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Arizona Botches Execution, Imposes Cruel and Unusual Punishment on Joseph Wood

ACLU -- Death Penalty News - Wed, 07/23/2014 - 7:29pm

FOR IMMEDIATE RELEASE
CONTACT: 212-549-2666, media@aclu.org

NEW YORK – At 3:49 PM MST, the state of Arizona executed Joseph Wood by lethal injection. This was the fifth execution in the United States since Clayton Lockett's horrific death in Oklahoma in April. Says Cassandra Stubbs, Director of the ACLU's Capital Punishment Project:

Today the state of Arizona broke the Eighth Amendment, the First Amendment, and the bounds of basic decency. Joseph Wood suffered cruel and unusual punishment when he was apparently left conscious long after the drugs were administered. According to his emergency papers filed by his attorneys, he was choking and snorting over an hour into the process. In its rush to put Mr. Wood to death in secret, Arizona ignored the dire and clear warnings from the botched executions of Oklahoma and Ohio. It's time for Arizona and the other states still using lethal injection to admit that this experiment with unreliable drugs is a failure. Instead of hiding lethal injection under layers of foolish secrecy, these states need to show us where the drugs are coming from. Until they can give assurances that the drugs will work as intended, they must stop future executions.

Categories: Prisoners Rights

Project Louise: On Exercise, Sex, Free Stuff And The Secret Of Life

CommonHealth (WBUR) - Wed, 07/23/2014 - 4:39pm

(Edson Fong via Compfight)

 

Dear Louise,

Let me be blunt: I’m afraid you’ve been having sex without orgasms.

When it comes to exercise, that is.

To extend this ham-handed metaphor a bit farther: I know some people say there’s no such thing as bad sex unless it hurts you. And of course there’s no such thing as bad exercise unless it hurts you. Any bit of activity, any rise from the couch, any flight of stairs, is good.

But I worry that halfway through your Project Louise year, while you’ve made truly laudable progress on healthier eating and emotional self-care, you clearly have yet to catch the exercise bug. Oh, you’ve tried, heroically, from bike rides to hot yoga to personal training. But it somehow hasn’t stuck.

So that’s the purpose of this letter: To try to jump-start your fitness, to remind you that in your original goals you listed “Create and follow a regular, sustainable exercise plan”; and most importantly, to try to persuade you that exercise — daily exercise, moderate to vigorous — is the magical secret of life.

(Readers, won’t you help? As in, let’s all pile on Louise! I end this letter with a few of my own quirky personal tips for making exercise a daily habit. If you’ll add a few of your own in the comments section, or whatever arguments you think might most help Louise get going, you’ll be rewarded not only by knowing you’ve helped but with a bit of WBUR swag. Just send an email to membership@wbur.org with “exercise tips” in the subject line, and specify whether you want a WBUR cup or baseball cap sent to the address you give.

And we can also all help with accountability. Louise has agreed that beginning tomorrow, she’ll get some form of activity or exercise every day by 7 p.m. and report in on it by 11 p.m. in the comments section below.)

True, we’re aiming for sustainable change and reporting to an online audience every day does not seem like a lifelong practice. But this is just for the month, just to try to establish the habit.

Some say it takes just 21 days to establish a new habit; it’s surely more complex than that – some research suggests the average is more like two months — but here’s how you know you’re there: It’s harder not to do it than to do it.

Louise, I do believe that’s the key. You’ve said that you don’t make time for exercise the way you do for reading because it’s not as pleasurable. I’d so love you to reach the point I’ve reached: I do enjoy the exercise in and of itself, but what most motivates me is the desire not to feel like crap on a given day. It’s harder to face the torpor and irritability of not doing it than the brief sweaty effort of doing it.

I know this is no small challenge. Behavioral change is a whole science. And this exercise thing is clearly a tough nut to crack: Our Project Louise coach, Allison Rimm, says that when her workshop participants look at their goals and priorities, exercise is most often the number-one thing that has fallen off their lists. The CDC says 80 percent of Americans don’t get the recommended dose of exercise: Two and a half hours a week of moderate exercise, or an hour and 15 minutes of vigorous workouts.

Allison suggests that you combine exercise with something pleasurable, like listening to books on tape.

That’s the carrot approach. But for me, it all began with a big stick.

That is, four years ago, when CommonHealth in its current incarnation began, we launched a series of posts headlined “Why To Exercise Today.” Week after week, we highlighted studies that found that exercise could help with everything from preventing cancer and dementia to preserving eyesight and hearing to improving mood and brainpower.

That’s all very nice. But what first sucked me into an everyday exercise habit was fear of the opposite. In middle age, we’re entering the killing fields of cancer and heart disease and aging. It gets tough out there. We need to exercise for the same reason my 87-year-old dad begins every single day with a workout: We don’t dare not to.

But let’s not get too grim. Now I’m getting to the orgasm part.

One of the hottest things in fitness these days is “High-Intensity Interval Training,” which in the old days we used to call “sprints.” An ever-more-persuasive body of research suggests that you should include at least some sprints in some of your workouts, to maximize your health benefits.

Rick, your trainer, can help you figure out what your fitness level will allow, but I’m here to tell you that breathing hard and sweating heavily and entering a brief, dervish-like state of workout frenzy can become one of life’s great pleasures. Maybe it’s the endorphins, maybe it’s the forgetting of the rest of the world for a few moments, maybe it’s just the joy of movement, I don’t know but it’s something I wish for you. And personally, if I never reached that little Nirvana, I’d be much less likely to want to work out every day.

My other quirky little personal tips:

1. Music, music, music: Without it, I would never even get once around the block. Take a few minutes and load your phone so you’ll always have it.

2. Peppermint lifesavers: Please don’t choke and then sue me, but I find that sucking on a peppermint lifesaver during my morning workouts gives me energy and keeps my mouth from drying out as I huff and puff. I like to work out on an empty stomach and think I would bonk quickly without that little candy aid.

3. Morning glory: People’s body clocks and schedules vary, but for me, it has to be morning, otherwise it’s just an intention that nags me all day and is never realized. Not to get into the weeds of your logistics, but I do believe you park at work beneath a veritable palace of fitness. If you could ever work it so that you regularly enter the palace before you enter the workplace, I think you might have it made.

4. Splurge on workout clothes: Unless you’re outside, you’ll be looking in the mirror.

5. Nothing you hate: Perhaps most important of all. We spend our fitness lives recovering from the traumas of school gym, from the shame and coercion. Now, you, and only you, are in charge of your workout. Well, true, we in the Project Louise peanut gallery do weigh in a bit. But when you’re in the gym or on the bike or the treadmill, you’re in charge. You never have to do anything you hate. (For me, that means no planks. Ever.)

You do need to get your heart rate up and work your major muscle groups, but how you do that is up to you. We’re grown-ups now, thank goodness. No one can ever make us try to climb those awful ropes again. But being grown-ups also means that our bodies are on a downhill slide, and if we don’t push back then down we go. In extreme cases, it could be a question of survival. But most of all, it’s quality of life — it’s feeling better and functioning better and making every (post-exercise) day brighter. It’s the closest thing to a magic pill we have. Except that it’s not a pill. it’s a daily effort — that also holds the potential of daily joy.

Readers, help! What are your most powerful arguments and favorite little workout tips? 

