As I said in my post last week on the foreign and comparative law reports we published in 2013, December is a good time to look back and evaluate the year. This has been a busy year for the In Custodia Legis blog team. So far we have published 233 posts in 2013 and May, with 27 posts, was our busiest month. This pushes the total number of posts since our founding in August 2010 to more than 860. Not bad, eh? Also, this year Barbara, Donna, Laney, and Robert, who had been avid guest bloggers for a while, decided they enjoyed blogging so much they joined the blog team. In addition, we added a new category to the blog, Research Guide, which thanks to the hard work of Barbara and Robert has proven quite popular with our readers.
As a member of the In Custodia Legis team, I constantly think about what types of posts our readers might enjoy reading. One way of gauging such interest is by looking at which posts attract more readers. Here is a list of the ten posts that topped the In Custodia Legis charts this year in the order of their popularity:
- Frequent Reference Question: How Many Federal Laws Are There?
- How to Locate Free Case Law on the Internet
- The Transition from THOMAS.gov to Congress.gov
- The Cyprus Banking Crisis and its Aftermath: Bank Depositors be Aware
- Congressional Record Added to Congress.gov
- Contract Law: A Beginner’s Guide
- Employment and Labor Law: A Beginner’s Guide
- Legal Drafting: A Beginner’s Guide
- How Robin Hood Defied King John and Brought Magna Carta to Sherwood Forest
- Nonprofit Organizations: A Beginner’s Guide
While preparing this post, I asked some of my colleagues what their favorite posts of the year had been. Here is what they told me:
I enjoyed Clare’s “Odd Laws of the United Kingdom,” because now I know conclusively that I may not operate a cow while intoxicated outside of Buckingham Palace.
I always love to read our interviews. We have published more than 120 of these now! I particularly enjoyed the interviews with many of the interns that we hosted in the Law Library this year. These students have such diverse backgrounds and interests and will no doubt have wonderful careers ahead of them. They provided great assistance to our research staff and really added to the international vibe here in the Law Library too – this year our interns were from countries all over the world, including Korea, China, Thailand, Ghana, France, and Ukraine.
My favorite post of the year was Kelly Buchanan’s post “Marmite: A Sticky Legal Issue.” Having spent time in Britain I had eaten marmite there and found it to be to rather awful – at least to my taste! But I am glad to know that Kelly and her fellow expat Kiwis will be able to get their New Zealand “black gold” on a regular basis.
I always like the interviews and the pics of the week. The two posts I remember enjoying most were: After the Fall of Richard the III: Vengeance and the Alteration of History and Odd Laws of the United Kingdom.
I don’t think I could pick just one favorite, but I really liked these: Marmite: A Sticky Legal Situation; Prudence, Parrots and an Odd Emperor: An Example of Legal Engraving; and Smoke from the Flame of Knowledge – Pic of the Week.
I really liked two of Nathan’s posts this year: How Robin Hood Defied King John and Brought Magna Carta to Sherwood Forest and Collection Development with Litteratura Iuris, or, Heads Will Roll – Pic of the Week.
Please do not hesitate to use the comments section to tell us what your favorite posts were this year or give us any feedback.
On behalf of the In Custodia Legis team, I would like to say thank you for reading and happy holidays!
James (Jim) Martin, Andrew Weber and I were talking about Christmas movies several weeks ago. Jim describes himself as a cynic, who “developed a taste for what I call ‘alternative Christmas,’ films such as The Lion in Winter and Desk Set.” Jim defines alternative Christmas films as “films that take place during the holiday period, but which do not directly concern Christmas.” For this post, Jim and I, with contributions from Robert Brammer and suggestions by the Blog Team, have identified some Christmas films that involve legal issues. Some of these fit into Jim’s alternative Christmas category, and some do not. Here are our picks.
Robert Brammer picked a little known film titled Ice Harvest. This film, set in Wichita, Kansas on a frigid Christmas Eve, follows the machinations of Charlie, an ethically challenged attorney, and his associates after they embezzle a large sum of money from a local mob boss. The attorney’s goal is to skip town as quickly as possible, but in classic noir fashion, a series of close calls and double-crosses ensure it will not be so easy. Conspiracy, embezzlement, and murder are just a few of Charlie’s undertakings that do not quite track the ABA’s Model Rules of Professional Conduct.
Jim Martin identified two movies about Christmas and the law. As he has noted, he is a cynic, and most of his favorite Christmas movies deal with the human drama of the holiday, but he admits to liking the original version of Miracle on 34th Street. The film concerns a man named Kris Kringle, who works as a Santa Claus for Macy’s and who, by his shining example, inspires even Mr. Macy and his chief competitor to embrace the spirit of giving during the season. Kris, due to an unfortunate event, ends up being the subject of a competency hearing because he believes he is the real St. Nick!
New York State at the time of the movie (immediately after World War II) had several methods for committing individuals who were thought to be a danger to themselves or others. One such procedure was upon the finding of “…a judge of a court of record of the city or county, or a justice of the supreme court of the judicial district in which the alleged mentally ill person resides or may be…”. Kris is tried in New York City by a Supreme Court judge (in New York the Supreme Court is not a court of appeals). The local prosecutor represents the State and Kris is represented by his friend, Fred Gayley. The procedures followed in court are not very accurate. Fred is able to convince the court, in part through the sage advice of the judge’s political advisor, to accept the existence of Santa Claus. The issue in dispute then shifts to the validity of Kris’ assertion. We see a child witness, the son of the prosecutor, giving testimony as a witness for the defense after being asked by the judge if he understands the need to tell the truth. Fred’s big legal coup is when the clerks at the post office, “an agency of the United States government,” as Fred tells the court, arrange to have sacks of undelivered letters addressed to Santa delivered to the courtroom where they are given to a delighted Kris. This results in an immediate finding by the court that Kris Kringle is Santa Claus. The case is then dismissed.
