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Viewpoints: Looking To The Supremes For Answer On Subsidies; 'Personhood' Laws

Kaiser Health News - Thu, 07/24/2014 - 9:22am

The Wall Street Journal: Fast-Tracking ObamaCare To The Supreme Court
Liberals are telling themselves that the latest ObamaCare legal challenge won't amount to much, although more nervously after the D.C. Circuit Court of Appeals ruled Tuesday that the White House is defying the law's plain text by allotting insurance subsidies through the federal exchanges. Allow us to increase their anxiety by speeding things along to the Supreme Court (7/23).

The Washington Post: Without Obamacare, What Would The Country Really Give Up?
After months of mostly encouraging news, many analysts have been upbeat about the law. Enrollment in private insurance and in Medicaid is up significantly. Nearly all of those buying private coverage are receiving tax credits, dropping their premiums by 76 percent, on average. Despite predictions to the contrary, a huge chunk — maybe something like half — of the newly insured lacked coverage before signing up, so the law isn’t just forcing people to move from one plan onto another whether they want to or not. The law is instead pushing the proportion of Americans without insurance down significantly. Given these things have happened despite a troubled rollout, it’s fair to be optimistic about year two (Stephen Stromberg, 7/23). 

The Washington Post: A Conservative Judiciary Run Amok
Retired Supreme Court Justice John Paul Stevens captured our ideal when he wrote of the judge as "an impartial guardian of the rule of law." By effectively gutting the Affordable Care Act on Tuesday, two members of a three-judge panel on the D.C. Circuit Court of Appeals showed how far right-leaning jurists have strayed from such impartiality. We are confronted with a conservative judiciary that will use any argument it can muster to win ideological victories that elude their side in the elected branches of our government (E.J. Dionne Jr., 7/23).

The New York Times' The Upshot: Two Americas On Health Care, And Danger Of Further Division
For decades, the United States has had a fragmented health policy. States called the shots on major elements of how health care and health insurance were financed and regulated. The result: a hodgepodge of coverage and a wide variance in health. The Affordable Care Act was intended to help standardize important parts of that system, by imposing some common rules across the entire country and by providing federal financing to help residents in all states afford insurance coverage. But a series of court rulings on the law could make the differences among the states bigger than ever (Margo Sanger-Katz, 7/23).

Bloomberg: Obamacare Takes A Body Blow
When you read through the ruling, it’s easy to see the many ways in which the law’s architects brought this on themselves. The law was highly complex, badly drafted and highly controversial. ... the Democrats had to push it through on a straight party-line vote with some adroit parliamentary maneuvering -- which gave them a health-care law, but one that was badly put together and couldn’t be substantially amended (Megan McArdle, 7/22).

Bloomberg: Obamacare Is Ending, And Other Nonsense
It's too soon to panic -- or celebrate, as the case may be: Obamacare isn't dead. And given the flimsy logic of the latest legal argument against it, there's a good chance it never will be (7/22).

Bloomberg: Courts Can't Fix Obamacare
Supporters of Obamacare have been lamenting that the law shouldn't be crippled by a mere "drafting error." But it's not at all clear that restricting tax credits to state-established exchanges was a drafting error. If Obamacare had proven more popular, or resistance to it weaker, then most states would have established exchanges. And if the law were put in place as written -- with the restriction on tax credits -- then the few holdouts would be under pressure to establish exchanges to get credits for their residents. Other health-care legislation before Congress at the same time as Obamacare had the same restriction (Ramesh Ponnuru, 7/22).

Bloomberg: Add Fraud To The List Of Obamacare Disasters
It sounds like the systems that are supposed to check identity, immigration status and income simply aren’t working at all; the system just assumes that you are who you say you are. This isn’t the only major part of the system that’s still missing .... the system that pays insurers still seems to be MIA. Presumably, the emergency team called in to fix the exchanges prioritized the bits that the public could see, leaving everything else for later. Compared to what was described by the Barack Obama administration (and the law), the system still seems to be half-built (Megan McArdle, 7/23).

The Fiscal Times: Obamacare OK’s Fake Accounts And Fake Promises
To this day, the federal exchange still lacks the “back end” needed to determine how many sign-ups actually have coverage and are paying their premiums, leaving the number of successful enrollments a guessing game based more on surveys than hard data. Now, however, the problem has expanded from failed enrollments to successful enrollments that shouldn’t have made it. The Government Accountability Office (GAO) conducted a small test of the Healthcare.gov site, which the Obama administration claims is functional now, to see whether the system could prevent fraudulent enrollments. In twelve attempts, the GAO succeeded in eleven fictitious enrollments (Edward Morrissey, 7/24).

