Viewpoints: Republicans' 'Repeal Trap;' 'Insufferable' Pajama Boy; ADHD Epidemic; ACLU's Campaign Against Catholic Hospitals
The Washington Post’s The Plum Line: The GOP Repeal Trap
The Journal Gazette of Fort Wayne, Indiana, reports on a fascinating exchange between GOP Rep. Marlin Stutzman and a local meat market owner, Lee Albright, who likes the Affordable Care Act and quizzed the Congressman about the real world implications of the GOP repeal stance (Greg Sargent, 12/18).
The Wall Street Journal: National Lampoon's ObamaCare Vacation
President Obama has responded to the ObamaCare debacle by bringing in Beltway liberal mastermind John Podesta as a senior West Wing hand, and he promptly announced his arrival by likening House Republicans to "a cult worthy of Jonestown" in an interview with Politico. The states running their own insurance exchanges are exacting more accountability for their ObamaCare failures. Enrollment and technical dysfunctions and security breaches akin to the 36 federal exchanges continue to beset Minnesota's operation, called MNsure. On Tuesday, April Todd-Malmlov, the exchange's executive director since 2011, resigned under political duress (12/18).
Politico: Pajama Boy, An Insufferable Man-Child
Pajama Boy’s place in Internet infamy was secured as soon as the insufferable man-child was tweeted out by Organizing for America. He is the face of a web ad that is the latest effort by the Obama team to leverage the holidays for conversation about Obamacare. "Wear pajamas," the ad reads. "Drink hot chocolate. Talk about getting health insurance. #GetTalking." ... If he has anything to say about it, Obamacare enrollments will spike in the next few weeks in Williamsburg and Ann Arbor (Rich Lowry, 12/18).
Bloomberg: Conservatives See the Light On High Deductibles
The revelation that many plans in the Patient Protection and Affordable Care Act's health insurance exchanges have high deductibles has put many of the law's conservative opponents into a corner: Once in favor of high deductibles, these critics of Obamacare are suddenly worried about the risk to consumers. The data show why their new position makes more sense (Aaron Carroll, 12/18).
The Fiscal Times: The Obamacare 'Shotgun Wedding' – Marry Or Lose Your Home
The rollout of the Affordable Care Act has provided many real-world examples of this, but perhaps none so "unintended" as the consequences discovered by the Seattle Times this weekend. Carol Ostrom, The Times' health reporter, told the story of 62-year-old newlyweds Sofia Prins and Gary Balhorn, who weren't exactly the models of wild, starry-eyed romantics. Their nuptials were motivated by a stronger desire to keep their house out of the hands of the federal government, thanks to a little-known key provision of Obamacare. Their meager incomes made them eligible for a federally subsidized health plan, and their assets would be protected. Does Obamacare actually allow the federal government to seize homes and other assets? (Edward Morrissey, 12/19).
Fox News: Republicans Can Win In 2014 If We Unite Around ObamaCare
"A house divided against itself cannot stand." Abraham Lincoln originally spoke these prophetic words in 1858 when describing the looming threat of the Civil War. Today, we Republicans should heed this warning as we look ahead to the challenges of the future – both for our Party and the country we all love. At this moment in time, the American people overwhelmingly agree with Republicans on the fundamental issue of next year's elections: ObamaCare (Scott Brown, 12/18).
And on other issues -
The New York Times: An Epidemic Of Attention Deficit Disorder
The hard-sell campaign by drug companies to drive up diagnoses of attention deficit hyperactivity disorder, or A.D.H.D., and sales of drugs to treat it is disturbing. The campaign focused initially on children but is now turning toward adults, who provide a potentially larger market (12/18).
Los Angeles Times: Are Catholic Hospitals Bad For Women's Health? ACLU Says Yes.
A word of caution: If you are a woman of child-bearing age, Catholic hospitals may be hazardous to your health. Why? Because Catholic-affiliated hospitals, which now account for one of every nine acute-care hospital beds in the country, aren't allowed to provide the medically accepted standard of care if it conflicts with Catholic teachings (Robin Abcarian, 12/18).
Roll Call: Congress Must Address The Long-Term Care Workforce
Direct-care work is undervalued and underpaid, in large part because these jobs are considered “low skill” and are performed primarily by a female workforce, more than half of whom are women of color. But ask any individual who needs personal care services — or their family members — and you are likely to find that the most valued person on the care team is the aide. ... Fortunately, the Commission on Long-Term Care’s majority and minority reports included a number of recommendations that Congress should get behind to build a 21st-century, direct-care workforce: better training and opportunities for career advancement; rate setting policies that guarantee wages sufficient to attract committed workers and reduce turnover; integration of direct-care workers into care teams; and improved data collection to inform policy decisions (Jodi M. Sturgeon, 12/18).