The second movie Jim found is an instance when a movie foresees legal issues years before they becomes well known to society. Such is the case in the holiday movie, Bachelor Mother, which stars Ginger Rogers (in her first major non-dancing role) and David Niven. This 1939 movie addresses the issues of child abandonment and custody. On Christmas Eve, Rogers sees a woman abandoning an infant on the steps of a home for abandoned children. When she goes to check on the child, she is confronted by a nurse who believes that she is the child’s mother. Any amount of denials by Rogers is unsuccessful in dissuading the employees of the institution. When they find out that she had recently lost her job at a department store, they contact David Niven, the son of the owner, to ask that she be reinstated so that she can keep her baby. Niven agrees and pressures Rogers to keep the baby. Ultimately Rogers and Niven will fall in love; but, before our happy ending Niven’s father, Charles Colburn, comes to believe that Niven is the baby’s father. An attempt to convince him otherwise results in a threat by him to sue for custody of the child: “I don’t care who the father is, I’m the GRANDFATHER!” In 2000, the Supreme Court of the United States in its decision in Troxel v. Granville, 530 U.S. 57, ruled that there is no constitutional basis for a statute supporting grandparents to have visitation rights. So, short of showing a compelling interest to be served by his meddling, Charles Colburn, however well-meaning he might have been, likely overstated his rights.
Like Jim, one of my favorite holiday movies is the Lion in Winter. This movie takes place during the reign of Henry II at his 1183 Christmas court. It is, among other things, a portrait of family disfunction since Henry has to let his wife Eleanor out of prison before she can join the family Christmas celebration. The action that drives the film is concerned with deciding which of Henry’s three sons (Richard, Geoffrey and John) will inherit the Angevin empire. According to the law of primogeniture, the eldest son Richard should inherit but Henry prefers his youngest son, John. I would also argue that this movie is also about women’s rights, or the lack thereof in the 12th century. Even though Queen Eleanor was a great heiress in her own right, as Duchess of Aquitaine, her husband Henry still had the legal right to keep her imprisoned!
The Blog Team suggested Home Alone and Love Actually as other possible candidates. For Home Alone the legal issue would be at what age, if any, does Illinois state law allow children to be home alone. I checked the Illinois code on this point and found that Illinois defined a neglected minor as any child under the age of 14 who is left at home alone unsupervised by a parent or guardian for an unreasonable period of time. However this specific section of the Illinois code, 705 ILCS 405/2-3(1)(d) was not passed until 2009 - almost 20 years after the movie originally occurred. For Love Actually, we came up with several possible legal issues: the custody arrangement between Liam Neeson’s character and his stepson; the immigrant status of the Portuguese housekeeper with whom Colin Firth falls in love; and when Bill Nighy’s character strips on television what role do obscenity and censorship laws play?
Robert Brammer and Nathan Dorn collaborated on our final pick, Gremlins. It is set in Christmas, but how is it tied to the law? A debate followed, questioning whether Gizmo was a wild animal, and whether his owner, a minor, could be strictly liable for the mayhem that resulted after Gizmo got wet after midnight. If strict liability is not available as a theory of recovery, could the city and/or the owners of the property that the gremlins destroyed successfully sue on a theory of negligence? Could a reasonable person ever foresee that getting Gizmo wet would lead to mass destruction? Let us know what you think in the comments. The resolution of this question will undoubtedly require a reading of everyone’s holiday favorite, the Restatement of Torts.
The Health Policy Commission’s (HPC) Quality Improvement and Patient Protection Committee held a hearing Monday on proposed amendments to 958 CMR 3.000, the Office of Patient Protection (OPP) regulation governing health plan internal and external appeals procedures. The proposed amendments follow a listening session that OPP convened over the summer, and include consumer-friendly changes required by the Affordable Care Act (ACA) and Massachusetts state laws, as well as changes to provide additional clarifications and protections for consumers.
For example, some positive changes prompted by the ACA include a faster turnaround time for both expedited and non-expedited external reviews; more detail and clarity for information provided in consumer notices; allowing patients with urgent medical needs to file both expedited internal and external appeals simultaneously; and requiring refunds to consumers of the external review fee if the consumer wins the review. And those are just a few of the improvements.
During the hearing, the Committee heard oral testimony from InterQual/McKesson Health Solutions, National Association of Social Workers (NASW), Massachusetts Association of Health Plans (MAHP), Health Law Advocates (HLA) and Health Care For All (HCFA), and Massachusetts Association of Behavioral Health Systems (MABHS). Here are some of the points raised:
- Jacqueline Mitus, Senior VP of Clinical Development and Strategy for McKesson Health Solutions and Laura Coughlin, VP of InterQual Development, raised concerns that providing criteria for medical necessity determinations to the public at no cost could breach confidentiality under intellectual property law and that the complexity of such information could create consumer confusion.
- Jonas Goldenberg, Director of Clinical Issues and Continuing Education at NASW, recommended more stringent criteria for clinicians participating in review panels and advocated that services should be automatically continued pending the outcome of an appeals process.
- Sarah Gordon Chiaramida, VP of Legal Affairs at MAHP, expressed concerns that requiring diagnosis and treatment codes on adverse determination notices would be confusing and may breach privacy protections by revealing protected health information to third parties. She further voiced concerns that the amendments around increased availability of translation services would be too costly and administratively burdensome for the health plans.
- Clare McGorrian, Senior Staff Attorney and Director of the Commercial Insurance Appeals Program at HLA provided testimony on behalf of both HLA and HCFA. She advocated that medical necessity criteria should be determined by providers with more clearly defined clinical expertise and recommended that adverse determination notices more prominently display deadlines for action, especially for expedited appeals and continued coverage for ongoing treatment .
- David Matteodo, Executive Director of MABHS, suggested that providers reviewing appeals be required to be licensed in Massachusetts.
The Health Policy Commission is accepting written testimony and comments from the public until 12 noon on Tuesday, December 24, 2013. For details on how to submit testimony electronically or via mail, see the Hearing Notice.
The Statewide Quality Advisory Committee (SQAC) met this week for its final 2013 meeting.
The group looked at an overview of the current Standard Quality Measure Set (SQMS), which includes 128 measures, 93 of which are mandated and 35 or which were recommended for inclusion by the SQAC after a measure nomination process. Seventy of the measures look at ambulatory care, 51 are for hospital care, and 7 look at care in post-acute settings (skilled nursing facilities and home health).
Looking at the priority areas that are covered by SQMS measures, 20% of them are care coordination measures, 16% are chronic disease measures, 12% are preventive care measures, 9% are pediatric measures, 9% are behavioral health measures, 6% maternal and neonatal health care measures, 27% are other and 0% are patient-centered care measures.
There was a lot of attention paid to patient-centered care measures during 2013 SQAC measures, with presentations on Patient-Reported Outcome Measures (PROMS) and patient confidence measures, as well as nominations for the inclusion of patient confidence and shared decision-making measures in the SQMS. While those measures were not chosen for inclusion, the SQAC will continue to look at them and, as CHIA Executive Director Boros said, will consider making stronger statements about their importance even if they are not included in the set.