The Wall Street Journal: McConnell's Campaign Lesson For The GOP
His Democratic opponent, Alison Lundergan Grimes, appeared in an ad sitting with a retired miner who wanted to know why Mr. McConnell "voted to raise my Medicare costs by $6,000. How are my wife and I supposed to afford that?" He and Ms. Grimes then stared at the camera for five seconds, before Ms. Grimes said, "I don't think he's going to answer that." He did answer, in 24 hours, in a video with clips of local and national media calling the charge "false," "misleading" and "laughable" since he didn't vote for the measure the miner cited. (It was a House proposal that never reached the Senate and wouldn't have raised the miner's Medicare costs.) The video even included footage of Ms. Grimes being pressed by Kentucky reporters to defend the ad. Then the McConnell campaign flipped the issue, reminding voters that President Obama's Affordable Care Act cut Medicare and saying that Ms. Grimes is "Obama's Kentucky candidate. Obama Needs Grimes. Kentucky Needs Mitch McConnell" (Karl Rove, 7/23).

The New York Times: Do Personhood Laws Protect Or Harm?
Ms. DeSamito and Ms. Loyola have been arrested or detained because of the increasing nationwide push to pass so-called personhood laws. These laws, though they vary state to state, by and large recognize fetuses, embryos and fertilized eggs as persons who are separate from the mothers who carry them. The laws seek to protect this category of persons, whether from strangers or from the mothers themselves. Jennifer Mason, a representative of the pro-life group Personhood USA, said on NPR’s "Fresh Air" in November that "the 14th Amendment requires equal protection under the law for everybody, and so we believe that every human being, regardless of their location, whether they're in the womb or out of it, deserves those protections and those rights." These laws now exist in 38 states, and some say they harm the mothers whose fertilized eggs, embryos and fetuses they aim to protect (Anna Altman, 7/23).

Categories: Health Care

Political Cartoon: 'Path Of Greatest Resistance?'

Kaiser Health News - Thu, 07/24/2014 - 9:20am

Kaiser Health News provides a fresh take on health policy developments with "Path Of Greatest Resistance?" By Nate Beeler.

Meanwhile, here's today's haiku:

GETTING BETTER ALL THE TIME?

The best physicians
seek recertification
to improve their care.
-James P. Richardson, MD 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Categories: Health Care

Summertime and the Fishing is Easy

Massachsuetts Trial Court Law Library - Thu, 07/24/2014 - 8:00am
Whether you are a catch and release angler or enjoy dining on the fruits of your labor, you might want to check out the 2014 Massachusetts Fish and Wildlife Guide to Hunting, Freshwater Fishing and Trapping as well as the 2014 Massachusetts Saltwater Recreational Fishing Guide.  In addition to giving helpful fishing tips, both guides provide a summary of the regulations on size and catch limits.  Don't forget to get your fishing license before you head out.  A license is required for both fresh and salt water fishing.  You get your license online or find a list of locations at http://www.mass.gov/eea/agencies/dfg/licensing/where-to-buy-a-license.html.  For additional information, see out Law About Recreational Hunting and Fishing.
Categories: Research & Litigation

First Edition: July 24, 2014

Kaiser Health News - Thu, 07/24/2014 - 7:08am

Today's headlines include more analysis of this week's conflicting appeals courts' decisions regarding a key part of the health law.  

Kaiser Health News: New Health Law Court Decisions Could Have Limited Political Impact
Kaiser Health News staff writers Mary Agnes Carey and Julie Rovner report: “Political analysts say this week’s court decisions on the legality of tax subsidies for those obtaining coverage under the Affordable Care Act may not have a broad impact on this fall’s midterm elections. The decisions sent a mixed legal message, complicating the political message as well. One appellate court panel ruled the subsidies cannot be provided in the 36 states relying on the federal insurance exchange; the other ruled in favor of the Obama administration, saying Congress intended that the subsidies be available regardless of whether states operated their own insurance marketplace” (Carey and Rovner, 7/24). Read the story.