 

Categories: Health Care

Groups Sue Tennessee Over Medicaid Enrollment Delays

Kaiser Health News - Wed, 07/23/2014 - 3:04pm

Three consumer advocacy groups filed a class-action lawsuit Wednesday accusing Tennessee officials of adopting policies that are depriving thousands of people of Medicaid coverage “to score political points.”

The suit was filed several weeks after the Obama administration ordered Tennessee and several other states to resolve problems that have led to a backlog nationwide of more than 1 million applications for Medicaid, the state-federal health insurance program for the poor. 

Tennessee officials responded to the administration, blaming many of the state's problems on the federal website, healthcare.gov. State officials did not immediately comment on the lawsuit.

Tennessee is the first state to be sued over Medicaid enrollment problems since passage of the federal health law, said Jane Perkins, legal director of the Washington, D.C.-based National Health Law Program, one of the groups that filed the suit in U.S. District Court in Nashville. The other plaintiffs are the Southern Poverty Law Center in Montgomery, Ala., and the Tennessee Justice Center, based in Nashville.

The lawsuit alleges that Tennessee makes it harder than any other state to enroll in its Medicaid program, called TennCare. The state has discontinued accepting applications in person at county offices and instead requires use of computer kiosks that connect people to healthcare.gov, making harder to enroll, according to the suit. The plaintiffs said that “thousands” of residents are applying every month and many are facing delays.

Under federal law, an application for Medicaid benefits must be processed within 45 days. But people in Tennessee are waiting as long as six months, the suit said.

“Tennessee officials are sacrificing the health of the state’s most vulnerable citizens just to score political points,” said Sam Brooke, an attorney for the Southern Poverty Law Center.

Tennessee is one of 24 states that did not expand its Medicaid program under the Affordable Care Act, turning down full federal funding that lasts through 2016 when states have to begin paying for up to 10 percent of costs.  The health law also required all states to streamline their Medicaid application process and gave states money to do that.

Tennessee Medicaid officials have downplayed the problem, saying that only a “small number” of people have had difficulty enrolling and blaming those problems on the federal online marketplace.

The federal marketplace was initially supposed to be a one-stop shopping place to apply for either Medicaid or subsidized individual health insurance, but there have been technical issues connecting applicants to that site with some state Medicaid programs.

The lawsuit wants the court to order Tennessee to give people decisions on their applications within 45 days, or grant them a hearing with state officials if that does not occur.

The plaintiffs in the case include April Reynolds, a mother of three, who applied for coverage in February but still has not been enrolled. In March, she had to be hospitalized with a blood pressure problem and now owes more than $20,000 for her care and was told by doctors that she needs to receive monthly checkups.

Reynolds has seen a doctor only once since March because she’s afraid to go into even deeper debt.

"It is time for the state to take responsibility," her husband, Ricky, said in a conference call with reporters. "We can't afford to pay for the doctor."

The lawsuit also describes how the family of a baby identified only as “S.P.” incurred more than $17,000 in medical bills after the child was diagnosed with a severe bacterial infection. Despite applying for Medicaid shortly after the baby’s birth in February, the family has struggled to get information about the status of their application. They have yet to receive coverage.

Plaintiff Melissa Wilson, a caretaker of three young grandchildren, has been stuck without care since February. Williams has kidney failure and is supposed to take 17 medications daily but can afford only three of them.

Wilson has called TennCare every two weeks since February, only to be told the status of her application is not known. Without coverage she can’t afford even to see her primary care doctor or take the drugs she needs, let alone see specialists. "What they are doing to me is wrong," she said of the state.

Categories: Health Care

Deep Poverty Among Children Worsened in Welfare Law's First Decade

Center on Budget and Policy Priorities - Wed, 07/23/2014 - 1:30pm
Since the mid-1990s, when policymakers made major changes in the public assistance system, the proportion of children living in poverty has declined, but the harshest extremes of child poverty have increased. After correcting for the well-known underreporting of safety net benefits in the Census data, we estimate that the share of children in deep poverty — with family income below half of the poverty line — rose from 2.1 percent to 3.0 percent between 1995 and 2005.…
Categories: Benefits, Poverty

Control: Why We Get Sucked Into Insanity (And Other Intense Workout Programs)

CommonHealth (WBUR) - Wed, 07/23/2014 - 12:17pm

“Insanity” workout in the recycling bin, waiting for regifting (Carey Goldberg/WBUR)

Veronica Thomas
CommonHealth intern

It’s time to come clean: Like my colleague, Carey, I too am an “Insanity” dropout.

Some people may say we’re weak or wimpy or quitters—in fact, many commenters declare just that—but a new study suggests that we fell into a very common marketing trap. We were bored by the same old exercises and hungry for something new—something intense. What we didn’t realize was that we might well be looking to intensity as a way to reassert control.

The new study, published in the Journal of Consumer Research, found that when a person’s sense of control is jeopardized, they are more likely to buy products that require hard work.

And man, are those workout programs hard. My first time trying Insanity—a high-intensity interval training program—I thought the 9-minute warmup was the actual workout. But Sean T, my glistening TV trainer, encouraged me to dig deeper. While simultaneously cursing his existence, I also managed to convince myself that somewhere deep, deep inside me I did have the strength to finish.

Turns out, my need to complete the workout every day for a month may have been about something more than just a boost to my usual fitness routine. According to the study, I may have been using ski jumps and burpees to regain some sense of control over my life.

From the press release:

“Intuitively, it would seem that feeling a loss of control might cause consumers to seek out a product that does NOT require them to exert very much effort. But we find that consumers actually look to products that require hard work to restore their belief that they can drive their own positive outcomes,” write authors Keisha M. Cutright (Wharton School of the University of Pennsylvania) and Adriana Samper (Arizona State University).

By looking across five smaller studies, the authors assessed how people’s feelings of control over health or fitness influenced their selection of products demanding either high or low effort. Those who felt a low sense of control were likelier to choose tougher programs and mantras. For instance, one study found that basketball players just defeated in a game were more likely to purchase shoes with the tagline, “Work harder, Jump higher.”

The study authors conclude that the more someone’s sense of control is threatened, the more likely that person is to pick a high-effort, bootcamp-like program. This finding is good news for the often-expensive DVD packs exalted by late-night infomercials. But what does it mean for us suckers who impulsively buy these products, then quit from burnout after a month?

Apparently, that’s often when we succumb to more low-effort schemes like diet pills or the “7-minute workout to get in shape super-fast.” The researchers found that when progress feels too slow for someone in a low-control situation, they are more likely to be sucked into products with quick-fix promises.

What I can’t help but wonder is where moderate exercise programs fit on the spectrum of control. Instead of spending money on extreme, temporary fixes, should we look for more realistic workout routines that can help us maintain control over the the long-haul? In my own experience, finding yoga—a workout I can consistently commit to—has balanced my mood and kept my apartment (relatively) free of dusty exercise DVDs.

Categories: Health Care

King County's Wellness Plan Beats the Odds

Kaiser Health News - Wed, 07/23/2014 - 12:03pm

SEATTLE – When King County, Washington, launched its employee wellness program seven years ago, its motive was clear. “We were being eaten alive by runaway medical costs,” says the county’s top executive Dow Constantine. 

By all accounts, the previous administration was desperate to bring down double-digit health care cost growth that threatened to destroy the entire budget. 

That partially explains why King County, which spends nearly $200 million per year to insure 14,000 workers and their families, who mostly live and work here in the county seat, was willing to risk millions more on a wellness program that would prove to break the traditional mold.