Based on the group’s discussion of domains and measure types that are under-represented in the SQMS, the next steps as outlined by Boros are for CHIA staff to:
- Develop a straw model for reporting on a specific population;
- Characterize existing SQMS measures as looking at overuse or unnecessary use of care, for those that do so, and propose other overuse measures that could be nominated for inclusion in the SQMS;
- Start looking at measures relating to outpatient specialist care.
The next SQAC meeting is Monday, February 10, 3-5 at CHIA, 2 Boylston Street, 5th floor. Sometime following that meeting, there will be a solicitation process for proposed measures for the measure set.
Caring for the elderly and frail population is complicated and expensive. In 2012, Medicare and Medicaid spent nearly $60 billion each on post-acute care and long-term care, respectively. These patients often get care in different settings, including inpatient (hospital-based), short-term post-acute care (such as skilled nursing facilities), and long-term care (such as nursing homes).
The payment methods can be confusing: Medicare covers large portion of inpatient and post-acute care and no long-term care, while Medicaid is the only program paying for long-term care (and only under very stringent conditions). This care is more and more expensive. Total Medicare costs are driven in large part by post-acute care (see Figure). And depending on the types of services required, long-term care could cost anywhere from $80,000 to $200,000 per year in the Washington DC area. Further, the quality of care varies widely according to Medicare’s Nursing Home Compare program; and many programs suffer from lack of clear coordination and high risks of repeated hospitalizations.
As the population ages, perhaps the highest-yield strategy is to care for the frail elderly, to the greatest extent possible, in their own homes. Not only would this satisfy many peoples’ wishes (nearly 90 percent of seniors desire to stay in their homes as long as possible), but also may save money and improve patients’ quality of life. A recent article in The Atlantic and white paper by Jonathan Rauch, a Brookings Institution Senior Fellow, profiled the difficulties of treating seniors at the hospital and the opportunities for home-based primary care. For example, a frail elderly patient that calls 911 and is sent to the hospital may be treated for their immediate condition but not for the multiple other interacting conditions they may have. With this new delivery model—which largely depends on coordinating and improving care for the elderly—seniors would receive visits at home from a team of health care providers, such as physicians, nurses, pharmacists, and social workers. This interdisciplinary team would coordinate the patient’s care and work to prevent avoidable hospitalizations and other costly complications. They might discuss medication management with a patient, reorganize a patient’s home to reduce the risk of a fall, or install an air conditioner in unbearably hot climates.Examples of delivery reforms
For example, in Northern California Sutter Health’s Advanced Illness Management (AIM) program brings together a care team of nurses, physical and occupational therapists, and social workers under the direction of a primary care physician to monitor a patient’s health and well-being, including non-medical issues such as home safety and transportation. AIM was started by Brian Stuart at Sutter Health after he saw that patients were receiving inappropriate and costly care at the end of life. The program currently covers about 2,000 patients and is expected to expand to 5,000 to 7,000 patients. The program is estimated to save Medicare $2,000 per patient per month by avoiding hospitalizations and readmissions.
Similar to the AIM program, On Lok Lifeways in California provides an alternative to the traditional method of caring for patients in a facility and seeks to keep patients in their homes. The program serves both Medicare and Medicaid patients in California and is the pioneer program for the Program for All-Inclusive Care of the Elderly (PACE) model of care. On Lok is built around interdisciplinary care teams that discuss the patients’ needs and plan accordingly, either visiting the patient at their home or having the patient come to the center for day visits. For example, the average On Lok participant is female and age 84, has 13 medical conditions and difficulty with more than two activities of daily living (bathing, eating, etc.), and is usually within the last three to four years of life. For these patients who require a lot of care, the physicians play a key role in organizing and managing patients’ care plans that are communicated to the rest of the care team. PACE organizations like On Lok receive monthly capitated payments based on the patients’ eligibility for Medicare and Medicaid and this pooled payments method allows them to provide needed services regardless of funding sources. On Lok’s method has been successful in improving care and lowering costs: the average cost of end-of-life care for On Lok is nearly $1,000 cheaper than the average for Medicare Part A and B beneficiaries in San Francisco.Delivery reforms need complementary payment reforms
The key to sustainable delivery reform is supporting payment. A step in this direction would be to change Medicare’s financial incentive structure. The Center for Medicare and Medicaid Innovation (CMMI), as part of the Affordable Care Act (ACA), announced the Independence at Home (IAH) Demonstration in 2011. This demonstration is designed to foster home-based primary care and test whether this type of care can reduce hospitalizations and readmissions, improve patient satisfaction, improve quality of care, and reduce Medicare costs. Primary care practices will be the primary providers for these chronically ill beneficiaries and will make in-home visits to patients while coordinating their care. To qualify for this demonstration, beneficiaries must have at least two chronic conditions, coverage under fee-for-service Medicare, need assistance with two or more activities of daily living (such as eating or walking), and had a hospital admission/received rehabilitative services within the last year. The demonstration is limited to 10,000 beneficiaries. CMS will use quality measures to track the beneficiaries’ care, and practices that meet these quality measures can receive bonus payments if they also meeting cost savings requirements. Examples of these quality measures include hospitalization and rehospitalization rates, emergency department visit rates, health status screenings and assessments, patient satisfaction, and confirmation of in-home safety assessments. While the bonus payments are built on top of existing fee-for-service Medicare, providers will have the incentive to improve the quality of care provided at home to high-cost, chronically ill beneficiaries.
While On Lok and the Independence at Home demonstration have similar objectives, their payment models differ. On Lok and other PACE organizations receive monthly payments from Medicare, Medicaid, and sometimes private resources, which are then pooled together to provide care to patients. On the other hand, the IAH demo is built on top of existing fee-for-service Medicare and thus providers receive payments for the number of services they provide. The bonus payments reduce the incentives for unnecessary or inappropriate services and holds providers accountable for meeting quality measures of beneficiaries’ care. While it is still too early to tell about the successes or lessons learned from the IAH demo, the PACE model has been successful over the last several decades at reducing costs and improving care.
No single payment reform may be best; it’s likely that different payment reforms may apply for different innovations.Authors
- Sara Bencic
- Darshak Sanghavi
Kurt DelBene, who previously was president of the Microsoft Office Division, was named by President Barack Obama to replace Jeffrey D. Zients and oversee efforts to rescue the federal government's health care website.