Kaiser Health News: Groups Sue Tennessee Over Medicaid Enrollment Delays
Kaiser Health News staff writer Phil Galewitz reports: “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” (Galewitz, 7/23). Read the story

The New York Times: Court Ruling On Health Care Subsidies Risks Loss Of Coverage
The conflicting court rulings left much unresolved — both cases will be appealed further, and additional cases challenging the subsidies in federal exchange states are still making their way through trial courts in Indiana and Oklahoma. But the ruling in Halbig v. Burwell, in which a panel of the United States Court of Appeals for the District of Columbia found that subsidies could be awarded only in states that set up their own insurance exchanges, raised the possibility that many of the 4.5 million people who were found eligible for subsidized insurance through the federal exchange would drop their new coverage (Goodnough, 7/23).

The Wall Street Journal: Key Question On Health-Law Subsidies: Were Plaintiffs Harmed?
That argument is simmering beneath court battles about the legality of insurance subsidies tied to the Affordable Care Act. Mr. Klemencic is a key plaintiff in a case in which a Washington, D.C., court Tuesday invalidated subsidies for consumers in up to 36 states, the ones relying on a federal insurance exchange. Whether challengers like Mr. Klemencic had legal standing to sue the Obama administration in the first place turns on whether he was harmed by the subsidies. The ruling struck down an Internal Revenue Service rule that said qualifying consumers could receive subsidies whether they bought coverage on a state-run insurance exchange or a federal one. A second court, in Virginia, upheld the legality of the subsidies in another ruling Tuesday (Kendall, 7/23).

The New York Times: Bolstered By Ruling, Republicans Attack Health Law
Republicans in Congress resumed their campaign against the Affordable Care Act on Wednesday with new zeal, fired up by a ruling of a federal appeals court panel that said premium subsidies paid to millions of Americans in 36 states were illegal. Republicans pointed to the ruling as evidence of problems in the law that could not easily be solved (Pear, 7/23).

The Associated Press: Study: 10M Have Gained Coverage Through Health Law
A new study estimates that more than 10 million adults gained health insurance by midyear as the coverage expansion under President Barack Obama’s law took hold in much of the country. The study published Wednesday in the New England Journal of Medicine found that the share of Americans ages 18 to 64 without insurance dropped by a little more than 5 percentage points (7/23).

Politico: New England Journal Of Medicine Report: 10 Million Newly Insured
The Obama administration is touting yet another study showing that the Affordable Care Act has expanded health insurance to millions of Americans — this one published in the New England Journal of Medicine and estimating that 10 million have gained coverage under the law. Using Gallup polling and HHS data, Harvard researchers estimate that the uninsured rate declined by 5.2 percentage points in the second quarter of this year, corresponding to 10.3 million adults gaining coverage — although that could range from 7.3 to 17.2 million depending on how the data are interpreted. At least one researcher also has an HHS affiliation (Winfield Cunningham, 7/23).

ProPublica/NPR: Federal Health Exchange Stays Busy After Open Enrollment Ends
For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act. It turned out that more than 5 million people signed up using HealthCare.gov by April 19 (Ornstein, 7/23).

The Associated Press: Medicaid Enrollees Strain Oregon
Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received. But an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid (7/23).

Politico: GAO: Too Early To Draw Obamacare Fraud Conclusions
It’s too early to draw conclusions about fraud in the Obamacare marketplaces, a congressional investigator said at a hearing focused on a report finding 11 out of 12 fake applicants were able to obtain subsidized health insurance. Republicans jumped on the report as proof that the health care law invites fraud, but the Government Accountability Office official said the sample is too small and investigators “can’t draw any conclusions” until their work is complete. The investigation is ongoing, GAO’s Seto Bagdoyan said, and the “intent of this sample was not to project in any way” based on this initial stage of work, but instead to identify areas of potential focus for future work (Weinger, 7/23).

USA Today: Health Care Jobs Lift Less-Educated Workers
The boom in health care jobs is skewed toward positions requiring less education, providing lower-paid workers a potential pathway to better careers, a new Brookings Institution report says. From 2000 to 2011, the number of workers in 10 large health care occupations who had less than a bachelor's degree surged 46%, vs. 39% growth for all health care jobs, the study says (Davidson, 7/24).

The Washington Post’s The Fact Checker: Exemptions For Congressional Staff In ‘Obamacare,’ Or Hypocrisy?
This is a complicated issue which we have explored before, but we will try to keep it simple. The health-care law requires members of Congress and at least some staffers to leave the Federal Employees Health Benefit Program (FEHBP) and join the health-care exchanges (Kessler, 7/23).