It may also explain why labor unions took the unusual step of joining management in a plan that would ultimately shift more health care costs to workers. 

But it doesn’t explain why this employee wellness program, which received an innovation award this year from Harvard University, has far surpassed all others in employee participation, health improvement and health care savings. 

The program’s unusually high financial incentives for participation and an extensive outreach program to promote it are credited in large part for the program’s success.

In its first five years (2007 to 2011), the county’s “Healthy Incentives” program invested $15 million and saved $46 million in health care spending with sustained participation by more than 90 percent of its employees. Two years ago, $61 million in surplus health care funds were returned to county coffers because cost growth was lower than actuaries had projected. Seattle, the state’s largest city, is the county seat.

Employee health improved dramatically, raising King County employees’ health status above the national average and keeping it there. Smoking rates dropped from 12 percent of employees to less than 5 percent, and more than 2,000 employees classified as overweight or obese at the start of the program lost at least 5 percent of their weight, more than halving their risk of diabetes. 

With an average age of 48.5 years and practically no turnover, the county’s worker population is getting healthier even as it’s growing older.  

Outsized Performance

These results, documented in a 2012 internal report by former staff economist John Scoggins, are remarkable when compared to the generally lackluster performance of other wellness programs run by large U.S. organizations, including state and local governments. According to a 2013 report from the Rand Corporation, about half of all U.S. large employers offer some type of wellness program and the number is growing. But few end up saving any money and employee participation has been limited. Many fizzle out after a year or two.

On average, only 47 percent of employees participate nationwide, and only 2 percent of organizations that offer the plans report any reduction in health care costs, according to the study, which was funded by the U.S. Departments of Labor and Health and Human Services. Overall savings from wellness plans offered by the organizations Rand surveyed were too small to be statistically valid.

Still, evidence shows that workplace health programs have the potential to promote habit-forming healthy behavior, improve employees’ health knowledge and help workers get necessary screenings, immunizations and follow-up care. The Affordable Care Act encourages employers to expand wellness programs by loosening federal regulations that limit the financial rewards employers can offer workers for reaching certain health goals such as quitting tobacco use.

King County’s intensive education and outreach effort cost the county nearly $7 million in the first two years. Since then, the effort has tapered, but six full-time employees still work to maintain the county’s high participation rate. “We want to make sure that no one is left out because of lack of knowledge,” said Brooke Bascom, who runs the program.

The biggest draw, Bascom said, has been the financial incentives King County offers its employees for participating.  Other wellness programs offer much less substantial rewards, according to the Rand report.

Among the 10 percent of employees who don’t participate in Healthy Incentives, most say it’s because they don’t want to share private information about themselves. A small number are given exceptions because of health conditions or family issues that prevent them from participating.

More Than a Wellness Plan

Healthy Incentives offers a model that state and local governments should replicate, said Stephen Goldsmith, director of the innovations award program at Harvard’s Kennedy School of Government. Washington state is already emulating parts of King County’s wellness plan and Oregon is trying to start a similar program. 

Here’s how the financial incentive part of the program works:

In the past, county employees didn’t pay a share of insurance premiums, but they did pay deductibles, co-insurance and co-pays. Healthy Incentives allowed workers to shave $200 off of their $500 deductible simply by filling out a health assessment form. They could get another $200 knocked off if they completed an “individual action plan,” such as attending six Weight Watchers meetings at work, completing five phone sessions with a tobacco cessation coach or learning how to better manage diabetes. Four years into the program, nonparticipants’ deductibles went up to $800.

In addition, employees who did not participate in the program had to pay a 10 percent higher co-insurance share of the cost of medical care after their deductibles were exhausted.  When you put those two incentives together, the individual savings could come to more than $1,000 per year.

The program also encourages the use of less expensive generic drugs by increasing the co-pay for name-brand drugs from $15 to $30, while decreasing the co-pay for generic drugs from $10 to $7. These changes, put in place in 2010, resulted in $2.4 million savings to the county and a $1 million savings to employees by 2011.

Higher Value Providers

The wellness program began when former County Executive Ron Sims, credited with the big idea, donated $1.3 million in county dollars to help a fledgling health care organization, the Puget Sound Health Alliance, develop a medical claims database to help identify doctors and hospitals in the county that offered the highest quality services at the lowest prices. He also recruited large local employers including Alaska Airlines, Boeing and Starbucks to contribute money to the effort.

By analyzing claims data, the group found that one provider organization, Group Health Cooperative, was costing the county an average of $4,000 less per person per year while providing higher quality services than all other providers in the area. Group Health already served 20 percent of the county’s employees through its Seattle-based accountable care organization.

To encourage more employees to use Group Health, the county eliminated the deductible and added a graduated co-payment of $20 to $50 based on employees’ Healthy Incentives participation levels. Regence BlueShield patients remained subject to existing deductibles of up to $800. As a result, an additional 2,274 employees switched to Group Health, bringing its share of coverage to 30 percent. Between 2010 and 2011, the shift to Group Health reduced county expenditures by $6.5 million and saved employees $2.2 million. 

“They needed a third party to do the research,” said Mary McWilliams who now runs the Alliance. “The unions would never have trusted the research if it had come from the county or the providers,” she said. The alliance since expanded to include the state of Washington. 

Now called the Washington Health Alliance, the group plans to determine the highest-value services by physician groups and hospitals within the Regence network. Once those providers are identified, employees will once again be steered in their direction through reduced out-of-pocket expenses. 

Too Much Rigmarole

Not everyone loved the program in the beginning. In its first two years, county employees objected to the time spent filling out forms and documenting their action plans. Some lodged formal complaints. Kathy Pompeo was one of them.  

A supervisor in the Sheriff’s Office, Pompeo runs a 24-hour crew of data-entry workers who have little time to fill out online forms detailing their daily wellness activities. “My staff was very frustrated and very negative,” she said. They were spending more time reporting on their activities than working on their healthy behaviors. They participated, “kicking and screaming.”

Bascom said the county took complaints to heart and made the process easier.  With such a diverse workforce — from bus drivers, road workers and custodians to law enforcement officers, doctors, attorneys and administrative workers — the county had to make accommodations so that everyone could participate. Bus drivers, for example, didn’t have access to computers, so the county developed a paper process.

Even the county executive complained that the process was cumbersome.  “You’d get up in the morning and exercise and then have to sit down and log on to a computer. It didn’t make sense,” Constantine said.

Now employees can text their activity to the program: “I’m walking my dog,” for example. And the county applies points toward their full participation status. 

Has the county made it too easy to comply? Bascom doesn’t think so.  Research shows that healthy habits can be formed in just four weeks. As for employees gaming the system by not really performing the activities they say they are, Bascom and others said they doubted much, if any, of that was going on.

“We’re a pretty ethical group,” Pompeo said, and there’s peer pressure to do the right thing. “It’s like having a running buddy or a diet buddy, only lots of them,” she said.

When Constantine took office in 2009, he was asked whether he wanted to continue the program. His response was immediate. “There was no question about continuing it,” he said.  “Every employee was doing it, so it got internalized…. My question is why this hasn’t been done a thousand times before.”