The New York Times: Ex-Microsoft Executive To Take Over Health Site Repairs
President Obama has chosen a former Microsoft executive, Kurt DelBene, to replace Jeffrey D. Zients as head of the effort to finish repairs on the government’s health insurance website, administration officials said on Tuesday (Calmes, 12/17).
Los Angeles Times: Former Microsoft Executive To Lead Effort To Fix Obamacare Website
Kurt DelBene, who most recently served as president of the Microsoft Office Division, will take over from Jeffrey Zeints, a management expert whom the president asked to rescue the site after its disastrous rollout on Oct. 1 (Levey, 12 17).
The Washington Post: Kurt DelBene, Former Microsoft Executive, Will Take Over Healthcare.gov
Several lawmakers, concerned about the Web site’s rocky rollout, had pressed the administration to install an outside expert to oversee its operations once Zients left. Zients, who was appointed in late October and oversaw major improvements in the system, had requested a month’s time to prepare for his next West Wing assignment. DelBene spent two decades managing large technical teams at Microsoft and recently served as president of its Microsoft Office division; he announced in July that he would retire by the end of the year. Sebelius said that he will work with Health and Human Services officials and the site’s general contractor, QSSI (Eilperin, 12/17).
The Associated Press/Washington Post: New Tech Honcho For Obama Health Care Website
DelBene’s appointment was announced Tuesday by Health and Human Services Secretary Kathleen Sebelius. He is married to Rep. Suzan DelBene, a Washington state Democrat, who also has a technology background. The website is the insurance portal for Obama’s health care law (12/17).
Politico: White House To Tap Microsoft Exec To Fix Healthcare.gov
DelBene will be in that role for at least the first six months of 2014, Sebelius said. He was most recently the president of the Microsoft Office Division and has been with the company since 1992. Bill Gates, Microsoft’s chairman and founder, praised DelBene for his expertise in "managing complex large-scale technology projects" (Kim, 12/17).
USA Today: White House Taps New Chief For Health Care Website
Sebelius said DelBene would provide oversight and advice on everything from technology to marketing, as well as execute the existing plan. "The President and I believe strongly in having one person, with strong experience and expertise in management and execution, who is thinking 24/7 about HealthCare.gov," she wrote. He will continue to work with QSSI, the general contractor for HealthCare.gov (Kennedy and Jackson, 12/17).
CQ HealthBeat: Microsoft Veteran Starts Wednesday As Six-Month Successor To Zients
Kurt DelBene, a former Microsoft executive married to Democratic Rep. Suzan DelBene of Washington state, will succeed Jeff Zients starting Wednesday as the Obama administration’s go-to figure in charge of making the federal exchange website run right. Health and Human Services Secretary Kathleen Sebelius said DelBene, 53, will be on the job for at least the first half of 2014, and will serve as her senior adviser (Reichard and Attias, 12/17).
CBS News: Former Microsoft Exec To Take Over HealthCare.Gov Oversight
Former Microsoft executive Kurt DelBene is taking over the management of HealthCare.gov, Health and Human Services Secretary Kathleen Sebelius announced Tuesday. This Wednesday, DelBene will replace former corporate executive Jeff Zients, whom the administration enlisted in October to manage the overhaul of the dysfunctional Obamacare website. In a blog post, Sebelius wrote that Zients -- who is slated in January to assume his new role as the director of the National Economic Council -- did an "outstanding job" improving the site. "Today, the site is night and day from what it was when it launched on October 1," she wrote (Condon, 12/17).
President Barack Obama met privately with executives from several technology companies to discuss the difficulties the administration has had with healthcare.gov.
USA Today: Obama Meets With Tech Execs To Talk NSA, Health Care
President Obama met privately with several tech executives Tuesday to discuss the administration's efforts to address problems with the federal online health care exchange as well as the fallout that national security leaks have had on their companies, according to the White House. Among those who were invited to the White House meeting were Apple's CEO Tim Cook, Yahoo! CEO Marissa Mayer, Facebook Chief Operating Officer Sheryl Sandberg and Google's executive chairman, Eric Schmidt (Madhani, 12/17).
The New York Times: Tech Leaders And Obama Find Shared Problem: Fading Public Trust
For months, leading technology companies have been buffeted by revelations about government spying on their customers' data, which they believe are undermining confidence in their services. The Obama administration has been blasted for the botched rollout of the health site, which prevented many people from signing up for health insurance in the first weeks of the site’s introduction, but seem to have been largely repaired since then. The meeting on Tuesday brought those two issues together into a common forum, and at least partly in the public eye (Calmes, 12/17).
Also in the news --
USA Today: Government Seeks Health Website Tech Help
The government put out a call for businesses that could address concerns at HealthCare.gov, the federal health insurance exchange. The Centers for Medicare and Medicaid Services asked small businesses to describe experience that compared in "size, scope and complexity" to the skills needed to create the website (Kennedy, 12/17).
For consumers seeking coverage on the state's health exchange, Maryland's insurers will extend the enrollment deadline from Dec. 23 to Dec. 27. Rhode Island also plans to extend its deadline. Meanwhile, news outlets offer updates from Texas, Connecticut, California, Minnesota, Wisconsin, Colorado and Washington.
The Washington Post: Insurers Agree To Short Delay For January Enrollment Through Maryland Health Exchange
Consumers seeking to obtain coverage starting Jan. 1 through Maryland's online health insurance exchange will get a few more days to apply, Gov. Martin O'Malley said Tuesday. O'Malley (D) said that all private insurers participating in the exchange, which has been riddled with technical glitches, have agreed to extend the enrollment deadline for January from Dec. 23 to Dec. 27 (Wagner, 12/17).
The Baltimore Sun: All Maryland Health Exchange Insurers Agree To Extend Deadline
All insurers selling policies on the state's health care exchange have agreed to extend the enrollment deadline for coverage that begins Jan. 1, state officials said Tuesday. Kaiser Permanente, United Healthcare and Evergreen Health Co-op on Tuesday joined CareFirst BlueCross BlueShield, the state's largest insurer, in agreeing to extend the deadline four days to Dec. 27 from Dec. 23 (Cohn and Cox, 12/17).
Reuters: Rhode Island, Maryland Extend State Obamacare Sign-Up Deadline
Rhode Island's new insurance marketplace said on Tuesday it will extend its deadline until the end of the year for consumers to sign up for private coverage plans under President Barack Obama's healthcare law and still get benefits on January 1. Medical insurance carriers participating in the Maryland Health Connection also agreed to extend the enrollment deadline to December 27 from December 23 to have coverage that begins on January 1, Governor Martin O'Malley's office said on its blog on Tuesday (12/17).
