For two weeks in a row now, I’ve noticed that the paperback list has included these two books:

“ObamaCare Survival Guide,” by Nick Tate, described as “An explanation of and arguments against the Affordable Care Act.” That was at number three in the category this week. And:

“Beating Obamacare”  by Betsy McCaughey, described as “A handbook on the healthcare law from one of its critics.”

Clearly some great marketing minds have been at work. Much of the law kicks in beginning next year, and how can you not be concerned that its 800-plus pages might be studded with new rules that affect you, your insurance premiums, your medical bills?

But clearly so many great marketing minds are having the same idea that the field (perhaps it’s even a new genre? The “Surviving Obamacare” genre?) seems to be getting a bit crowded. On Amazon.com, I see that there are even two books with the same title: Tate’s, and another called “ObamaCare Survival Guide” with the subtitle, “The Affordable Care Act and What It Means for You and Your Healthcare.” It’s described as “a more objective and less partisan easy-to-read guideline to the law than the highly advertised Nick Tate’s ObamaCare Survival Guide.”

Readers, have you checked out any of these books? We’ll order them and take a look. We’ll also be shopping around for the best “What Will Obamacare Mean To Me?” material. Suggestions welcome. Harvard Professor John McDonough, himself the author of Inside National Health Reform, recommends MIT economist Jonathan Gruber’s health reform comic book as the easiest read for the lay public, but we’d note that it’s more of an overview than a guide to the nitty-gritty details.

Jennifer Haberkorn reports:

The debt ceiling agreement could jeopardize millions of dollars, and perhaps billions, in initiatives from President Barack Obama’s health care reform law if the super committee can’t come up with required spending cuts.

Many of the pots of money in the law — one of the Democrats’ most prized pieces of legislation — could get trimmed by the debt deal’s sequestration, or triggered cuts. The funds for prevention programs and community health centers, grants to help states set up insurance exchanges and co-ops, and money to help states review insurance rates could be slashed across the board if the panel can’t find enough cuts this fall.

Funding for the temporary high-risk pools for pre-existing conditions could be sliced, too, as well as grants to improve maternal and child health. And as previously reported by POLITICO, the law’s cost-sharing subsidies — which are supposed to help low-income people pay their out-of-pocket expenses — could face the ax, too.

Romney, inching ever-closer to becoming an official GOP presidential candidate, is probably not doing a lot of celebrating today.

But as WBUR’s Martha Bebinger and Bob Oakes report this morning, the state’s health law is still front and center politically: with near universal access to health insurance achieved, phase two of the law, trying to contain costs, is the top legislative priority of Gov. Deval Patrick. And on the law’s fifth birthday, experts continue to assess its impact:

There is little solid research that shows residents are healthier or are living longer as a result of the law, but there are lots of individual tributes.

Dennis Foley was 59 when he walked into an emergency room two years ago with a life-threatening foot infection. While treating that infection, doctors diagnosed diabetes, high blood pressure and a heart problem — and signed him on to the state’s health insurance plan. This was his first visit to a doctor in 30 years.

“I ended up with a severe foot infection, went to Good Samaritan Hospital,” Foley said. “It was an 18-day stay. They enrolled me in MassHealth and [I'm] doing good.”

Foley is among the 98 percent of the state’s residents who now have health insurance. Five years after enacting reform, Massachusetts has the lowest uninsured rate in the country.

Here’s an assessment findings from the Blue Cross Blue Shield of Massachusetts Foundation on the law after five years:

–401,000 more Massachusetts residents have health insurance coverage than did before reform.
–Massachusetts has the highest rate of insurance in the country with 98.1 percent of residents insured.
–There has been no evidence of subsidized coverage “crowding out” employer- sponsored insurance, and employer offer rates have grown from 70 percent to 76 percent since implementation of reform.
–Public support for Massachusetts health reform has remained strong with two out of three adults supporting reform.
–Most employers believe health reform has been good for Massachusetts and 88 percent of Massachusetts physicians believe reform improved, or did not affect, care or quality of care.
–The cost of health care and the annual rate of increase in health care spending remains a challenge. With no intervention, per capita health care spending in Massachusetts is projected to nearly double by 2020.

