affordable care act


Study: The Deadly Toll Of Opting Out Of The New Medicaid Expansion



Here are some serious numbers from Harvard researchers regarding the 25 states that have opted out of expanding Medicaid coverage under the Affordable Care Act:

We estimate that due to the opt-outs 7.78 million people who would have gained coverage will remain uninsured. This will result in between 7,115 and 17,104 more deaths than had all states opted-in.

Writing for the journal Health Affairs blog, researchers led by Samuel Dickman, a medical student at Harvard Medical School/Cambridge Health Alliance, estimate further severe health woes linked to states’ decisions to forgo expanded Medicaid, including:

•712,037 more persons diagnosed with depression
•240,700 more persons suffering catastrophic medical expenses
•422,533 fewer diabetics receiving medication
•195,492 fewer women receiving mammograms
•443,677 fewer women receiving pap smears


Here’s more from the Cambridge Health Alliance news release (and for full disclosure, all of the study authors are members of the national group, Physicians For a National Health Program, which advocates that the U.S. adopt a Canadian-style single payer health system. PNHP did not pay for any part of this research, according to a spokesperson):

Dickman and his colleagues, longtime health researchers at Harvard Medical School and the City University of New York drew on demographic data from the Census Bureau’s 2013 Current Population Survey and estimates on Medicaid take-up rates from the Congressional Budget Office and elsewhere to characterize those who would remain uninsured in states opting out of Medicaid expansion.

They developed estimates of the health effects of remaining uninsured based on previous studies that used state-level data on Medicaid expansions and death rates, the National Health and Nutrition Examination Survey Mortality Follow-up, and the Oregon Health Insurance Experiment.

In addition to arriving at national estimates, the researchers were able to break the findings down by state.

For example, in Texas, the largest state opting out of the Medicaid expansion, approximately 2 million people who would otherwise have been insured will remain uninsured as a result of the state’s action.

“Texas’ refusal to accept federal money to expand Medicaid will result in 184,192 more people experiencing depression, 62,610 more people suffering catastrophic medical expenses, and as many as 3,035 avoidable deaths,” said Dr. Steffie Woolhandler, a professor of public health at the City University of New York who is also on the faculty at Harvard Medical School. Continue reading

In Defense Of Health Care Law, Obama Cites Mass. Success

President Obama spoke at Faneuil Hall about the federal health care law. (Charles Dharapak/AP)

President Obama spoke at Faneuil Hall Wednesday about the federal health care law. (Charles Dharapak/AP)

President Obama’s visit to Boston Wednesday was a carefully orchestrated effort to revive momentum for the Affordable Care Act. The president took the stage at Faneuil Hall, the same place where former Gov. Mitt Romney signed the Massachusetts health coverage law in 2006.

Romney was not invited. Instead, Faneuil Hall was packed with hand-picked supporters of Obamacare. The president congratulated those who supported the 2006 law for making Massachusetts the state with the lowest rate of uninsured people in the country.

“And it’s because you guys had a proven model that we built the Affordable Care Act on this template of proven bipartisan success,” Obama said. “Your law was the model for the nation’s law.”

But rolling out the model nationwide has been rocky. Some governors are refusing to participate. The U.S. House of Representatives has voted to repeal the national law again and again. And the federal website, where Americans are supposed to be able to shop for insurance, is a mess.

“There’s no denying it,” the president said, “right now the website is too slow. Too many people have gotten stuck and I am not happy about it. And neither are a lot of Americans who need health care. And they’re trying to figure out how they can sign up as quickly as possible. So there’s no excuse for it. And I take full responsibility for making sure it gets fixed ASAP.”

Obama looked to Massachusetts for relief. Continue reading

Looking Back: What Really Happened At The Start Of Mass. Health Reform

A lot of Obamacare supporters point to Massachusetts as proof that signing up the uninsured is a big, but doable task. Here, in 2013, that’s a reasonable conclusion.