Categories: Health Care

Commentary: Chairman Ryan Needs to Play It Straight on Poverty Programs

Center on Budget and Policy Priorities - Wed, 07/23/2014 - 11:51am
House Budget Committee chairman Paul Ryan will unveil a proposal tomorrow to address poverty and, in doing so, faces a choice: play it straight in making the case for his plan, or succumb to the temptation to mischaracterize key poverty data and research to paint the safety net as an abject failure. To his credit, Mr. Ryan has spent time visiting poor communities, and his proposal will merit thoughtful review. He is, of course, entitled to propose whatever he wants. He is …
Categories: Benefits, Poverty

Dueling Rulings On Health Law Subsidies Leave States In Lurch

Kaiser Health News - Wed, 07/23/2014 - 9:50am

States are pondering their places in the health law's federal- or state-based health insurance exchanges after a pair of contradictory appeals court rulings Tuesday threw up in the air if states that use the federal exchange can offer subsidies to their residents to help afford coverage.

The Richmond Times-Dispatch: Appeals Courts Issue Contradictory Rulings On Health Care Subsidies
Two federal appeals courts on Tuesday issued contradictory rulings on whether low- and middle-income people may receive federal subsidies to buy policies in the states that did not set up their own health insurance exchanges. The issue, which could be heading to the U.S. Supreme Court, is crucial in 34 states, including Virginia, which did not set up their own health exchanges. … In Virginia, 82 percent of the 216,356 people who signed up for marketplace plans in the first enrollment period got financial assistance. Those 177,000 people are receiving an annual average of $3,048, according to the state Attorney General’s Office (Cain and Martz, 7/22).

The Oregonian: Dueling Health Care Law Rulings Leave Experts Split On Oregon's Insurance Premium Subsidies
Conflicting federal appeals court rulings over whether the federal health insurance exchange can issue premium tax credits won't have any effect in Oregon over the short term. The long-term outcome may have to wait for a U.S. Supreme Court ruling, and potentially won't even be settled then. That's because Oregon's plan to use the federal exchange in 2015, while keeping some functions under state control, may fall into a legal gray area, experts said Tuesday. At issue is whether all states, including those using the federal exchange, can issue reduced premiums to people with qualifying incomes under the 2010 Affordable Care Act. About 70,000 Oregonians received the subsidies this year (Budnick, 7/22).

The Boston Globe: Mass. Unlikely To Be Affected By Health Care Rulings
Will Tuesday’s conflicting court rulings on federal health insurance subsidies have any bearing in Massachusetts? It appears unlikely, even though the state has left open the possibility of joining the federal healthcare.gov insurance marketplace. If the Massachusetts Health Connector does go that route, it would still be considered a state-based exchange, but one supported by the federal government -- and it’s not clear whether the rulings would apply (Freyer, 7/22).

The Milwaukee Journal Sentinel: Dueling Court Rulings Leave Obamacare Subsidies Up In Air
The rulings could affect subsidies for more than 4 million people nationally, including more than 100,000 in Wisconsin, and created immediate confusion among some consumers. Arise Health Plan, which sold individual plans in Milwaukee as well as elsewhere in eastern Wisconsin, said it received phone calls Tuesday from confused customers. An estimated 90 percent of the 130,000 people in Wisconsin who have bought health plans sold on the marketplace set up under the law qualified for subsidies (Boulton and Gumpert, 7/22).

Des Moines Register: Obamacare Rulings Could Affect 24,000 Iowans
More than 24,000 Iowans could lose subsidized health insurance if courts ban the government from helping pay for policies purchased on the federal government's online marketplace, Iowa's insurance commissioner said today. ... Iowa is one of [36] states that do not have their own health-insurance marketplaces. Leaders here looked into building one, but decided instead to use the federal version of the system, called healthcare.gov (Leys, 7/22).

Georgia Health News: Exchange Subsidies Draw Conflicting Court Rulings
More than 190,000 Georgians are enrolled in the health insurance exchange created by the Affordable Care Act. But if a D.C. federal court ruling announced Tuesday on exchange subsidies is ultimately upheld, that Georgia number could shrink precipitously. The U.S. Court of Appeals for the District of Columbia ruled Tuesday that the language of the ACA allows subsidies, or discounts, only for people who obtain coverage through exchanges run by the states, and not by the federal government. Georgia is among 36 states whose insurance exchanges are federally run (Miller, 7/22).

Kansas Health Institute News Service: Conflicting Rulings On Obamacare Subsidies Put Consumers In Limbo
Conflicting federal court rulings are raising questions about whether consumers in Kansas and Missouri will continue to be eligible for subsidies when purchasing private health insurance through the Obamacare marketplace (McLean, 7/22).

The CT Mirror: Obamacare’s Big Day In Court Means Little For CT
Two federal courts issued conflicting rulings on the health law known as Obamacare Tuesday, but their decisions aren’t expected to directly affect Connecticut residents. That’s because the cases address whether it’s legal for the federal government to help pay the insurance premiums of people who buy their insurance through federally run marketplaces known as exchanges. Connecticut’s health insurance exchange, Access Health CT, is run by the state, not the federal government. That means the legality of federal subsidies provided to Access Health customers is not in question (Becker, 7/22).

Categories: Health Care

CNN Poll: Half Of Americans Say Obamacare Has Helped Their Families Or Others

Kaiser Health News - Wed, 07/23/2014 - 9:47am
A CNN poll finds that more than half the public says the health law helped their families or others, but fewer than one in five say they have personally benefited. Meanwhile, election-year politics in Ohio may lead to the release of 2015 premiums on Oct. 1 and business and consumer groups seek to influence benefits.

CNN: Is Obamacare Working?
More than half the public says Obamacare has helped either their families or others across the country, although less than one in five Americans say they have personally benefited from the health care law, according to a new national poll. A CNN/ORC International survey also indicates that a majority of Americans oppose the Affordable Care Act, but that some of that opposition is from people who don't think the measure goes far enough (7/23).

The Star Tribune: Dayton Wants Health Insurers To Reveal 2015 Rates On Oct. 1
Election-year politics are shining a spotlight on health insurance rates, with Gov. Mark Dayton now asking the state’s insurance plans to voluntarily agree to release them on Oct. 1. Republicans have pressed for release of the 2015 health insurance rates before the November election, even though there’s no requirement that insurers do so until open enrollment starts on Nov. 15. Minnesota had the lowest insurance rates in the nation in the first year under the federal health law, but some Republicans suspect that rates will go up (Crosby, 7/22).

Kaiser Health News: Capsules: Business Groups, Consumer Advocates Draw Lines In The Sand About Essential Benefits
During a July 21 Capitol Hill briefing, members of the Affordable Health Benefits Coalition, a business interest group including the U.S. Chamber of Commerce and the National Retail Federation, said they would push to reshape essential benefits, arguing that current regulations have led to unaffordable hikes in insurance premiums (Luthra, 7/23).

Categories: Health Care

Undercover Agents Get Health Insurance Subsidies With Fake IDs

Kaiser Health News - Wed, 07/23/2014 - 9:44am

Federal investigators, working undercover for the Government Accountability Office, said they had been able to obtain subsidized health insurance under the health law using fictitious identities and false documents. The administration said it was working on remedying the verification problems.

The New York Times: Investigators Detail Missteps In Verification For Health Care
Federal investigators working undercover said Tuesday that they had been able to obtain subsidized health insurance under the Affordable Care Act using fictitious identities and false documents. The investigators, from the Government Accountability Office, said their tests indicated the Obama administration was not adequately verifying information submitted by applicants (7/22).