The Texas Tribune: In North Texas, ACA Navigators Under Scrutiny
For Martha Blaine, the 10 Affordable Care Act "navigators" who meet clients daily on behalf of the Community Council of Greater Dallas blend in with the rest of her staff. … The Community Council is one of several Texas organizations awarded a combined $11 million from the federal government to hire and train so-called navigators to help the uninsured seek insurance in the new online marketplace, which has been riddled with technical problems (Rocha, 12/18).
The CT Mirror: CT Insurance Exchange Enrollment Up More Than 50 Percent In Two Weeks
Connecticut’s health insurance exchange is enrolling about 1,400 people a day and is on track to have 50,000 to 60,000 people signed up for health care coverage by the end of the year, an official said Tuesday. Jason Madrak, chief marketing officer for Access Health CT, the state’s exchange, said about 20,000 people have signed up for private insurance plans through the marketplace, about 70 percent of whom will get federal financial assistance to discount their premiums. In addition, about 17,000 people have signed up for Medicaid coverage through the exchange, Madrak said (Becker, 12/17).
The San Jose Mercury News: Bay Area Health-Plan Enrollments Outpacing Much Of State
The Bay Area is outpacing much of the rest of California in the number of enrollees who have signed up for a plan on the state's health insurance exchange since it opened for business, experts say. Since Oct. 1, some 22,166 individuals in the Bay Area counties of Contra Costa, Alameda, Santa Clara, San Mateo and San Francisco have signed up for an insurance plan, according to new figures released Tuesday by Covered California. While the five counties have 16 percent of the state's population, they boast 20 percent of the exchange's total enrollment of 109,296 tallied by Nov. 30. An estimated 13 percent of those eligible for subsidies live in these five Bay Area counties (Seipel, 12/17).
Minnesota Public Radio: MNsure: Some May Need To Reapply
MNsure officials are telling about 1,000 health plan applicants that they need to sign into their accounts and re-apply for coverage in order to receive federal tax credits. The problem stems from earlier troubles MNsure had in calculating individual premium tax credits. It affects consumers who've applied for coverage but not enrolled and don't have a family member on a government health program such as Medical Assistance or MinnesotaCare (Stawicki, 12/17).
The Milwaukee Journal Sentinel: Latest Obamacare Problems In State Involve Online Issues For Three Insurers
In the latest round of difficulties with Obamacare in Wisconsin, plans offered by at least three insurers temporarily disappeared from the online insurance marketplace last week. Before they came off the federal healthcare.gov website for about a day, some of the plans from one company posted incorrect information about deductibles, according to the insurer. The issue occurred Dec. 11 and was fixed by the next day, though federal authorities have not explained what went wrong (Marley, 12/17).
Health Policy Solutions (a Colo. news service): Sen. Bennet Buys Insurance, Wants Exchange Improvements
Bennet, a Democrat from Denver, is among thousands of Coloradans who are rushing to beat a Dec. 23 deadline to sign up for health insurance so they’ll be covered come Jan. 1. Connect for Health Colorado CEO and Executive Director Patty Fontneau said she reached out to Bennet’s office after learning that he had waited a long time to have his phone call answered. "It's my understanding that he found the website and system to work well," Fontneau said, but added that she’s aware of the long hold times and is working to fix them (Kerwin McCrimmon, 12/17).
The Seattle Times: Small Businesses Could Get Health Insurance Price Break
Small employers in Washington will now have a shot at a tax break that could cut their health insurance costs in half. Next year, small businesses that meet certain requirements and sign up for coverage through the Small Business Health Options Program, or SHOP, could apply for tax credits that would pay for up to 50 percent of their insurance premiums for employees (Stiffler, 12/17).
The administration is delivering the data to states so that they can enroll new applicants. Meanwhile, in Virginia, the legislative panel holds its last meeting of the year without a recommendation about Medicaid expansion, and Colorado reports its latest enrollment figures.
The Associated Press: States To Get Medicaid Cases From Federal Website
Federal officials have begun sending Medicaid applications to states so they can enroll people, beginning with a handful of places where technical problems that have marred the new insurance marketplace are expected to be less of an issue. Until now, the applications were not forwarded as promised to the states, which put the enrollment process in limbo for those who are eligible to get health care coverage through Medicaid (Sanner, 12/17).
The Associated Press/Washington Post: Va. Medicaid Expansion Holds Final Meeting Of Year
A Virginia legislative commission still appears a long way from deciding whether to recommend Medicaid expansion. The Medicaid Innovation and Reform Commission held its last meeting of 2013 Tuesday. The chairman, Sen. Emmett Hanger, described it as an informational meeting with presentations from experts on issues like Medicaid fraud and federal health care law revenue provisions (12/17).
The Roanoke Times: State Medicaid Expansion Stalls
The [Virginia] General Assembly will begin its 2014 session without a plan to expand eligibility for Medicaid and obtain federal funds that would cover the full cost of expanded coverage for the first three years. A legislative commission set up to serve as a gatekeeper on the issue held its final meeting of the year Tuesday without making any recommendations for legislative action. The panel has been monitoring state-level reforms to Medicaid services and has heard lengthy presentations about the economic and health care impacts of expanding eligibility for coverage. But, like the legislature itself, the commission is divided over how the state should proceed (Sluss, 12/17).
Health Policy Solutions (a Colo. news service): Colorado Adds 50,000 To Medicaid Rolls In Two Weeks
Medicaid expansion is galloping forward in Colorado with the state adding nearly 50,000 additional people in the first two weeks of December to the state's Medicaid rolls. Altogether in Colorado, more than 114,000 people have qualified to start receiving care by Jan. 1 through Medicaid, the public health insurance program for low-income people and the disabled. Sign-ups for private health insurance through Colorado's exchange continue to increase with a deadline fast approaching on Dec. 23 to get coverage that starts on New Year's Day. As of mid-December, 23,009 people have signed up for private health plans through Connect for Health Colorado (Kerwin McCrimmon, 12/17).
Pushing back against those who warn that low numbers of younger subscribers in new insurance marketplaces could lead to a spiral of higher premiums and falling enrollments, Kaiser Family Foundation analysts say the signup of young adults "is not as important as conventional wisdom suggests."