New England Journal of Medicine: Accelerating The Adoption of High-Value Primary Care — A New Provider Type Under Medicare?
Although the proposed Medicare physician payment reform is an important step in the right direction, we believe that a bolder approach is needed to accelerate the adoption of [advanced primary care practice] APCP. We propose that Medicare adopt APCP as a new provider category, with its own eligibility standards and accountability for performance on patient outcomes, care, and resource use, linked to a new payment approach (Dr. Richard J. Baron and Karen Davis, 12/18).
New England Journal of Medicine: Political Tug-of-War and Pediatric Residency Funding
One of many effects of the government shutdown was the defunding of the Children's Hospitals Graduate Medical Education (CHGME) Payment Program. ... With this year's CHGME funding appropriation far from certain, pediatric residents and fellows are being paid out of clinical and other reallocated revenue — which undoubtedly creates pressures in other parts of the children's health care system. Though this stopgap measure helps to continue the training of pediatricians and the care of their patients, we hope that in the future, GME funding can avoid being caught in this type of political tug-of-war (Drs. Charlene A. Wong, Jeremiah C. Davis, David A. Asch and Richard P. Shugerman, 12/19).
Community Legal Aid will now accept and screen applications for those in need of legal services. Contact CLA at 1-855-CLA-LEGAL / 1-855-252-5342.
Intake hours starting January 6, 2014 are:
Monday, Tuesday, Thursday and Friday: 10:00 a.m. to 12:15 a.m.
Wednesday: 1:30 p.m. to 4:15 p.m.
Community Resources Information, a non-profit organization, provides a page listing legal assistance resources in Massachusetts. Also, see our Find a Lawyer page.
Today's headlines include reports that insurers will extend the payment deadline for Jan. 1 health coverage until Jan. 10.
Kaiser Health News: What If I Don't Like The Coverage Offered By My Employer?
Kaiser Health News consumer columnist Michelle Andrews outlines the health insurance options for people offered coverage at work (12/19). Watch the video or read the transcript.
The New York Times: Uninsured Skeptical Of Health Care Law In Poll
Americans who lack medical coverage disapprove of President Obama’s health care law at roughly the same rate as the insured, even though most say they struggle to pay for basic care, according to the latest New York Times/CBS News poll (Goodnough and Kopicki, 12/18).
The Washington Post: Insurers Volunteer To Extend Payment Deadline For Health-Care Coverage To Jan. 10
Just a few days remain before a Dec. 23 deadline to sign up for coverage that will begin Jan. 1, and the last-minute blitz that federal health officials have predicted appears to be materializing. It puts intense pressure on insurers to send bills to their new customers — and on consumers to pay right away. Under government rules, coverage cannot begin until people pay their first month’s premium. Extending the payment deadline creates breathing room for the industry and for people who are eager for their insurance to begin, averting a holiday week in which tens of thousands of Americans might not know whether their coverage would start on time (Goldstein, 12/18).
The New York Times: Health Insurers Extend Deadline For First Premiums
Insurance companies, worried about potential chaos next month as people begin seeking coverage under the federal health care law without completing the necessary paperwork, have agreed to give consumers an extra 10 days to pay their first-month premiums, according to a statement from the companies’ trade group on Wednesday (Abelson, 12/18).
Los Angeles Times: Health Insurers Extend Obamacare Payment Deadlines
Health insurers nationally said they would give consumers until Jan. 10 to pay for health coverage starting Jan. 1 as part of government-run exchanges under the federal healthcare law. But some state exchanges, including those of California and Connecticut, indicated they would stick with slightly different deadlines that were already extended. The extensions come amid a sharp rise in applicants and continued difficulties for many people trying to navigate the sign-up process (Terhune, 12/18).
The Associated Press/Washington Post: Insurers Allow More Time To Pay Under Health Law
Consumers anxious over tight insurance deadlines and lingering computer problems during the holidays will get extra time to pay their premiums under President Barack Obama’s health care law, insurers announced Wednesday. The board of the industry’s biggest trade group — America’s Health Insurance Plans — said consumers who select a plan by Dec. 23 will now have until Jan. 10 to pay their first month’s premium. That’s 10 extra days beyond a New Year’s Eve deadline set by the government (12/18).
The Wall Street Journal’s Washington Wire: Health Insurers Allow Some To Pay Premiums Late
Health insurers acceded to a request from the Obama administration and said they would delay a deadline for some people to pay their insurance premiums. The move is part of the last-minute rush to get ready for the full rollout of the Affordable Care Act, also known as Obamacare, on Jan. 1. People buying coverage on the new health-insurance exchanges created by the law must choose a policy by Dec. 23 in order to get coverage starting in the new year (Landers, 12/18).