The Washington Post: Federal Undercover Investigation Signs Up Fake Applicants For ACA Coverage
The results of the inquiry by the Government Accountability Office are evidence of still-imperfect work by specialists intended to assist new insurance customers as well as government contractors hired to verify that coverage and subsidies are legitimate. The GAO also pointed to flaws that linger in the marketplace’s website, healthcare.gov (Goldstein, 7/22).

The Wall Street Journal: Fictitious Applicants Able To Get U.S. Health-Insurance Tax Credits
The investigation will be the focus of a House Ways and Means subcommittee hearing Wednesday on the potential for waste and fraud in the subsidies. Republicans opposed to the health law say the GAO's findings are evidence of the government's inability to verify information, which they say creates the potential for fraud and abuse (Armour, 7/22).

The Associated Press: Agents Get Subsidized ‘Obamacare’ Using Fake IDs
Undercover investigators using fake identities were able to secure taxpayer-subsidized health insurance under President Barack Obama's health care law. The weak link in the system seemed to be call centers that handled applications for thousands of consumers unable to get through online (7/23).

NBC News: GAO Sting Finds It Easy to Fake It, Get Obamacare Premiums
Eleven out of 12 fake applications for government-subsidized health insurance got through a verification process and the bogus beneficiaries are still covered, the Government Accountability Office said Tuesday. The GAO launched the sting to check to see how well the Obamacare process checks for counterfeit applications. The results were messy, GAO’s Seto Bagdoyan says in testimony prepared for a hearing Wednesday of the House Ways and Means oversight subcommittee (Fox and Seidman, 7/23).

Categories: Health Care

How Will The Latest Health Law Decisions Affect You?

Kaiser Health News - Wed, 07/23/2014 - 9:43am

News outlets offer consumer impact insight over Tuesday's rulings on the health law's subsidies to buy health insurance on the federal and state marketplaces.

McClatchy: Confused About the Health Care Rulings?
Contrary rulings Tuesday on a key element of the Affordable Care Act by two separate federal appeals courts raise a variety of questions (Pugh, 7/22).

Kaiser Health News: Brief Consumer Guide To Health Law Court Decisions
On Tuesday two U.S. appeals courts issued conflicting rulings on a subject that’s important to millions of people: the availability of subsidies to help purchase coverage under the health-care law. Kaiser Health News’ Mary Agnes Carey answers some frequently asked questions about those court decisions and how they impact consumers (7/22).

Categories: Health Care

Marketplace Confronts Confusion In Face Of Conflicting Rulings

Kaiser Health News - Wed, 07/23/2014 - 9:43am

News outlets report that providers and insurers worry the two appellate court decisions could undermine the stability of the newly expanded health insurance markets. Meanwhile, governors in those states that opted not to set up their own marketplaces may face pressure if consumers who used healthcare.gov to shop for coverage lose their subsidies.  

The Wall Street Journal: Hospitals, Insurers Say Subsidies Rulings Further Confuse The Issue
Health-industry officials said Tuesday's dueling court rulings over federal health-law subsidies set the stage for another bout of confusion as consumers return to marketplaces this fall to shop for next year's coverage. "People are going to be coming in with more questions about these court cases," said Jason Stevenson, a spokesman for the Utah Health Policy Project, a nonprofit organization that has navigators that aid residents in enrolling on the federal exchange. "People are already asking about the long-term stability of the ACA" (Wilde Mathews, Weaver and Armour, 7/22).

Modern Healthcare: Clashing Rulings On Exchange Subsidies Raise Fear of Instability
Healthcare providers and insurers fear that today's conflicting appellate court rulings on the legality of Obamacare premium subsidies offered through the federal insurance exchange could have a destabilizing effect on the newly expanded insurance market (Robeznieks, 7/22).

The Wall Street Journal: Some Governors Face Fallout Over Health Law Ruling
The prospect of millions of people losing federal tax credits they obtained under the health law places some governors and legislators in a tough spot in the run-up to this fall's elections. Some 36 states turned over the task of running the health law's insurance exchanges to the federal government. If courts ultimately back Tuesday's decision by a federal appeals court in Washington, D.C., which held that Americans can obtain tax credits only if their state is operating its own exchange, then officials in these states may come under pressure to find ways to ensure residents keep subsidies (Radnofsky and Peters, 7/22).

Politico: Democrats Still Haven’t Learned Obamacare Lesson
The conflicting rulings were another wake-up call for Democrats about the fragility of the health care law -- and a reminder that whenever they think a lawsuit is no threat to the law, it’s probably a threat to the law. It’s all because of what most Democrats insist is a drafting error in the law, but it’s kind of a big one. The federal health insurance marketplace is now serving 36 states that couldn’t or wouldn’t set up their own exchanges (Nather and Haberkorn, 7/22).

Meanwhile, a look at the courts --

Politico: How Obama’s Court Strategy May Help Save Obamacare
Last fall, President Barack Obama and Senate Majority Leader Harry Reid deployed the “nuclear option” to help get three liberal judges onto the D.C. Circuit appeals court. Tuesday’s ruling on Obamacare is a dramatic example of why they forced the issue (Gerstein, 7/22).

The Associated Press: Judges in Health Care Rulings Vote Party Line
In rapid succession, six federal judges on two appeals courts weighed in on a key component of President Barack Obama's health care law. Their votes lined up precisely with the party of the president who appointed them. It was the latest illustration that presidents help shape their legacies by stocking the federal bench with judges whose views are more likely to align with their own (7/23).

Categories: Health Care

Questions Abound As Two Appeals Courts Split On Legality Of Health Law Subsidies

Kaiser Health News - Wed, 07/23/2014 - 9:42am

Two U.S. courts of appeals reached different decisions regarding the issue of whether the health law's subsidies can be used by consumers shopping for health coverage on the federal exchange, because their states opted against setting up their own online insurance marketplace. This development injects confusion as the Obama administration works toward the next open enrollment season, which is slated for November. Ultimately, the issue could land before the Supreme Court.

Kaiser Health News: Appeals Courts Split On Legality Of Subsidies For Affordable Care Act
Two U.S. appeals courts Tuesday reached opposite conclusions about the legality of subsidies in the Affordable Care Act, a key part of the law that brings down the cost of coverage for millions of Americans. In Washington, a three-judge panel at the U.S. Appeals Court for the D.C. Circuit ruled that the Internal Revenue Service lacked the authority to allow subsidies to be provided in exchanges not run by the states (Rovner, 7/22).

The New York Times: New Questions On Health Law As Rulings On Subsidies Differ
Two federal appeals court panels issued conflicting rulings Tuesday on whether the government could subsidize health insurance premiums for millions of Americans, raising yet more questions about the future of the health care law four years after it was signed by President Obama. The contradictory rulings will apparently have no immediate impact on consumers. But they could inject uncertainty, confusion and turmoil into health insurance markets as the administration firms up plans for another open enrollment season starting in November (Pear, 7/22).

NPR: Obama's Health Care Law Has A Confusing Day In Court
Another wild legal ride for Obamacare on Tuesday: Two U.S. Court of Appeals panels issued conflicting decisions on an issue with the potential to gut the health care overhaul. The two rulings could lead to another U.S. Supreme Court showdown over the controversial law, all because of what one of the law's opponents initially called "a glitch" (Totenberg, 7/22).