Nancy Turnbull, an associate dean at the Harvard School of Public Health, says the nation continues to keep an eye on Massachusetts. “We never would have had federal reform had Massachusetts not passed our reform law and had we not implemented it successfully,” Turnbull said. “People are watching very carefully and will continue to watch carefully: Can we replicate the success that we’ve had on the coverage side, on the cost side?”

Readers, share your assessment of these five years of reform on WBUR’s Facebook page here.

And if you want to party with the wonks tonight, here, courtesy Health Care For All, is your chance (Mitt will likely not be there):

TONIGHT Health Care For All to Celebrate Fifth Anniversary of State Health Reform at Annual “For The People” Event
State and National Health Care Leaders to be Honored for Work to Advance Access to Care

BOSTON-In celebration of five successful years since Massachusetts became the first state in the nation to guarantee health care to all its residents, Health Care For All will host an event honoring health care leaders.

WHAT: Health Care For All’s Annual “For The People” Event Celebrating the Fifth Anniversary of Massachusetts Health Reform and Honoring State and National Leaders Whose Work Has Advanced Access to Health Care

WHEN: TONIGHT, April 12, 2011 from 5:30 PM – 8:00PM

WHERE: Westin Copley Place Boston
10 Huntington Avenue
Boston, MA 02116

WHO: 550 confirmed guests, including government officials, health care executives, business leaders and consumers. At the event, Health Care For All will honor:

–Cindy Mann, Deputy Administrator and Director of the Center of Medicaid. In this role, Cindy is responsible for the development and implementation of national policies governing Medicaid, the Children’s Health Insurance Program (CHIP), and the agency’s provider survey and certification activities.

–Nancy Turnbull, Associate Dean for Educational Programs and a senior lecturer in health policy at the Health School of Public Health. She is also a consumer representative on the Massachusetts’ Connector Authority Board.

–Baystate Brightwood Health Center in Springfield, where patients receive culturally-competent, high-quality care no matter their income.

…Beyond being ignorant, DeMint’s comments are dangerous. I’ve long argued that the Massachusetts health care plan is not only toxic to Mitt Romney’s presidential candidacy, but it could prove toxic to the entire Republican Party. If Romney is excused for crafting and signing the Massachusetts health care plan, it significantly undermines the case against ObamaCare and weakens the effort to repeal it. The reason is that opposition to ObamaCare will start to look increasingly political and less about principle. It’s true that a state mandate doesn’t raise the same Constitutional questions as the federal mandate, but it still is government forcing an individual to purchase a product. These comments are especially dangerous coming from DeMint, who is known as a leading conservative and ObamaCare opponent. Let’s hope it’s an isolated incident and not part of a broader trend.

1. Win over a wary public
2. Be brief

David Nather writes:

…the public is still deeply divided over [Obama's] biggest legislative accomplishment. Anything he says will be picked apart by groups on the left and the right – not to mention the entire health care industry – for clues about how strongly he’ll stand behind the law.

So, the best strategy, he says, will be to concisely reiterate the health law benefits that have already kicked in — no insurance bans on pre-existing conditions, more coverage for preventative care, tax credits for small businesses — and then move on, leaving Republicans, who voted in the House last week to repeal the law, to bicker and fret over the details — at their own peril.

This time, Obama will talk about the benefits of the law and may make a case that it will help the economy in the long run, “but it will be brief,” said Neera Tanden, chief operating officer at the liberal Center for American Progress and a former top official at the Department of Health and Human Services during the health care debate.

Keeping the health care discussion short would set up a “nice contrast” with Republican efforts to repeal or withhold funding from the law, which could consume so much time on Capitol Hill that the Republicans themselves could face demands to spend more time on the economy, Tanden said.

And here’s Kaiser Health News with advice for the President from nine health policy experts on what to say about about health reform in the speech.

