chief of the DIvision of Women’s Health, Brigham and Women’s Hospital

Unfortunately, not all U.S. women will benefit from the new system of care. With June’s Supreme Court ruling, some states may refuse to expand Medicaid to millions of our country’s poorest women, many of whom are near elderly, depriving them of access to preventive services available to Medicaid recipients and a better chance at a healthy life.

Let’s be clear that the preventive health services available under the ACA will allow women to become healthier and help reduce cost. Prior to reform, more than half of U.S. women were not up-to-date on recommended preventive health services, a fact not surprising given the growing epidemic of chronic illness among women that is costly, at an estimated $466 billion per year, yet preventable.

The new preventive services available to women with private insurance include:

Well-woman visits: Half of women delay or avoid well-woman preventive services due to cost barriers. Continue reading

Report: States That Most Need ACA Medicaid Cash Likely Won’t Take It

An update on which states are most likely to opt out of the Medicaid expansion under the newly-energized Affordable Care Act tells a sad story. The states that most need the federal money to cover their poor, sick residents are the ones most likely to snub it, according to a report in The Incidental Economist.

The Advisory Board (see their map above) says these five states won’t participate in the expansion of the federal program:

Florida: Gov. Rick Scott (R) said, “Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program.” In addition, the governor said the state will not establish an insurance exchange (Pear, New York Times, 7/2).
Louisiana: In an interview on NBC’s “Meet the Press,” Gov. Bobby Jindal (R) said, “Every governor’s got two critical decisions to make. One is do we set up these exchanges. And, secondly, do we expand Medicaid. And, no, in Louisiana, we’re not doing either one of those things” (Barrow, New Orleans Times-Picayune, 7/2). Continue reading

Bulletin: Individual Mandate Survives As A Tax, 5-4 Ruling Upholds ObamaCare

Chief Justice John Roberts Saves The ACA. Who knew?

Read the full opinion here.

So, the mandate is constitutional. Chief Justice Roberts joins left of court. Medicaid provision is limited but not invalidated, says Scotusblog.

Bottom line: “The entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read,” says Scotusblog. “Roberts saved the ACA.”

Amy Howe blogs: “The money quote from the section on the mandate: Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.”

Howe: “The Court holds that the mandate violates the Commerce Clause, but that doesn’t matter b/c there are five votes for the mandate to be constitutional under the taxing power.

(Thank you Scotusblog!)

More from Kennedy’s dissent, from Scotusblog: “In opening his statement in dissent, Kennedy says: “In our view, the entire Act before us is invalid in its entirety.”

For a laugh between all this serious talk, check out tumblr’s “When Scotus Upheld ObamaCare.”

Amy Howe summarizes the ruling in plain English:

The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

Howe notes Roberts’ rationale for his opinion here:

From the beginning of the Chief’s opinion: “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.”

The New York Times front page declares: Victory For Obama

Video Debate: Is RomneyCare Really The Parent Of ObamaCare?

Tonight is going to be all candy, so let’s start the week with a few vegetables, as we sometimes refer to our health policy posts. Not that the above video is lima-bean-like; it’s a lively — though civil — Republican-Democrat debate about whether it’s fair to consider Massachusetts health reform as the “parent” of the federal health overhaul.

As CommonWealth magazine executive editor Michael Jonas introduces it:

We recently launched a new video feature on CommonWealth’s website involving webcam-based discussions between two people. I thought our most recent installment of “Face to Face” might be of interest to you and CommonHealth readers: a discussion of “Romney” and “Obamacare” between two of the people best qualified to chew over the issue that dogs Romney’s campaign perhaps more than any single topic.

Talking over the issue are Tim Murphy, who was Romney’s secretary of health and human services and the administration point-man on the 2006 Massachusetts law, and John McDonough, who was in the thick of the 2006 reform as director of Health Care for All and then went on to serve as senior policy adviser to Ted Kennedy’s Senate Health, Education, Labor and Pensions Committee, where early work on the federal law took place.