USA Today: States Say Health Sign-Ups On Exchanges Increasing
States with their own well-running health insurance exchanges reported on Wednesday an increase of 30% to 40% in enrollments from last week to this week. "We're seeing huge interest," said Peter Lee, director of California's exchange, during a conference call sponsored by Families USA, a health care advocacy group that supports the Affordable Care Act. Six months ago, "no American knew about" the state exchanges (Kennedy, 12/18).
Politico: Obamacare Crashes Into Romneycare
Massachusetts created a Romneycare-inspired template for President Barack Obama’s health reform effort. Now, as the Bay State is struggling to upgrade for the Obamacare era, its enrollment system is buckling under technical glitches like those that hobbled HealthCare.gov. State officials are increasingly concerned that thousands of Massachusetts residents seeking coverage are lost in a wilderness of misfiled applications and cybermalfunctions. Now, they’re moving ahead with a labor intensive backup plan aimed at making sure that no one loses coverage when Obamacare starts in January (Cheney, 12/18).
Los Angeles Times: California’s Health Exchange Botched Letters To 114,000 Households
Adding to consumer confusion ahead of a major enrollment deadline, California's health insurance exchange sent flawed eligibility notices to nearly 114,000 households due to a computer error. The Covered California exchange said the letters sent from Nov. 22 to Dec. 7 had blank spaces or missing information on people's eligibility for insurance or federal premium subsidies (Terhune, 12/18).
The Washington Post’s Wonk Blog: California Is Averaging 15,000 Obamacare Enrollments Each Day
State health exchanges are reporting a surge in enrollment -- and consumer interest -- as they near a late December deadline to purchase insurance coverage. If November had an Obamacare surge, consider this the December deluge. California averaged 15,000 daily enrollments early last week, about double the sign-ups the state had in early December. New York is now seeing about 4,500 residents choosing plans each day and, in Connecticut, the number is hovering around 1,400. With consumer interest seeming to spike, these states and others are increasing call center staffing by half (Kliff, 12/18).
The Washington Post: Delaney Says Maryland Still Should Weigh Switching To Federal Health Exchange
Rep. John Delaney continued to press the idea Wednesday that Maryland should consider abandoning its online health insurance exchange in favor of the federal marketplace, despite representations by Gov. Martin O’Malley that the most pressing problems hindering enrollment have been fixed. Delaney (D-Md.) said in an interview that he still believes Marylanders seeking insurance might be better served by the federal exchange. He acknowledged that the switch would present some challenges but said he doesn’t think those are necessarily greater than those posed by the state site, which has been riddled with glitches since its Oct.1 launch (Wagner, 12/18).
The Wall Street Journal: More Turmoil In State Health Exchanges
Some states have signed up tens of thousands of new customers, and several states said Wednesday they are seeing healthy demand ahead of Dec. 23—the deadline in most states for getting coverage starting Jan. 1. But at least four of the 14—Hawaii, Maryland, Minnesota and Oregon—have had serious technical problems, and all four have now replaced directors less than three months after opening their exchanges. As of Dec. 1, fewer than 4,500 people had managed to sign up for private insurance in Minnesota, according to an Obama administration report. Minnesota's governor expressed impatience with progress on fixing the exchanges' problems last week (Schatz, 12/18).
The Associated Press/Washington Post: Minn. Could Delay Deadline For Exchange Enrollment
Leaders of Minnesota’s health insurance marketplace said Wednesday they might postpone next week’s deadline to enroll for January coverage, after a chaotic rollout of the state program that led to the resignation of its former executive director. April Todd-Malmlov, who had led Minnesota’s marketplace since its inception under the federal health care law, abruptly resigned Tuesday without a severance package. She faced criticism for taking a vacation to Costa Rica last month amid problems with a buggy website, long helpline waits and erroneous data sent to insurance companies (12/18).
The New York Times: Minnesota Becomes Fourth State To Lose Chief Of Exchange
The director of Minnesota’s health insurance exchange, April Todd-Malmlov, abruptly resigned this week, making the exchange the fourth state program to see a leadership change in the midst of mounting criticism over the rollout of President Obama’s new health care law. At a news conference on Wednesday, Ms. Todd-Malmlov’s successor was quick to promise fixes to problems still plaguing consumers, many of whom are worried about getting coverage by Jan. 1, when new policies under the law are set to take effect (Yaccino, 12/18).
The Wall Street Journal: A Medicaid Bet In Wisconsin
If Wisconsin Gov. Scott Walker ever runs for president, expect him to talk about his "third way" for Medicaid—a plan that rejects part of President Barack Obama's health law while extending coverage to more poor in the state. It is a fine line to walk for Mr. Walker, who could face a tough re-election fight next year. But his stance shows how one battle-tested Republican is trying to appeal to voters and respect conservatives' distaste for the Affordable Care Act (Peters and Radnofsky, 12/18).