The Washington Post: Federal Appeals Courts Issue Contradictory Rulings On Health-Law Subsidies
The conflicting rulings give traction to the most serious current threat to the Affordable Care Act, which has been battered by a series of legal challenges since it was enacted four years ago. The dispute centers on whether the subsidies may be awarded in states that chose not to set up their own insurance marketplaces and instead left the task to the federal government. About 5.4 million people had signed up for coverage on the federal exchange as of this spring, federal figures show. About 87 percent of them received subsidies (Somashekhar and Goldstein, 7/22).

The Wall Street Journal: Appeals Courts Issue Conflicting Rulings On Health-Law Subsidies
In a blow to President Barack Obama's signature legislative achievement, a panel of the U.S. Court of Appeals for the District of Columbia Circuit, on a 2-1 vote, invalidated an Internal Revenue Service regulation that implemented a key piece of the 2010 health law. The regulation said subsidies for health insurance were available to qualifying middle- and low-income consumers whether they bought coverage on a state or federally run exchange. Two hours later, a three-judge panel of the U.S. Court of Appeals for the Fourth Circuit in Richmond, Va., reached the opposite conclusion, unanimously ruling that consumers in states relying on the federal marketplace could receive subsidies. That handed the White House a victory that counteracted the administration's loss in the other case (Kendall and Armour, 7/22).

Los Angeles Times: Federal Appeals Courts Issue Conflicting Rulings On Obamacare
The legal battle gives Obamacare’s opponents another shot at trying to kill the law in the high court, a goal they fell one vote short of in 2012. In that case, four justices voted to strike down the entire legislation as unconstitutional. Chief Justice John G. Roberts Jr. joined the four liberal justices to uphold the core of the law. This time, the outcome at the high court would turn on whether at least one of the five conservative justices agreed to uphold Congress’ broad goal of providing all Americans with insurance they can afford (Savage, 7/22).

Politico: Wild Day For Obamacare: Appeals Court Rulings Conflict
For now, no one will have their subsidies cut off while the legal battle continues. The Obama administration said it will appeal the D.C. ruling on Halbig v. Burwell by asking for an en banc review involving the full panel. “We are confident in the legal case that the Department of Justice will be making,” said White House press secretary Josh Earnest. The plaintiffs in the fourth circuit’s King v. Burwell in Virginia haven’t yet said what they’ll do next (Winfield Cunningham, 7/22).

The Associated Press: Appeals Courts Split on Health Law’s Subsidies
President Barack Obama's health care law is snarled in another big legal battle, with two federal appeals courts issuing contradictory rulings on a key financing issue within hours of each other Tuesday. But the split rulings don't necessarily mean another trip to the Supreme Court for the Affordable Care Act. And White House spokesman Josh Earnest immediately announced that millions of consumers will keep getting financial aid for their premiums as the administration appeals the one adverse decision (7/23).

Reuters: Latest Obamacare Legal Knot Won’t Be Easy To Untangle
U.S. judges have their work cut out for them untangling a legal knot created on Tuesday when two federal appeals courts released conflicting rulings hours apart going to the heart of the role the federal government will play in Obamacare. The latest conservative challenge to President Barack Obama's healthcare overhaul will not necessarily land in the U.S. Supreme Court, although it could end up there as soon as this year if the two lower courts go on disagreeing. At stake is how millions of Americans pay for private health insurance, or if they can afford it at all (Ingram, 7/22).

Bloomberg: Obamacare On Path Back To Higher Court After Ruling Split
The U.S. Supreme Court may not be done with Obamacare yet. With appellate courts reaching opposite conclusions on the same day about a crucial financing provision of the 2010 law, a third showdown before the justices is probable. Splits among the federal circuits have preceded previous high court rulings on the Affordable Care Act. In 2012, the law was narrowly upheld when the court ruled Congress has the power to make Americans carry insurance or pay a penalty. Last month, the court said private companies can claim a religious exemption from a requirement that they offer birth-control coverage (Harris and Zajac, 7/23).

USA Today: Appeals Court Panels Issue Split Decisions On Obamacare
The federal subsidies offered through the exchanges have reduced monthly insurance premiums by 76% for those who qualify, federal health officials say. The average monthly premium dropped from $346 to $82. In 2016, an estimated 7.3 million people in the 34 states with federal exchanges would receive subsidies totaling $36 billion, according to the Urban Institute. To qualify for subsidies, participants must have incomes below 400% of the federal poverty line, or $95,400 for a family of four (Wolf, 7/22).

McClatchy: Courts Issue Conflicting Rulings on Health Care Tax Subsidies
Two appeals courts on Tuesday reached radically different conclusions about whether millions of consumers in 36 states can use tax credits to help buy health coverage on the federal health insurance marketplace. The conflicting rulings, combined with two other pending challenges still awaiting decisions, potentially tee up for the Supreme Court its next landmark health care case and leave one of the Affordable Care Act’s signature provisions in a state of legal limbo (Doyle and Pugh, 7/23).

Categories: Health Care

Obama VA Nominee Gets Warm Reception From Lawmakers

Kaiser Health News - Wed, 07/23/2014 - 9:42am
Members of the Senate Committee on Veterans' Affairs indicated Tuesday they would likely endorse Robert McDonald, President Barack Obama's nominee to take over the Department of Veterans Affairs. A full Senate vote could come as early as next week.

The Washington Post: Obama Nominee McDonald Pledges To ‘Transform’ VA
President Barack Obama’s choice to lead the Department of Veterans Affairs pledged Tuesday to transform the beleaguered agency, saying that “systematic failures” must be addressed. Robert McDonald cited problems with patient access to health care, transparency, accountability and integrity, among other issues (7/22).

The Wall Street Journal: VA Nominee Gets Warm Reception At Confirmation
If confirmed, Mr. McDonald would take over from Sloan Gibson, who has been acting as VA secretary since Eric Shinseki's resignation in late May following revelations of systemic problems including falsified reports about patient appointment wait times. Mr. McDonald was a paratrooper in the Army's 82nd Airborne Division before beginning a 33-year career at Procter & Gamble Co., including serving as CEO from 2009 to 2011 (Kesling and Schwarz, 7/22).

Modern Healthcare: McDonald Moves Closer to VA Secretary Role; Senate Could Vote by Aug. 1
Robert McDonald on Tuesday moved a step closer to Senate confirmation as the next secretary of veterans affairs, appearing before the Senate Committee on Veteran Affairs to favorable comments from committee members. A formal committee vote on his nomination is likely as soon as Wednesday. Full Senate confirmation could come before Congress' August recess begins (Dickson, 7/22).

And a VA funding bill hits a long-term funding roadblock --

USA Today: VA Budget Request Snags Veterans Health Bill
After meeting last week, lawmakers say they won't send a stopgap veterans' health bill to the president's desk without working out details on longer term Veterans Affairs spending. The rift comes after VA acting Secretary Sloan Gibson sent Sen. Bernie Sanders, I-Vt., a memo detailing how VA would use the $17.6 billion Gibson requested last week as part of "additional resource needs" through fiscal year 2017 (Kennedy, 7/22).