But back in 2007 and 2008 things were a lot messier, and some advocates for universal coverage were worried.

Here’s why:

2006 Romneycare handshake

In this April 12, 2006, file photo, then-Gov. Mitt Romney is seen with lawmakers and staffers after signing the state’s universal health coverage law at Faneuil Hall in Boston. (AP File)

1) It looked like the state had, by a lot, underestimated the number of people who would be eligible for free and subsidized coverage. (In 2006, the estimate was 140,000. By April 2008, the estimate rose to 225,000, based on early sign-ups. Enrollment plateaued at 177,000 in 2009.)

2) A dramatic increase in first enrollment put a strain on doctors and health care services at every level.

3) Patients, many of whom had not had insurance for years, had a lot of problems they hadn’t taken care of and were seeking more tests, surgery and other treatment that drove up costs.

4) State budget watchers started to panic. The governor’s office kept going back to the Legislature to ask for more money and a few top lawmakers began to question whether the state could afford to fund the coverage law.

5) Employers saw an increase in workers who, to avoid the individual mandate penalty, signed up for their employer’s coverage, which increased employers’ outlays for health insurance.

Of course we don’t know if people who’ve gone without insurance around the country will behave like Massachusetts residents.  Continue reading

As Nation Braces For Obamacare, Mass. Tackles Health Costs

If for some reason you’re not already drowning in the rough waters of U.S. health policy — what with the Affordable Care Act’s health exchanges launching today and Congress and President Obama still duking it out over the four-year-old law upheld by the U.S. Supreme Court — well, you’re in luck. Because in the midst of all this Obamacare angst and government shutdown, our fair state this week kicks off the Oscars of health wonkdom, aka, the Massachusetts Health Policy Commission’s Annual Health Care Cost Trends Hearing.

It’s a time for state health care officials and bureaucrats to conduct a little reality check with insurers, hospitals, businesses and consumers to ensure that everyone’s making a good-faith effort to hold down medical costs.

Stuart Altman, economist and professor of National Health Policy at Brandeis University and chair of the board of the Massachusetts Health Policy Commission, says the role of the commission is to keep all of the players involved in the health system accountable and sharply focused on driving down costs while improving quality. “We’re like a big searchlight on the system to say ‘Hey this is good’ or Hey, this is not good,” and then follow up, Altman said on WBUR’s Radio Boston Monday.

Gov. Deval Patrick

Gov. Deval Patrick

Here’s a little background on the hearings, to be held at the University of Massachusetts, Boston, from the state:

The cost containment law, signed by Governor Patrick in August 2012, empowered the Health Policy Commission with monitoring health care delivery and payment system reform and developing policies to reduce overall cost growth while improving the quality of patient care. The Commission is governed by an independent board of health care experts who will use the two-day hearing to examine hospitals, insurers and provider organizations about their work to meet the new cost growth benchmark (3.6% for 2013 and 2014), improve care coordination and provide consumers with price transparency tools. Market consolidation’s impact on the Massachusetts health care system will also be a hearing focus.

If you want to get a jump on the hearings, go wild and check out the pre-filed testimony here. Continue reading

How ‘The Berwick Report’ May Play Out In Massachusetts

Dr. Don Berwick, a candidate for governor of Mass.

Dr. Don Berwick, a candidate for governor of Mass.

Don Berwick, a Democrat, is running for Governor of Massachusetts. But yesterday, he issued a “Letter to the people of England.” The subject? Britain’s National Health Service (NHS) and Berwick’s recommendations for improving safety and restoring confidence after higher than expected death rates at one hospital rocked the country.

Berwick conducted his review and issued his report, pro bono, at the request of Prime Minister David Cameron. Today, he spoke with reporters in Boston about the health care and political lessons his work in the UK offers for Massachusetts.

Q: How do you think this report relates to people in Massachusetts. What do they take away from it?