The Washington Post’s Wonk Blog: Why Obamacare Won’t Spiral Into Fiery, Actuarial Doom
The rumors of an Obamacare death spiral have been greatly exaggerated. So say Larry Levitt, Gary Claxton and Anthony Damico, experts at the Kaiser Family Foundation who have put together a new brief analyzing what would happen if young adults snubbed the Affordable Care Act. Even if young people sign up at half the rate the administration hopes for, it would nudge premiums up only by a few percentage points, their report says (Kliff, 12/17).
Kaiser Health News: Capsules: Study: It’s All Healthy People — Not Just Young Adults — Who Are Critical To ACA Success
Pushing back against those who warn that low levels of younger subscribers could threaten coverage sold under the health law, analysts for the Kaiser Family Foundation say enrollment of young adults 'is not as important as conventional wisdom suggests.' Even if insurance pools contain only 25 percent young adults rather than the hoped-for 40 percent, medical claims and other costs would exceed premium revenue by only about 2.4 percent, they estimate. That’s far below the kind of loss that would lead to an unsustainable spiral of huge premium increases and fewer and fewer subscribers, they say (Hancock, 12/17).
Reuters: Obamacare Death Spiral Looks Unlikely: Study
A threat to America's health insurance overhaul has been that young people would not buy coverage in new marketplaces, possibly pushing the program into a disastrous spiral of falling enrollment and rising premiums. But this worst-case scenario is looking more far-fetched, according to a study by the Kaiser Family Foundation, which sees just slight increases in premiums in 2015 even though enrollment of younger people so far is well below the Obama administration's target (Lange, 12/17).
CQ HealthBeat: Fears About Insurance Market ‘Death Spiral’ Overblown, Kaiser Analysis Suggests
Insurers are likely to eke out small profit margins even if fewer young adults enroll in health exchanges than the administration is targeting, according to a new analysis by the nonpartisan Kaiser Family Foundation. The report suggests that the online marketplaces will be viable even if young adults enroll at a 50 percent lower rate than older people (Adams, 12/17).
Both insured and uninsured Americans worry about what the health law means for them, a new poll reveals. In the meantime, however, another poll says that despite concerns over the measure, the public is not keen on giving control of the law to Republicans over Democrats in next year's elections.
CBS News: Poll: Both Uninsured, Insured Skeptical About Obamacare
Skepticism about the health care law extends to both insured and uninsured Americans, according to a CBS News/New York Times poll. Both groups disapprove of the law overall, and while the uninsured are more positive about the law's personal impact than those with insurance, more still think the law will hurt rather than help them. CBS News and The New York Times interviewed 702 adults who do not have health insurance for this poll. Just 15 percent of insured Americans think the health care law will help them personally, but that number rises to 33 percent among the uninsured. Still, more uninsured Americans think the health care law will hurt them (37 percent) (Dutton, De Pinto, Salvanto and Backus, 12/17).
CBS News: For Uninsured, Obamacare Looks Like A Mixed Bag
Toni Lewis of Puyallup, Wash., is thrilled that in spite of her pre-existing conditions, she'll be able to purchase insurance next year via Obamacare. Still, the impact the Affordable Care Act will have on her life seems mixed. "It gives people that have a low income a chance to get insurance, those who have pre-existing conditions can get insurance again -- I have pre-existing conditions myself -- it generally helps people all around," Lewis told CBS News. "Unfortunately, I'm still one that kind of falls through the cracks" (Condon, 12/18).
The Washington Post: The Silver Lining For Democrats On Obamacare
The myriad problems with the rollout of HealthCare.gov and the Obamacare exchanges have pushed President Obama's approval ratings to a new low and, to hear many tell it, might give Republicans a leg up in the 2014 election. But tucked into the new Washington Post-ABC News poll released Tuesday is a cautionary tale for the GOP. It is this: Despite the country's opposition to the Affordable Care Act and Obama's leadership on it, it doesn't want to turn the reins over to Republicans (Blake and Sullivan, 12/18).
The Senate is nearing final passage of a bipartisan two-year budget proposal that is giving lawmakers on both sides of the aisle hope that cooperation on other legislation is on the way.
The Associated Press/Washington Post: Bipartisan Budget Agreement Nears Final Passage
A modest, bipartisan budget pact designed to keep Washington from lurching from fiscal crisis to fiscal crisis and ease the harshest effects of automatic budget cuts is on the brink of passing the Senate. The Senate is on track to clear the bill Wednesday for President Barack Obama’s signature after a 67-33 vote Tuesday in which it easily hurdled a filibuster threshold (12/18).
The New York Times: Budget Deal Offers A Reprieve From Washington Paralysis
The question is whether it will be a turning point that will clear the way for agreements on long-stalled issues like Medicare, the tax code and immigration or simply be an asterisk in the history books. To President Obama and his strategists, the cross-aisle accord offers what one called "green shoots of hope" that next year may turn out better than this year. Along with the change in filibuster rules making it easier to confirm nominees, the White House sees prospects for progress, even if limited (Baker and Weisman, 12/17).
Politico: Senate Poised To Pass Budget Deal
The Senate voted Tuesday to advance a bipartisan two-year budget deal -- a move that puts Capitol Hill one step closer to a thaw in the fiscal wars that have paralyzed Washington. ... The deal sets discretionary spending at $1.012 trillion for the current fiscal year and $1.014 trillion in fiscal 2015. It raises revenue through fee increases but there are no tax hikes or entitlement reforms, demands that had thrown wrenches in previous fiscal talks. Another round of sequester cuts due to take effect in January will be replaced with more targeted spending cuts (Kim, 12/17).
Viewpoints: New Healthcare.gov Czar Knows Something About Computer Bugs; Fears About Inadequate Drug Coverage
Los Angeles Times: Can An Ex-Microsoft Guy Cure Healthcare.gov?
Seriously, one has to hope the new guy -- Kurt DelBene, former head of the Microsoft Office Division -- brings only a portion of Microsoft's heritage along with him. Aside from the XBox, the software giant isn't known for great consumer experiences. Its products have been maddeningly complex and notoriously buggy, at least in their early versions. Kind of like HealthCare.gov! (Jon Healey, 12/17).
The Wall Street Journal: Incompetence
I have begun to worry about the basic competency of the administration, its ability to perform the most fundamental duties of executive management. ... They do the talking part, but the doing? They had 3½ years to make sure ObamaCare will work, three years to get it right top to bottom, to rejigger parts of the law that they finally judged wouldn't work, to make the buying of a policy easy on the website. And they not only couldn't do that, which itself constitutes an astounding and historic management failure, they make it clear they were taken aback by their failure (Peggy Noonan, 12/17).