Warning: Since none of these unofficial advisees seem to have a sense of humor on this topic, here’s an older post from The Onion on some alternative health reform proposals. My favorites include:

Melancon-Cooper Bill: Would create a low-cost government-administered health insurance plan, but would prohibit anyone from buying into it

Griffith-Cantor Bill: Low-income families would be allowed to huddle outside hospital windows in the cold and look at wealthier families receiving care

Hutchinson-Snowe Bill: Children insured on a cuteness scale

Grayson Bill: Rep. Alan Grayson will personally punch in the face any insurance executive who turns down a valid claim

Blookross-Feiser Bill: Although no one is exactly sure who these two shadowy congressmen are, their bill would mandate a twofold increase in insurance premiums and force patients to buy name-brand drugs

This afternoon, however, I spoke with Michael Doonan, an assistant professor of health policy at Brandeis, who says reformers, in fact, have a lot to worry about. Here are his top three concerns about the national health reform law following yesterday’s Virginia decision that the insurance mandate is unconstitutional.
1. Implementation Slow-Down

Even if ultimately found constitutional, the immediate danger for supporters of reform is that the decision will slow state implementation.  And it is not like the states are going gangbusters. Twenty states have brought suit against the individual mandate. In the most recent elections 11 governorships switched from Democrats to Republican governors.  In 29 states Republicans — most of whom oppose or ran against reform — are now responsible for implementation. How enthusiastically do you think they are the preparing for reform? The Virginia decision and media coverage add an element of doubt and bolster those who want to roll back or put the breaks on reform.  This decision will provide further “evidence” for these unenthusiastic states to sit on their hands.

2. Without The Mandate, Things Fall Apart

While the Obama Administration is confident that they will ultimately win this fight, they also declare that things like the Medicaid expansions and tax subsidies are not contingent on the individual mandate.  Actually these expansions are far less valuable without a mandate. It is widely understood that without the individual mandate, we can forget about insurance reforms such as banning pre-existing condition exclusions, guarantee issue, and modified community rating which spreads health risk and costs across broader populations. But national reform absent a mandate will cover but a fraction of the 32 million estimated by CBO. It will cease to be national reform.

3. Don’t Forget Massachusetts

Remember back to the beginnings of Massachusetts reform and the Urban Institute/Blue Cross Blue Shield of Massachusetts Foundation report stating (and I am paraphrasing) “if you don’t have an individual coverage mandate you can’t get to universal coverage or even close.”  The Massachusetts experience bears this out. Vermont and Maine expanded subsidies and created new government programs, but guess what? Very few people enrolled. States have also tried Medicaid and State Children’s Health Insurance (CHIP) buy-in programs with subsidies similar to what will be available in the new health exchanges. Again very few people enrolled.

The Virginia decision is a paper cut to national reform, but this won’t stop opponents from crying ouch and using this to slow implementation. This is a real problem. In the long-term the Supreme Court will rule and the robed ones will decide the fate of the individual mandate and with it the success of national reform.

Republicans continue to talk about repealing the law (though experts say that scenario is pretty much impossible), but Rovner reports that industry has already invested a lot, and at this point, going back to square one on health reform would cause major headaches:

…while a large majority of GOP voters told exit pollsters they strongly support the idea of starting from scratch on the health overhaul issue, major players in the health care industry — usually strong Republican allies — are a lot less enthused about the idea.

“No one has said what this bill would be replaced with,” said Richard Umbdenstock, president and CEO of the American Hospital Association. “But doing away with this would certainly be the wrong thing. … People have been gearing up for some time, well before this actual bill got passed, to make these changes locally, and have invested a lot.”

It’s not just hospitals. Employers, particularly large employers, have already put considerable time, effort and money into implementing the parts of the law that have already taken effect. And just the possibility that the law will be repealed or substantially changed could present a serious problem.

]]> 2010-11-19T11:30:01-05:00 http://commonhealth.wbur.org/2010/09/health-reform-101-the-cartoon http://commonhealth.wbur.org/2010/09/health-reform-101-the-cartoon#comments Tue, 21 Sep 2010 13:38:53 +0000 http://commonhealth.wbur.org/?p=1798 With several key provisions of the national health care reform law about to kick in, the folks at the Kaiser Family Foundation created a simple, animated movie, narrated by ABC and NPR commentator Cokie Roberts, to explain the 1,000-plus-page law to a wary, politically over-spun public.

Check it out here:

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