A: Well…this report is not part of the campaign; I had agreed to do it prior to the announcement and getting people involved with the campaign, and the work does come to a close now, except for perhaps occasional advisory interactions. But this is about large system change, I mean, here you have a system with 1.4 million employees. That’s the size of the National Health Service, spending 100 billion pounds. And it’s a good example of how a very large system constantly needs the attention of leaders to the continual improvement of whatever it’s trying to accomplish. It’s an example of how the field I’ve been investigating for 30 years now, continuous improvement in quality, can be brought to scale. Continue reading

Sebelius, Rolling Stones Fan, Confident On Health Law Deadline

HHS Secretary Kathleen Sebelius

HHS Secretary Kathleen Sebelius

How well do you know your Secretary of Health and Human Services? That’s the big question posed by a quiz today on Politico.  Secretary Kathleen Sebelius, who, according to the quiz, is a high school jock with a soft spot for the Rolling Stones, has been in the news recently about growing concerns around the lagging implementation of the Affordable Care Act.

On Here and Now last week, WBUR’s Meghna Chakrabarti asked Sebelius about glitches in rolling out the national health law.  The HHS secretary also responded to criticism that she’s been involved in the collection of funds from private sources — like health care and insurance providers — via the not-for-profit organization Enroll America.  

Sebelius had this to say:

“Enroll America is not a creation of mine.  Continue reading

One Benefit Of ObamaCare: A Boom In Breast Pumps

While much of the discussion over the Affordable Care Act has revolved around big, complex questions about the insurance market, health exchanges and new payments systems for delivering care, The Washington Post reports on one of the law’s more intimate, down-to-earth provisions: free breast pumps.

Indeed, as The Post’s Sarah Kliff notes: pump demand is intensifying following full implementation of the law’s provision requiring insurers to cover the cost of providing breast pumps and lactation consultants to women.

(Wayan Vota/flickr)

(Wayan Vota/flickr)

She writes:

“We’re getting a lot of calls from prospective mothers and new mothers,” said Bruce Frishman, president of New Hampshire Pharmacy and Medical Equipment, a supplier based in the District. “We’ve started stocking a lot more pumps that would be purchased through insurance.”

Yummy Mummy, a New York boutique that specializes in breast pumps and accessories, is in the process of acquiring a warehouse and call center to accommodate the increased demand.

“I have three employees taking calls right now,” owner Amanda Cole said. “We’re still in the stage where we’re figuring out how to add fax machines and phone lines. It’s all very new to us.” Continue reading

Citing Shifting Landscape, Medicaid Insurer Jumps Into Commercial Market

A comparison of monthly premiums for a single 35-year-old (Source: The Connector)

A comparison of monthly premiums for a single 35-year-old (Source: The Connector)

Citing the fast-shifting, post-Affordable Care Act health insurance landscape, Network Health, a nonprofit Medicaid health plan, is branching out into the commercial market. That means individuals, families and small businesses will be able to purchase Network’s less expensive plans — which don’t include hospitals in the state’s most expensive hospital network, Partners Healthcare — through the state’s Health Connector, and through Network Health directly.

Why now?

Well, first of all, the other Medicaid plans in the state — such as Boston Medical Center’s plan — have already done it. Moreover, with the ACA kicking in in earnest next year, all of the insurers are scrambling for market share.

Network Health President Christina Severin said through a spokesperson that despite its history as a Medicaid plan, “we wanted to offer the same high-quality affordable coverage to an even larger percentage of Massachusetts residents, both individuals and through the business communities, and in doing so, expand on our mission to improve the health and wellness of the diverse communities we serve. We are also preparing for changes that will inevitably occur in our market when federal health care reform takes full effect. The Affordable Care Act is changing the country’s health care system, and seeking to make Exchanges more dynamic marketplaces. We very much believe that Network Health’s value proposition is an excellent match with this evolving market place.”