The Washington Post: Paul Ryan To Unveil Anti-Poverty Plan
The new proposal, called an “Opportunity Grant,” would begin on a pilot basis. It would consolidate a range of safety-net programs — from food stamps to housing vouchers — into a single grant offered to states. State governments, working with local officials and nonprofit and faith groups, would then distribute the money, with strict accountability standards. Medicaid, the health program for the poor, would not be included (Goldfarb, 7/22).

The Wall Street Journal: Paul Ryan To Propose Sweeping Consolidation In Antipoverty Pitch
A signature part of Mr. Ryan's past budget plans has been deep reductions in spending on Medicaid, the hybrid state and federal health care program for the poor. Mr. Ryan, in his op-ed, didn't say whether Medicaid spending would be effected by his Opportunity Grant plan (Paletta, 7/23).

The New York Times: Gilead Reports Strong Sales of Sovaldi, Putting It On Pace to Become A Blockbuster 
Sales of the new hepatitis C drug Sovaldi reached $3.5 billion in the second quarter, a huge figure that puts it on track to become one of the world’s best-selling medicines but could intensify concerns about society’s ability to pay for it. The sales, announced on Wednesday by Gilead Sciences, were an increase from the $2.3 billion in the first three months of the year, the first full quarter of sales since the drug’s approval in December (Pollack, 7/23).

The Wall Street Journal: Hepatitis C Pill Rockets Gilead Into Big Leagues
For decades, a liver disease that would slowly kill the infected person didn't even have a name, let alone an effective medicine. Now, a new pill promising to cure most cases of the disease, eventually called hepatitis C, is believed to be the biggest new drug launch ever, catapulting maker Gilead Sciences Inc. 13% into the ranks of the top-selling pharmaceutical companies (Rockoff, 7/23).

Politico: Robert McDonald Could Soon Be Confirmed To VA
The Senate is expected to vote on the White House’s nominee to lead the embattled Department of Veterans Affairs before senators leave for a five-week August recess, Sen. Bernie Sanders (I-Vt.) said on Wednesday (French, 7/23).

Politico: CDC Lab Head Quits After Anthrax Scare
The head of a laboratory at the Centers for Disease Control and Prevention in the spotlight after dozens of employees were potentially exposed to live anthrax bacteria has resigned. Michael Farrell resigned on Tuesday, CDC spokesman Tom Skinner said. Farrell had led the Bioterror Rapid Response and Advanced Technology laboratory on the agency’s Atlanta campus since 2009 (Norman, 7/23).

The Wall Street Journal: Invoking Anti-Fraud Law, Louisiana Doctor Gets Rich
Over two decades, the 65-year-old internist has filed 12 lawsuits accusing health-care companies of defrauding taxpayer-funded programs such as Medicare. Five of his suits have together led the government to recover hundreds of millions of dollars. Those successful suits have also enriched Dr. LaCorte, who has received a $38 million cut under a federal law that encourages fraud reporting. Much was from a $250 million U.S. settlement with Merck & Co. in 2008 over allegations it overcharged Medicaid for Pepcid, a heartburn drug. He used part of his portion to buy a boat he named Pepsid (Loftus, 7/23).

The Washington Post: Virginia Psychiatric-Bed Registry Does Not Work As Intended, Lawmakers Told
A four-month-old psychiatric-bed registry that is supposed to provide up-to-the-minute information for Virginians who need emergency mental health treatment is being updated as seldom as once a day, state officials told a panel of lawmakers this week (Shin, 7/22).

The Associated Press: Healthy Virginians Aim Of State Panel
First lady Dorothy McAuliffe is joining a panel of public health experts intent on promoting policies to ensure a healthier Virginia. The Virginia Department of Health is convening the meeting Wednesday at the University of Virginia in Charlottesville. Called the “Excellence in State Public Health Law Conference,” the meeting is intended to assess policy proposals for improving the health of all Virginians (7/23).

NPR: States Help New Mothers Get Birth Control Through Medicaid
Here's the catch: Her Medicaid plan won't pay for contraception if she tries to get it while she's still at the hospital. New York has just joined five other states in making it easier for our fictional mom to have access to the kind of family planning options she was seeking without worrying about the price tag. At first glance this is a technical issue about Medicaid reimbursements. But it is also about postpartum contraception and which women have access to it (Farrington, 7/23). 