Meanwhile, a Missouri whistleblower asks about future protections --

St. Louis Post Dispatch: Local VA Whisteblower Questions Acting Secretary During St. Louis Visit
As the acting secretary of Veterans Affairs vowed to crack down on whistleblower retaliation in the department, the former chief of psychiatry at the local VA health care system said he was recently demoted for the second time after filing a complaint last fall. Dr. Jose Mathews on Tuesday asked secretary Sloan Gibson what protections he and other whistleblowers can expect after a national crisis of treatment delays has uncovered numerous problems in the VA health care system. Gibson, who was in St. Louis for the national convention of the Veterans of Foreign Wars, addressed VA employees in a town hall meeting at the John Cochran hospital on North Grand Boulevard (Bernhard, 7/23).

Categories: Health Care

Contraception Accommodation For Religious Groups To Be Broadened

Kaiser Health News - Wed, 07/23/2014 - 9:41am

The Obama administration said Tuesday it will create a new option for certain religious nonprofits that object to the health law's contraception mandate and which does not entail submitting a form that they say also violates their religious beliefs.

The Washington Post: In Response To Court Ruling, Administration Works To Ensure Contraceptive Coverage
The Obama administration said Tuesday that it is coming up with a work-around to ensure that employees of certain charities, hospitals and colleges whose leaders have religious objections to contraceptives can still get birth control through their employee health insurance plans. The administration made its plans known in a legal brief filed with the U.S. Court of Appeals for the 10th Circuit in Denver. The alternative plan, which is still being developed, is in response to a recent Supreme Court order questioning the government’s current process for allowing nonprofit organizations to opt out of a requirement that their health plans cover all contraceptives that have been approved by the Food and Drug Administration (Somashekhar and Barnes, 7/22).

The Wall Street Journal: Obama Administration To Revise Part Of Contraception Rule
The Obama administration said Tuesday it will revise a compromise arrangement for religiously affiliated universities and charities that object to providing contraception in workers' health insurance plans, in response to a Supreme Court order earlier this month (Radnofsky, 7/22).

Politico: Administration To Broaden Contraception Accommodation For Religious Groups
The Obama administration will create a new option for certain religious nonprofits that object to both the Obamacare contraception mandate and the earlier administration efforts to find accommodation for them, according to a court document filed Tuesday. The brief filed in the U.S. Court of Appeals for the 10th Circuit says the administration is broadening the accommodation policy after the Supreme Court ruled that Wheaton College, a religious institution, did not have to provide contraception in employee health plans while the issue makes its way through the courts. Details were not spelled out (Kenen, 7/22).

The Associated Press: Government Drafting Birth Control Accommodation
The Obama administration is developing a new way for religious nonprofits that object to paying for contraceptives in their health plans to opt out, without submitting a form they say violates their religious beliefs. The government has been searching for solutions since the Supreme Court decided an evangelical college in Illinois can avoid filling out the form while the case is being appealed (7/22).

Categories: Health Care

Highlights: Calif. Nurse Union In Contract Fight; Personhood Measure In Colo.; Md. Transgender Coverage

Kaiser Health News - Wed, 07/23/2014 - 9:41am

A selection of health policy stories from California, Colorado, Maryland, Kansas, Missouri, Washington state and Minnesota.

Kaiser Health News: California Nurses Union Braces For Contract Battle
But this is no church service, and nurses are not here to worship. The California Nurses Association is rousing its troops for battle. California’s powerful nurses’ union will begin bargaining next week with Kaiser Permanente on a new four-year contract for nurses at its Northern California hospitals. (Kaiser Health News is not affiliated with Kaiser Permanente.) Kaiser operates the largest hospital system in the state, by number of hospitals and number of hospital beds, and is the eighth largest health system in the country (Dembosky, 7/22).  

Denver Post: Rally Against Personhood Measure Held At Colorado Capitol
A ballot measure that would change wording in the Colorado Criminal Code and Wrongful Death Act to include unborn human beings drew opponents and supporters to the state Capitol on Tuesday, with both sides vehemently arguing the initiative's eventual endgame. The rally was sponsored by a wide-reaching coalition of political, medical and religious interests who decried Amendment 67 as an attempt to effectively ban abortions and a woman's ability to make her own health care decisions (Cotton, 7/22).

Baltimore Sun: Maryland Shifts Insurance Policy to Cover Transition-Related Care of Transgender Employees
In a reversal of state health care policy, transgender state employees in Maryland can now access gender reassignment surgery, hormone therapy and other transition-related care under their state-provided health insurance plans. The change quietly went into effect at the start of this month as the result of legal negotiations in a discrimination case brought against the state by Sailor Holobaugh, a 31-year-old clinical research assistant in neurology at the University of Maryland School of Medicine in Baltimore (Rector, 7/22).

Kansas City Public Media: Kansas Docs Say Plan For Transplant Waits Would Make Patients Sicker
For the past several years, the United Network for Organ Sharing, or UNOS, which coordinates transplants nationally, has been studying ways to address liver transplant disparities by changing the way donated livers are allocated and shifting some organs away from healthier patients and toward sicker ones. Today, most livers donated in Kansas and the western part of Missouri are used locally, with about 40 percent going to nearby areas of the Midwest and a few outside the region. UNOS is considering a change from this mostly local allocation strategy to a more regional, or even national, approach. Under some of the plans being studied, organs donated in Kansas City would be sent much more often to places as far away as Phoenix, Minneapolis and Salt Lake City, depending on where they're needed most (Smith, 7/22).

Seattle Times: Hospital System Stops Affiliation With Small Hospitals In Washington State 
PeaceHealth, a Catholic health-care system, has delayed indefinitely its planned affiliations with small hospitals in Snohomish and Skagit counties, citing higher-than-expected costs in the effort to roll out a medical information-technology system. Nancy Steiger, PeaceHealth CEO and chief mission officer for its Northwest network, said PeaceHealth could not make a final commitment at this time to Cascade Valley Hospital in Arlington or Skagit Regional Health in Mount Vernon. Just a few weeks ago,  PeaceHealth realized the heavy lifting to integrate systems with the two hospitals would come at the exact same time as the push to get the Epic medical information-technology system up and running in PeaceHealth’s hospitals around the region, Steiger said in an interview Tuesday (Ostrom, 7/22).

Minnesota Public Radio: Is Minn. Medical Technology Industry In Decline?
Once a bastion for the medical device industry, Minnesota may be losing its competitive edge. … The Daily Circuit looks at the health of our state's medical technology companies, and how changing industry dynamics may have motivated the proposed Medtronic-Covidien merger (7/23).

Categories: Health Care

Viewpoints: Halbig Decision Is 'Ominous,' 'Major Victory For The Rule Of Law,' 'Far From Last Word'

Kaiser Health News - Wed, 07/23/2014 - 9:40am

The New York Times: An Ominous Health Care Ruling
Millions of low- and moderate-income people who signed up for health insurance with the help of federal tax-credit subsidies could find themselves without coverage or facing big premium bills if a destructive decision handed down by a federal appeals court in Washington on Tuesday is not reversed. It would be a crippling blow to the ability of the Affordable Care Act to reduce the ranks of the uninsured with grievous consequences for vulnerable customers (7/22). 

The Wall Street Journal: Upholding ObamaCare – As Written 
In Halbig v. Burwell, the D.C. Circuit Court of Appeals held that the Administration violated the Affordable Care Act by expanding subsidies to the 36 insurance exchanges run by the federal government. The plain statutory language of ObamaCare repeatedly stipulates that these credits shall flow only through "an Exchange established by the State." The 2-1 panel majority thus did not "strike down" part of ObamaCare, as liberals and the media claim. Using straightforward textual construction, the court upheld the law the President signed but it vacated the illegitimate federal-exchange subsidies he tried to sneak in via regulation (7/22).