Network Health was purchased by Tufts Health Plan in November 2011, but the decision to enter the commercial market wasn’t a condition of the sale, a Network Health spokesperson said. Rather, it was just a business reality. WBUR’s Martha Bebinger had a few more questions about the deal and here are some answers:

Q: Will Network Health be underpricing Tufts Health Plan and if so, how?

A: NH compared its relationship with Tufts Health Plan to “The Gap and Banana Republic.” Continue reading

Commentary: When Patients Fall Through The Health Coverage Gap

By Dr. Nancy Adams
Guest Contributor

Ms. X has worked hard — and fast — as a barista for years. She’s employed by a company that offers her access to health insurance, but she has never been allowed to work a 40-hour week — an increasing problem in many industries nationwide.

As a poorly controlled diabetic with high blood pressure and cholesterol, Ms. X needs a minimum of six prescription medications. She should also be monitoring blood sugars daily and have lab tests every three to four months.

But because her health insurance requires high out-of-pocket deductibles for medicines, testing strips, and lab tests as well as office visits, she cannot afford to pay for all the recommended care. So her diabetes remains poorly controlled, and that increases her risks of heart disease, peripheral vascular disease, blindness and kidney failure.

Dr. Nancy Adams

Dr. Nancy Adams

As a primary care provider for 30 years in Chelsea, Mass., I have had first-hand experience dealing with all the defects of our current health care system. And I have spent many hours trying to explain to intelligent, interested consumers why it is so flawed. A fundamental problem is that the incentives for the consumer and those for insurers and providers have been misaligned.

The insurer who pays for this year’s health costs for Ms. X, and saves hundreds of dollars by making her pay more out of her own pocket, is unlikely to be the same one who spends many thousands of dollars years from now if she is hospitalized or needs procedures.

If she does develop complications, by the time she is covered by Medicare, she may need care from multiple specialists and many more medications and tests. In a worst-case scenario, she could end up needing hundreds of thousands of dollars in additional care. The old saying “penny wise and pound foolish” certainly applies.

As health costs rise, more and more patients have to pay increasing amounts out of pocket, and this “penny-wise” problem is getting worse. Current annual deductibles for all consumers now average more than $1000 for an individual and more than $2000 for a family nationwide. Continue reading

Medical Research: By Law, It’s All About You

Your tax dollars fund medical research, but your say in what research actually gets done is exactly…zero.

Now, a new, Congressionally-authorized nonprofit born of the Affordable Care Act is proposing a different model: What if medical research were driven not just by profit-seeking drug makers or academic researchers with niche interests? What if, instead, research pursuits bubbled up from patients and their caregivers based on the concerns, confusion and questions that arise from real-life dealings with the health care system?


The Patient-Centered Outcomes Research Institute (PCORI) is the first, and clearly the most ambitious, publicly-funded effort to integrate patients and caregivers more directly in figuring out what works in health care. They’ll be able to push for what they need most, whether it’s more effective asthma treatments, clearer information on childhood vaccines or preventing falls among the elderly.

Eventually, a new body of evidence — by, about and for patients — will be easily accessible to anyone trying to navigate the health care system or seeking reliable data on preventing, diagnosing or treating an illness, says PCORI’s executive director Dr. Joe Selby, formerly the director of research for Kaiser Permanente, Northern California..

What’s Best For Me?

In a radical rethinking of what constitutes “health research,” patients are central to this endeavor and participate in every stage of the process: from generating and selecting study topics to determining the most effective strategies for communicating the results (not everyone subscribes to The New England Journal of Medicine, the thinking goes). PCORI has already spent $31 million to fund 50 pilot projects (out of 856 submitted) and it estimates $427 million in research commitments will be made by the end of 2013. By the close of the decade, PCORI expects to invest about $3 billion in research.

Currently the group is soliciting specific questions from patients and caregivers nationwide that might ultimately be developed into research projects. The questions can be on anything with a clinical focus: basically, any question that begins: “What’s best for someone like me?” qualifies. Continue reading