The Washington Post: McAuliffe To Reappoint McDonnell’s Health Secretary, Bill Hazel
Gov.-elect Terry McAuliffe will keep Gov. Robert F. McDonnell’s health secretary as his own, a choice that could help the new governor sell Medicaid expansion to wary Republicans but that also infuriates some abortion rights activists (Vozzella, 12/18).
Politico: Michelle Obama Steps Into Health Care Spotlight
President Barack Obama has struggled to sell his health care law this fall — and until now, he’s largely been without his top seller: first lady Michelle Obama. The first lady has done little to promote the Affordable Care Act in recent months, marking a shift from her usual role as the president’s middle class messenger — a move that allowed her to sidestep the political battles over the law, and questions about the administration’s trustworthiness (Epstein, 12/18).
The Washington Post: Senate Passes Bipartisan Budget Agreement
Congressional leaders appointed Senate Budget Committee Chairman Patty Murray (D-Wash.) and House Budget Committee Chairman Paul Ryan (R-Wis.) to negotiate a cease-fire. The resulting agreement would roll back sharp spending cuts known as the sequester over the next two years, sparing the Pentagon from more reductions and restoring billions of dollars for domestic programs. The $62 billion cost would be more than covered by $85 billion in alternative policies, such as higher security fees for airline passengers, deeper cuts for Medicare providers and less generous retirement benefits for federal workers, including military retirees younger than 62. The deal makes no effort to solve the nation’s biggest budget problem: a social safety net strained by an aging population. But it also would not raise taxes or reduce Medicare benefits, leaving each party’s core ideological commitments intact (Montgomery, 12/18).
NPR: Congress Poised To Permanently Fix Its Medicare Payment Glitch
The two-year budget deal approved by the Senate Wednesday aims to prevent another government shutdown. It also includes a familiar annual rider — language to avert a steep pay cut to doctors who treat Medicare patients. But this time might be different, with a fix that lasts. After more than a decade of temporary solutions, it appears Congress may be on the verge of permanently solving its persistent problem in the way it makes Medicare payments to doctors. The problem was actually created by Congress itself, back in 1997, through a flawed formula called the Sustainable Growth Rate, or SGR. And every year since 2002, when the formula first began calling for cuts, the SGR has created political and fiscal fits for lawmakers (Rovner, 12/19).
The New York Times: Growth In U.S. Health Care Spending Slows
Nationally, spending on health care is growing at the slowest pace ever recorded. Annual spending on health care often grew more than 10 percent a year during the 1970s and ’80s. Growth dipped in the 1990s, only to rise again, but starting in the early 2000s, the rate began falling. It is now just about 4 percent a year. Yet in the latest New York Times/CBS News poll, just 5 percent of all Americans — and 3 percent of uninsured respondents — said that health care spending has moderated. Half of respondents said that costs have been going up at a faster rate lately (Lowrey, 12/18).
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Consumer columnist Michelle Andrews outlines the health insurance options for people offered coverage at work. A transcript follows.
Q: In 2014, can an individual with employer-sponsored health insurance drop that coverage and then either get coverage through a state exchange or just go without insurance and pay the individual mandate penalty?
A: Starting in 2014, most people can buy health insurance on the state exchanges, and people with incomes up to 400 percent of the federal poverty level may qualify for premium tax credits to make coverage more affordable. But not everyone will qualify for this subsidized coverage. If your employer offers job-based insurance and you choose to buy a plan on the exchange instead you generally won't qualify for subsidies unless your employer coverage is considered to be either unaffordable or inadequate. Your employer coverage would be considered unaffordable if the premium for individual coverage costs more than 9.5 percent of your income. It would be considered inadequate if it doesn't cover at least 60 percent of your allowed medical costs. If you choose, you can skip having insurance altogether but, as you noted, if you do you'll owe a penalty. In 2014, the penalty for not having health insurance will be either $95 or 1 percent of your household income, whichever is greater. The penalty will gradually increase until in 2016 it reaches the greater of $695 or 2.5 percent of your income. But consider your decision carefully. If you decide not to buy insurance during the open enrollment period that started this fall and continues through next March, if you get sick and change your mind you won't be able to buy a policy through the state exchanges until the next open enrollment period. There are some exceptions to that, but generally you would have to wait.
WhataEUR(TM)s Good for the Parent is Good for the Child: Access to Health Care Coverage Benefits the Whole Family
What it is an updated, comprehensive, readable, understandable guide to all the changes happening to health coverage in Massachusetts due to the ACA. Today the Blue Cross Foundation released Re-forming Reform Part 2, by Elisabeth Rodman of the Foundation staff.
The report looks at the changes to subsidized coverage for low income people, new eligibility and enrollment policies, altered regulations affecting private insurance, and also includes some payment reform initiatives.
If your reading this blog, you’ll probably like this report. Get it here.
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).