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Categories: Health Care

Brain Scientists Learn To Alter And Even Erase Memories

CommonHealth (WBUR) - Thu, 07/24/2014 - 6:12am

This optogenetic device uses light to activate specific brain cells. (Courtesy McGovern Institute for Brain Research at MIT)

For 32 years, Leslie Ridlon worked in the military. For most of her career she was in army intelligence. Her job was to watch live video of fatal attacks to make sure the missions were successful.

“I had to memorize the details, and I have not got it out of my head, it stays there — the things I saw,” she says. “The beheading — I saw someone who got their head cut off — I can still see that.”

Leslie Ridlon retired from the military eight years ago, but she finds she cannot work because she suffers from severe PTSD. (Courtesy)

Ridlon is now 49 and retired from the military last year, but she finds she cannot work because she suffers from severe post traumatic stress disorder. She has tried conventional therapy for PTSD, in which a patient is exposed repeatedly to a traumatic memory in a safe environment. The goal is to modify the disturbing memory. But she says that type of therapy doesn’t work for her.

“They tried to get me to remember things,” she says. “I had a soldier who died, got blown up by a mortar — he was torn into pieces. So they wanted me to bring that back. I needed to stop that. It was destroying me.”

She has concluded that some memories will never leave her. “Everything I could get rid of as far as memory I think I’ve already done it,” she says. “I think the deep ones that you suffer from, I don’t think anyone can take them away. I don’t believe anyone can. I think the ones I have now, they’re going to just stay there. I’m just going to have to manage them.”

But what if these traumatic memories could be altered or even erased permanently? Researchers say they are beginning to be able to do that — not just in animals, but in people as well.

Not long ago, scientists thought of memory as something inflexible, akin to a videotape of an event that could be recalled by hitting rewind and then play. But in recent decades, new technology has helped change the way we understand how memory works — and what we can do with it. Scientists can now manipulate memory in ways they hope will eventually lead to treatments for disorders ranging from depression to post-traumatic stress to Alzheimer’s disease.

“We now understand there are points in time when we can change memory, where we can create windows of opportunity that allows us to alter memories, and even erase specific memories,” says Marijn Kroes, a neuroscientist at New York University.

Kroes is working on doing just that in an NYU lab. On a recent afternoon, he was preparing a 21-year-old female subject for a three-day experiment.

He attached electrodes to the subject’s wrist so he could apply mild electric shocks when certain pictures appeared on the computer. This technique creates a fear memory—which he tests by measuring the subject’s sweat response.

On the second day of the experiment, Kroes shows the subject the same pictures to bring up the fear memory. He then waits 10 minutes — that’s the window, he says, when the memory becomes highly sensitive and vulnerable to change.

NYU neuroscientist Marijn Kroes attaches electrodes to subjects’ wrists and applies mild electric shocks when certain pictures appear on a computer, creating a fear memory. (Courtesy)

“Briefly reactivating the memory weakens or pries the memory loose,” he says. “The connections in the brain for that memory, normally they would re-stabilize again, but if you interfere with that process you cause loss of those connections between brain cells, and as a result you lose the memory.”

After he waits 10 minutes, he again shows the images to the subject without the shocks.

“The trick here is, instead of immediately trying to teach people that a situation is safe, you first remind of their emotional experience,” he says. “And now you wait a little while, and this opens up a window of opportunity in which you can update and alter the memory.”

On the third and final day of the experiment, Kroes tests whether he is successful: Did he get rid of the fear memory?

“In her case, if we truly have been able to override the fear memory, she should not show any fear response to those stimuli,” he says. And indeed, “What we now see is a flat line — that means she doesn’t show fear responses. Thus, we see no evidence that she still has a fear memory.”

While scientists long believed that memories were stored in the brain permanently, they now understand that memory is in fact malleable. Kroes says this knowledge — and the ability to specifically alter memory on a cellular level — could lead to new treatments for people with many conditions.

NYU neuroscientist Marijn Kroes says the ability to alter memories could lead to new treatments for people with many conditions. (Rachel Gotbaum for WBUR)

“By understanding that memory is flexible, we can think of ways we can interfere with that flexibility,” he says. “For example, this allows us to potentially come up with new treatments for psychiatric disorders. But you can also think of ways we can understand how to optimize memories in people with degenerative disorders such as Alzheimer’s and dementia.”

