For Uninsured, Clearing a Way to Enrollment
By ABBY GOODNOUGH
LA GRANGE, Ky. — Kelli Cauley’s fingers raced over her keyboard as she asked the anxious woman at her side a series of questions. What was her income? How many people lived in her household? Did she smoke? (“That’s the only health question it asks,” Ms. Cauley said of the application they were completing.)
The woman, a thin 61-year-old who refused to give her name, citing privacy concerns, had come to the public library here to sign up for health insurance through Kentucky’s new online exchange. She had a painful lump on the back of her hand and other health problems that worried her deeply, she said, but had been unable to afford insurance as a home health care worker who earns $9 an hour.
Within a minute, the system checked her information and flashed its conclusion on Ms. Cauley’s laptop: eligible for Medicaid. The woman began to weep with relief. Without insurance, she said as she left, “it’s cheaper to die.”
Known as “navigators” or “assisters,” people like Ms. Cauley are going to work across the country, searching for the uninsured and walking them through the enrollment process. Under the Affordable Care Act, these trained, paid counselors typically work for community groups or government agencies, with a mandate to provide impartial guidance. Given the problems plaguing the federal online insurance exchange used by 36 states, the workers have become even more important in helping people understand their insurance options.
But in Kentucky and some of the 13 other states that have their own exchanges, which in general are running more smoothly than the federal site, watching navigators on the job also provides the clearest view yet of how enrollment could work once the technical problems of HealthCare.gov are resolved.
President Obama and proponents of the health care law have held up Kentucky in recent weeks as a model for the national enrollment effort. The state is far ahead of most of the nation in signing up people: As of Nov. 1, more than 27,854 Kentuckians had enrolled in Medicaid under the law’s expansion of that program, and 4,631 had signed up for private plans through the state-run exchange, known as Kynect. The state says it is enrolling 1,000 people a day.
In contrast to the federally run exchange with all its problems, Kynect has had relatively few — for several reasons, Kentucky officials said. The primary contractor, Deloitte, worked closely with the state agency that runs health programs, ensuring guidance and oversight. Unlike the federal government, the state tested its online exchange early and often, so problems were addressed before the website went live. And people can check whether they qualify for Medicaid or subsidies without creating an account, a requirement that caused huge bottlenecks on the federal exchange.
While most states lack enough navigators to reach all who need help, Kentucky is spending $11 million in federal money to promote its exchange, and it shows: Ads for Kynect blanket television and radio, city buses and highway billboards in Louisville.
Strategic Move Exempts Health Law From Broader U.S. Statute
By ROBERT PEAR
WASHINGTON — The Affordable Care Act is the biggest new health care program in decades, but the Obama administration has ruled that neither the federal insurance exchange nor the federal subsidies paid to insurance companies on behalf of low-income people are “federal health care programs.”
The surprise decision, disclosed last week, exempts subsidized health insurance from a law that bans rebates, kickbacks, bribes and certain other financial arrangements in federal health programs, stripping law enforcement of a powerful tool used to fight fraud in other health care programs, like Medicare.
The main purpose of the anti-kickback law, as described by federal courts in scores of Medicare cases, is to protect patients and taxpayers against the undue influence of money on medical decisions.
Kathleen Sebelius, the secretary of health and human services, disclosed her interpretation of the law in a letter to Representative Jim McDermott, Democrat of Washington, who had asked her views. She did not explain the legal rationale for her decision, which followed a spirited debate within the administration.
Under the Affordable Care Act, millions of people will be able to buy insurance from “qualified health plans” offered on exchanges, or marketplaces, run by the federal government and by some states.
Most of the buyers are expected to be eligible for subsidies to make insurance more affordable. The subsidies, paid directly to insurers from the United States Treasury, start in January and are expected to total more than $1 trillion over 10 years.
Ms. Sebelius said the Health and Human Services Department “does not consider” the subsidies to be federal health care programs. She reached the same conclusion with respect to federal and state exchanges, built with federal money, and with respect to “federally funded consumer assistance programs,” including the counselors, known as navigators, who help people shop for insurance and enroll in coverage through the exchanges.
The federal exchange has been plagued with problems since it opened on Oct. 1. The Obama administration said that the online enrollment system for the exchange was out of service again for 90 minutes on Monday afternoon in an “unscheduled outage.” That was in addition to the scheduled down time from 1 a.m. to 5 a.m. each day.
President Obama, speaking at a political event on Monday night, said he was determined to fix the problems that have frustrated millions of people trying to use the website for the federal exchange.