The Washington Post: Separating Fact From Fiction In Health Care
So much of the news the past few months has been dominated by the foibles of the Affordable Care Act. Yet the truth about how good or bad various parts of this major piece of health reform are won't be known for a long time (Michelle Singletary, 12/17).
Los Angeles Times: Who Are The New Uninsureds?
It was always the case that the nation's medically uninsured were disproportionately non-white, poor and southern. These people were the prime targets of the Affordable Care Act, which aimed to bring them coverage in part by the federally-funded expansion of Medicaid. Two surveys released Tuesday by the Kaiser Family Foundation show how the demographics of the uninsured will change, thanks to the ACA. More precisely, the surveys show how they will change as a result of inaction -- the failure of 25 states to expand Medicaid, which the ACA's drafters expected to address the coverage problems of the poor (Michael Hiltzik, 12/17).
The Wall Street Journal: (Almost) Everyone Loses
Some [people without insurance] no doubt do [desire it], and lacked insurance because a pre-existing condition made them uninsurable in the pre-ObamaCare regime. But some lack insurance because they don't want it, don't feel they need it, are completely indifferent, or think it costs too much. What does ObamaCare do for them? "To" them is more like it. It jacks up their premiums to pay for all the mandated coverages -- especially if they're young and healthy and thus least likely to think they need insurance to begin with. It then tells them that they must buy insurance, whether they want it or not (James Taranto, 12/17).
USA Today: Contraceptive Challenge Exposes Double Standard
Even as birth control coverage became mandatory and the administration fights to the Supreme Court to force compliance, The Washington Post reports that insurers "have pared their drug benefits significantly." While your plan must always cover cheap birth control pills, you better read the fine print to make sure the plan covers expensive drugs for grave afflictions such as cancer, multiple sclerosis or HIV (Robert George, 12/17).
The Fiscal Times: HealthCare.Gov's Back-Office Problems Move Front And Center
What counts in a sale isn't so much the pitch, but the closing of the deal. Without an order and check in hand, the transaction isn't complete. HealthCare.gov – and all of the state exchanges for that matter – have made a great pitch, although it seems that the federal site and states dependent upon it have yet to fully execute their transactions. Through November, about 2 million Americans made it through the application process on the exchanges. But will they be able to choose the right plan and actually get insurance? The jury's still out (John F. Wasik, 12/18).
The Fiscal Times: Obamacare – The Lump Of Coal In America's Stocking
In the spirit of the season, I bring tidings of great joy – especially for the GOP. The country continues to heal, but President Obama is not getting much of the credit. Because Republicans in the House had a rare moment of sanity and passed a budget, their star is shining a little brighter. ... The mess that is Obamacare is a gift to Republicans, and one that can't be returned (Liz Peek, 12/18).
The Star Tribune: Back To Basics After MNsure Shakeup
The board of directors at MNsure has serious work ahead to regain Minnesotans' confidence as glitches mount and as the health insurance marketplace suddenly finds itself without a top leader. April Todd-Malmlov, the executive director of the website at which Minnesotans may shop and sign up for insurance under the Affordable Care Act, resigned under fire Tuesday evening. She is being replaced on an interim basis by Scott Leitz, an assistant commissioner at the Department of Human Services. The seven-member board, which held a closed meeting yesterday to discuss Todd-Malmlov's two-week trip to Costa Rica in the midst of MNsure's launch, needs to ensure it does nothing further to undermine the fledgling effort (12/17).
The Tennessean: Expanding Medicaid Is Not Answer For TN
State Democratic leaders continue to lambaste Gov. Bill Haslam for "the worst moral and mathematical failure in a generation" by not expanding Medicaid in Tennessee. Revisiting recent history might help shine some light on this controversial issue. In the early 1990s, Tennessee pivoted to TennCare, our Medicaid equivalent. The goal was and remains noble. Help the poor access health care and enable our state to improve managing the growing Medicaid portion of our state's budget. The reality was harsh, however (Jim Brown, 12/17).
The Tennessean: Let's Heed Golden Rule And Expand Medicaid
"Do not do to others what is hateful to you" is a commonly accepted cornerstone of all faith traditions. As people of faith, if we claim to live by the "Golden Rule", what does that mean? We don't think it means we are complacent because many sitting in our sanctuaries have the ability to obtain healthcare. If our families couldn't afford to take their children to the doctor, if some suspicion of disease in our husband or wife couldn't be checked out because the money wasn't available, or if disease was found and couldn't be treated, the roofs of our churches and synagogues would likely lift with our reverberating anguish and calls for justice. ... We urge our state officials to take immediate action to submit a proposal (The Tennessee Plan) to federal officials that can win approval to use federal funds to purchase private health insurance for Tennesseans with incomes up to 138 percent of the poverty level (The West Nashville Clergy Group, 12/16).
Philadelphia Daily News: Corbett's Medicaid Proposal Is An Unhealthy Plan
As part of the Affordable Care Act, the federal government encouraged states to expand coverage of Medicaid, and in return, would fund the cost of that expansion fully for the first few years, and 90 percent afterward. Republican governors opposed to health-care reform have rejected this expansion, leaving their most vulnerable citizens out in the cold. [Gov.] Corbett has sent a proposal to the feds with an alternate plan that he claims would be more cost-effective -- subsidizing Medicaid-eligible people to buy coverage directly from the health exchange. But there are so many punitive -- and illegal -- components of his plan that no one expects it to pass muster (12/18).
The Milwaukee Journal Sentinel: Millenials Are Smart To Avoid Obamacare
President Barack Obama has a problem with millennials. We brought the votes and the noise in 2012: 60% of us voted for him in Wisconsin. But the honeymoon is officially over. Young Americans were once the most enthusiastic supporters of Obamacare, but we are now the law's most ardent foes. The latest poll shows that 57% of people ages 18 to 29 disapprove of this law — and only 13% of my generation "definitely" plans on signing up. What turned us against the law we once liked? Reality (Evan Feinberg, 12/17).
And on other topics -
The New York Times’ Economix: How Medicare Subsidizes Doctor Training
When Congress established Medicare in 1965, it set up payments to subsidize residencies "until the community undertakes to bear such education costs in some other way." Exactly what that meant was unclear, notes Fitzhugh Mullan, a physician and health policy professor at George Washington University. After all, who is this "community," and why would it voluntarily take over this financial responsibility if the federal government was already paying for it? (Catherine Rampell, 12/17).