The hope is that these new approaches can also be used to strengthen memories in patients with memory loss. In the meantime studies are underway in patients with PTSD and other disorders such as addiction. But Kroes warns at this point he and other scientists only have a very early grasp of how these new techniques actually work. And they still have much more work to do before these new discoveries can be translated into effective treatments for the millions of patients suffering from memory and anxiety disorders.

Still, he and other researchers see a major shift in the concept of memory.

“I think it forces us not to think of memory as a video tape where we press play at the moment where we experienced an event,” says Elizabeth Kensinger, an associate professor of psychology at Boston College. “But instead think of the process of recalling a past event as a very active process where our brains are constantly trying to fill in pieces.”

And new technology is allowing scientists to manipulate memory directly in animals.

In the lab of Professor Susumu Tonegawa, a Nobel Prize-winning scientist at the MIT Picower Institute for Learning and Memory, researchers are using a powerful new tool called optogenetics to see how memory works in specific cells in real time.

“Moment by moment we our using our memory,” says Tonegawa. “It’s important for us to know how we form a memory, how we record a memory and how it goes bad under certain conditions.”

With optogenetics, scientists use lasers to identify specific memory cells and also to manipulate those cells.

Recently, Tonegawa’s lab used optogenetics to implant false memories into lab mice. Now, his lab is working on altering memories of mice with depression and symptoms of post-traumatic stress. The idea is to modify painful and stressful memories.

People like Leslie Ridlon, the veteran with PTSD, are waiting for the progress in labs to reach the point that it can help them.

“If someone took away all the bad memories and I could function every day, that would be great,” she says.

More:

Categories: Health Care

New Health Law Court Decisions Could Have Limited Political Impact

Kaiser Health News - Thu, 07/24/2014 - 5:01am

Political analysts say this week’s court decisions on the legality of tax subsidies for those obtaining coverage under the Affordable Care Act may not have a broad impact on this fall’s midterm elections.

The decisions sent a mixed legal message, complicating the political message as well. One appellate court panel ruled the subsidies cannot be provided in the 36 states relying on the federal insurance exchange; the other ruled in favor of the Obama administration, saying Congress intended that the subsidies be available regardless of whether states operated their own insurance marketplaces.

Political candidates as well as voters will have to wait until the outcome of appeals of the cases to know their impact. But that didn’t stop some politicians from trying to immediately exploit the issue, among them House Speaker John Boehner. He said Tuesday the ruling by the Court of Appeals for the District of Columbia that the health law prohibits subsidies in federally run exchanges is “further proof that President Obama’s health care law is completely unworkable. It cannot be fixed.”

While individual candidates may try to capitalize on the decisions, political analysts see difficulties for both parties.

It may be too late for the threat of millions of Americans losing health law subsidies to be a major issue in the fall elections, said Jim Manley, of Quinn Gillespie Public Affairs and a Democratic strategist.

“I’m not convinced it’s going have much impact either way. Republicans are entering dangerous ground again where they’re going to be in a position to be taking away people’s health care. But a final court decision won’t occur for a while,” Manley said. He thinks the focus of the elections will be on jobs and the economy, rather than the health law.

John Feehery, also of Quinn Gillespie and a Republican strategist, agreed. He said the Republican base “is already mobilized. Some of them hate Obamacare and some of them hate Obama.” But it’s easier for Republicans “just to run against Obama” rather than the health law.

GOP strategist John Murray doubts that Democrats will be able to make much of the subsidy issue in the midterm elections, either. “We are within striking distance of the fall elections. The ability to take things like this and infuse them into the bloodstream of a campaign this late in the game – we’re basically in August – I think is wishful thinking for Democrats,” he said.

And Tony Carrk, of the liberal Center for American Progress, said it’s better for Democrats not to threaten Republicans, but to simply point out that the law is working. He said that particularly with the next open enrollment period starting just after the election, Democrats should “take any chance we can get to highlight what the law does, and who it impacts.”

On the other hand, should courts eventually rule that subsidies are not, in fact, permitted in the three dozen states whose exchanges are being run by the federal government, then all bets would be off, said those on both sides.

“Conservatives are putting themselves in a corner,” said Carrk. “Right now they’re rooting for the law to fail and for people to pay more for their health care.”

GOP strategist Feehery agreed that Republicans might not benefit if the lawsuit invalidating subsidies in federal exchange states eventually succeeds. In that case, he said, “Republicans might have to worry about being blamed for taking the subsidy away.”
Categories: Health Care

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

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