Los Angeles Times: Administration Can’t Afford To Lose On Obamacare Subsidies
A federal appeals court in the District of Columbia shocked supporters of the 2010 healthcare law Tuesday by ruling that millions of Americans would no longer be eligible for health insurance subsidies. Shortly thereafter, a panel at the U.S. 4th Circuit Court of Appeals in Richmond, Va., came to the opposite conclusion on a similar lawsuit, upholding the subsidies. The full D.C. Circuit should follow the 4th Circuit's lead and reject the first panel's ruling, which wildly misconstrues Congress' intent (7/22). 

The Washington Post: D.C. Circuit Court Ruling On Obamacare Was Wrong – But The 4th Circuit Got It Right
First blame Congress. Generally a useful rule these days, it certainly holds when considering Tuesday’s worrying, though possibly temporary, setback for the Affordable Care Act in the U.S. Court of Appeals for the District of Columbia Circuit. Blame Democrats who pressed through a bill containing contradictory language. Blame Republicans who, in their drive for full repeal, have declined to fix the ambiguities and unintended consequences that turn up in any sizeable piece of legislation (7/22). 

USA Today: Ruling Ignores Congress’ Intent: Our View 
Obamacare supporters should hope the law has nine lives, because it may have used up another one Tuesday. A panel from the second most powerful court in the country ruled, in effect, that nearly 5 million people who got their health insurance through the federal insurance exchanges this year weren't entitled to subsidies. Obamacare's subsidies are what make coverage affordable for many of the people the law requires to buy health insurance — hence the law's name: the Affordable Care Act. Taking those subsidies away could make insurance too expensive for millions of low- and middle-income people, crippling a crucial part of the law (7/22). 

USA Today: A Victory For The Rule Of Law: Opposing View 
The D.C. Circuit's decision Tuesday morning in Halbig v. Burwell is a major victory for the rule of law. And correspondingly, the Fourth Circuit's contrary ruling hours later, in King v. Burwell, is a loss. Under the Constitution, Congress is responsible for making the law while the president must faithfully execute it. With a statute as complex as the Affordable Care Act, it's tempting for the administration to bend it for policy reasons. But, as the D.C. Circuit ruled, this is flatly illegal (Sam Kazman, 7/22). 

The Washington Post: Why Obamacare Probably Isn’t Doomed
The Affordable Care Act took a potentially serious hit today when the D.C. Circuit Court of Appeals struck down a rule that extended the law’s health-care subsidies to residents of the three-dozen states where the federal government runs a health insurance exchange. But the fact that another court of appeals upheld the same rule on the same day shows that the legal issue is very thorny and will very likely be ultimately resolved by the Supreme Court. And the administration probably will come out ahead in the end (Tom Goldstein, 7/22). 

The New York Times’ The Upshot: Rulings On Health Law Are Far From Last Word 
An appellate court ruling issued Tuesday would be very bad news for the Affordable Care Act if it became the law of the land. But it’s still a long way from a settled issue, as a second appellate decision, issued a few hours later, highlighted (Margo Sanger-Katz, 7/22).

The Washington Post: Why The D.C. Circuit Was Wrong To Eviscerate Obamacare
The country was almost out of this Obamacare mess. After years of political strife and Obama administration management failures, after an exacting legal review that included two high-profile Supreme Court cases, after broken Web sites were improved, after some people lost plans the liked, after others gained plans they would never have been able to afford, after millions of people enrolled, and after the rate of uninsured Americans dropped, the Affordable Care Act finally seemed to be finding its footing, and there were indications that the nation would finally move on (Stephen Stromberg, 7/22). 

Forbes: Halbig Court Opinion: A Victory For The Rule Of Law, But Merely A Speed Bump For Obamacare
If the IRS had never written its rule expanding the spending authority of the federal exchange, Obamacare wouldn’t have collapsed. Why? Because, over time, every state would have taken the “free” federal cash. ... The original Medicaid program, passed in 1965, was optional for the states. Most states signed up within a few years, but there were one or two holdouts. Arizona, the last holdout, set up its Medicaid program in 1982. The point is: every state now participates in Medicaid (Avik Roy, 7/23).

The Wall Street Journal: Reining In ObamaCare – And The President
A three-judge panel of the U.S. Court of Appeals for the D.C. Circuit -- a tribunal second only to the Supreme Court -- ruled on Tuesday that the Obama administration broke the law. The panel found that President Obama spent billions of taxpayer dollars he had no authority to spend, and subjected millions of employers and individuals to taxes he had no authority to impose. The ruling came in Halbig v. Burwell , one of four lawsuits aimed at stopping those unlawful taxes and expenditures. It is a decision likely to have far-reaching repercussions for the health-care law (Jonathan H. Adler and Michael F. Cannon, 7/22). 

The Wall Street Journal: Aid Veterans Affairs By Nixing Budget Gimmickry 
The worst scandal in decades at the Department of Veterans Affairs doesn't only involve unethical staffers cooking the books on waiting times, inexcusable as that is. Woefully inadequate VA funding and budget gimmicks by multiple Congresses and administrations created the long waiting lists in the first place (Garry Augustine, 7/22).

Journal of the American Medical Association: New Expensive Treatments for Hepatitis C Infection 
Perhaps surprisingly, most media coverage of this important development in HCV treatment has not focused on the cure rates but, rather, on cost. The price of sofosbuvir is essentially $1000 per pill, or $84 000 for a standard 12-week course. The fact that pricing in the United Kingdom for a similar regimen is $54 000, and perhaps as low as $900 in Egypt and other developing countries, indicates that the pricing in the United States is a purely financial decision by Gilead and has outraged many. Indeed, some pharmacy benefit managers are calling on their clients to boycott these products until alternatives are available late in 2014. But is the pricing unfair? (Troyen Brennan and William Shrank, 7/22).

Los Angeles Times: How To Escape The Medical Care Debt Trap
An analysis this year by NerdWallet Health found that about 60% of all bankruptcies are health related. And a comprehensive study by Harvard researchers who examined a large sample of 2007 bankruptcy filings found that, "using a conservative definition, 62.1% of all bankruptcies … were medical." That research, published in the American Journal of Medicine, found that most of these "medical debtors were well educated, owned homes and had middle-class occupations" (Steve Trumble, 7/22).

The New York Times: A Dearth In Innovation For Key Drugs
There is clearly something wrong with pharmaceutical innovation. Antibiotic-resistant infections sicken more than two million Americans every year and kill at least 23,000. The World Health Organization has warned that a “post-antibiotic era” may be upon us, when “common infections and minor injuries can kill.” Even the world’s tycoons consider the proliferation of antibiotic-resistant bacteria one of the crucial global risks of our times, according to a survey by the World Economic Forum (Eduardo Porter, 7/22). 

Los Angeles Times: Can Laura’s Law Really Help The Mentally Ill? Researcher Tom Burn’s Surprising Conclusion.
Laura's Law has been an option for counties in California since 2003, but only in recent weeks have three of the most populous ones — Los Angeles, Orange and San Francisco — voted to implement it. The law — like another one in New York, Kendra's Law — allows families or officials to ask the courts to order outpatient treatment for the seriously mentally ill (Patt Morrison, 7/22). 

Categories: Health Care

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