JAMA: The Optimal Practice Of Evidence-Based Medicine: Incorporating Patient Preferences In Practice Guidelines
Research evidence is necessary but insufficient for making patient care decisions. An effective but toxic chemotherapeutic regimen is the treatment one patient with cancer can and will take, another patient can take but will not, and yet another patient could not take even if wanted. ... Guideline panelists must recognize, with humility, the challenges they face in working often without access to informed patient preferences and acknowledge that their recommendations should rarely assume uniform patient values and contexts in favor of a particular course of action (Dr. Victor M. Montori, Juan Pablo Brito, Dr. M. Hassan Murad, 12/17).
JAMA: Enhancing Physicians' Use Of Clinical Guidelines
In part because of inadequate adherence to guidelines, preventable harm is the third leading cause of patient death, and one-third of health care spending—estimated at nearly $1 trillion, or $9000 per household—is for therapies that do not improve patients' health. ... Increasing evidence suggests that harms once deemed inevitable, such as central line–associated bloodstream infections, are largely preventable (Dr. Peter J. Pronovost, 12/17).
Los Angeles Times: Katie Couric And The Celebrity Medicine Syndrome
An email with the subject line "OMG" recently came from one of our mothers, and it contained chilling information about the HPV vaccine. "200 people have died from it," Mom claimed, "and it does not even last long enough to prevent cervical cancer." Her source was not her doctor, a new study or the Food and Drug Administration. Her information came from a recent episode of Katie Couric's ABC talk show about "all sides" of the "HPV controversy." Since then, most of the alarmist vaccine claims made in the episode have been debunked. But Mom remains a victim of celebrity medicine: She heard a warning from someone famous, believed it and spread the misinformation. Unfortunately, Mom is not alone. Celebrities have crept into our medicine cabinets and kitchens, influencing what pills we pop, tests we order and foods we fear (Julie Belluz and Steven J. Hoffman, 12/18).
In addition to joining her husband in a White House meeting with mothers, Michelle Obama will do a series of interviews with the nation's most popular African-American radio hosts to encourage people to sign up for coverage through the health law.
The Associated Press/Washington Press: Obama, First Lady Meet With Moms On Health Care
President Barack Obama and first lady Michelle Obama are meeting with mothers in the Oval Office to promote the president’s health care law. The White House says Wednesday’s meeting will focus on ways the law can benefit families. White House spokesman Jay Carney says moms are a key part of the administration’s outreach because they play a major role in helping their family members, peers and adult children sign up for health insurance coverage (12/18).
The Hill: First Lady To Go On Radio Blitz For Obamacare
Michelle Obama will sit for a trio of interviews with urban radio stations as part of a coordinated White House blitz intended to promote ObamaCare coverage among mothers and minorities. The first lady will be interviewed Wednesday evening by Yolanda Adams, Al Sharpton, and Joe Madison, three of the nation’s most popular African American talk radio hosts (Sink, 12/17).
The health law allows job-based health plans to boost the rewards for workers who adopt healthier habits.
The Boston Globe: Despite Push, US Employers Wary Of Health Incentives
Would $1,700 a year motivate you to drop a few pounds? How about $3,000 to quit smoking? That is how much, on average, the government is allowing employers to reward their workers beginning in January 2014 for doing things like losing weight, lowering their cholesterol, and keeping their blood pressure in check. A new, little-known provision of the Affordable Care Act boosts the maximum incentives for workplace programs that encourage employees to get healthier in hopes of lowering insurance costs (Jan, 12/18).
Fox News: Union Official: Smoking, Obesity, Other Health Issues Could Mean Paying More Under ObamaCare
Under ObamaCare, smoking, obesity and other health conditions sometimes penalized by wellness programs can force even those with employer-provided insurance to pay more, an officer of the National Union of Healthcare Workers said Tuesday. "I run five miles a day, I don't drink, I don't smoke. And by the Kaiser wellness program that a number of employees we represent are covered by, I'm two pounds from being overweight," said John Borsos. Kaiser said in a statement late Tuesday that its program is voluntary and does not penalize those who don't meet the program's goals, although that is not true for other programs (Angle, 12/18).
The Oregonian: Health Reform: Is Childhood Dental Insurance Required? That All Depends
Navigating health reform's rules on childhood dental insurance is turning out to be a real pain in the gums. The Affordable Care Act lists pediatric dental and vision coverage as one of 10 essential benefits that health plans must offer. But in Oregon, consumers purchasing insurance through the state's exchange don't have to buy it. And in Washington, where its purchase is required if you have kids, federal tax credits won't help offset the additional cost of the coverage (Hunsberger, 12/17).
Criticized about the launch of Minnesota's health insurance marketplace and about a tropical vacation, April Todd-Malmlov resigned Tuesday.
The Associated Press: Embattled Minn. Health Exchange Chief Resigns
The chief of Minnesota’s health insurance marketplace resigned Tuesday after facing criticism over the troubled rollout and a questionably timed international vacation. April Todd-Malmlov submitted her resignation during an emergency closed session of the government board of MNsure, Minnesota’s version of the insurance exchange that’s tied to the federal health care overhaul. She had been under increasing pressure over insurance sign-up problems and failed to get a vote of confidence from Democratic Gov. Mark Dayton last week (Bakst, 12/17).
Minnesota Public Radio: MNsure’s Executive Director Resigns
Assistant Commissioner for Health Care Scott Leitz will serve as the interim executive director for MNsure until the agency can find a permanent replacement for Todd-Malmlov. MNsure's technological problems coincided with ongoing political fallout from Todd-Malmlov's decision to go on a two week international vacation at the end of November with her partner, James Golden - the state Medicaid Director, who has been working on the rollout of MNsure (Stawicki and Richert, 12/17).
The Star Tribune: Embattled MNsure Director Resigns Amid Increasing Criticism
Todd-Malmlov’s abrupt departure comes as thousands of Minnesotans scramble to enroll in the state’s online insurance marketplace by Jan. 1. The implementation of Minnesota’s program has gone more smoothly than in other states, but it still has been marked by countless technical glitches, delays and frustrated consumers (Helgeson and Crosby, 12/17).
Pioneer Press: Under Fire, MNsure’s Executive Director Abruptly Resigns
[R]ecent reports that Todd-Malmlov vacationed in Costa Rica last month sparked outrage, even though MNsure board members knew of the trip and Todd-Malmlov maintained daily contact with health exchange officials. "I commend the members of the MNsure board for their strong action to change immediately the executive staff leadership," Gov. Mark Dayton said in a statement (Snowbeck, 12/17).