“When the unexpected happens, when the unanticipated happens, we’re just going to work on it,” Mr. Obama said. “We’re going to fix things that aren’t working the way they should be. We’re going to smooth this thing out, and we’re just going to keep on going.’ ”
Obama to Campaign to Ensure Health Law’s Success
By JACKIE CALMES
WASHINGTON — On the fifth anniversary of his election, President Obama told a rally of grass-roots supporters on Monday evening that “I’ve got one more campaign in me” — to make sure his signature health care law works.
The president, who has faced four years of Republican attacks against the law in Congress, state capitals and the Supreme Court, sought to reassure about 200 leaders of his Organizing for Action network at its health care summit meeting. His comments followed a month of controversy since the law’s health insurance exchanges opened, including the program’s malfunctioning website and complaints about canceled policies.
“When the unexpected happens, when the unanticipated happens, you know, we’re just going to work on it. We’re going to fix things that aren’t working the way they should be, and we’re going to smooth this thing out,” Mr. Obama told his mostly young supporters at the St. Regis Hotel near the White House.
Organizing for Action, which grew out of Mr. Obama’s election campaign network, is dedicated to helping build support for his governing agenda. With the president on the defensive over the Affordable Care Act, the White House was eager for the group’s help in getting out the word on the president’s commitment to fix thehealthcare.gov website. The site’s problems have prevented untold numbers of Americans, mainly those without employer-provided group health insurance, from enrolling for individual coverage in the new, state-based marketplaces or exchanges. Mr. Obama urged the group’s members to spread any success stories “far and wide.”
“Every day there are new stories to tell,” he said, recounting a letter he received from a Lexington, Ky., man who wrote that his household of six had found a better policy at half the price of his $1,500-a-month plan, and with a deductible of $500 instead of $3,000.
Mr. Obama has been widely criticized for having promised as a presidential candidate that Americans could keep their current coverage under his insurance program, and on Monday he modified his language in the face of reports, long anticipated, that some companies had canceled individual policies because they did not meet minimum coverage standards set by the Affordable Care Act.
“If you have or had one of these plans before the Affordable Care Act came into law, and you really liked that plan, what we said was you can keep it if it hasn’t changed since the law was passed,” Mr. Obama said.
Tapping Medical Marijuana’s Potential
By JANE E. BRODY
Marijuana has been used medically, recreationally and spiritually for about 5,000 years. Known botanically as cannabis, it has been called a “crude drug”: marijuana contains more than 400 chemicals from 18 chemical families. More than 2,000 compounds are released when it is smoked, and as with tobacco, there are dangers in smoking it.
Medical marijuana clinics operate in 20 states and the District of Columbia, and its recreational use is now legal in Colorado and Washington. A Gallup poll conducted last month found that 58 percent of Americans support the legalization of marijuana.
Yet researchers have been able to do relatively little to test its most promising ingredients for biological activity, safety and side effects. The main reason is marijuana’s classification by Congress in 1970 as an illegal Schedule I drug, defined as having a potential for abuse and addiction and no medical value.
American scientists seeking clarification of marijuana’s medical usefulness have long been stymied by this draconian classification, usually reserved for street drugs like heroin with a high potential for abuse.
Dr. J. Michael Bostwick, a psychiatrist at the Mayo Clinic in Rochester, Minn., said the classification was primarily political and ignored more than 40 years of scientific research, which has shown that cellular receptors for marijuana’s active ingredients are present throughout the body. Natural substances called cannabinoids bind to them to influence a wide range of body processes.
In a lengthy report entitled “Blurred Boundaries: The Therapeutics and Politics of Medical Marijuana,” published last year in Mayo Clinic Proceedings, Dr. Bostwick noted that the so-called endocannabinoid system has an impact on the “autonomic nervous system, immune system, gastrointestinal tract, reproductive system, cardiovascular system and endocrine network.”
There is evidence that several common disorders, including epilepsy, alcoholism and post-traumatic stress disorder, involve disruptions in the endocannabinoid system, suggesting that those patients might benefit from marijuana or its ingredients.
Decrying GOP sabotage of HealthCare.gov
The rollout of the federal health-care exchange under the Affordable Care Act has been a grade-A debacle. There is absolutely no denying it. And The Post’s bigSunday story on the combination of poor planning and political timidity puts the entire mess into perspective. Knowing that President Obama relentlessly admonished his team that “if the Web site doesn’t work, nothing else matters” makes it all the more infuriating.
But there were two tidbits in the 2,800-word piece that were previously known but still served to enrage me, especially now that we see how well the GOP’s premeditated campaign to try to kill Healthcare.gov is working.
Although the statute provided plenty of money to help states build their own insurance exchanges, it included no money for the development of a federal exchange — and Republicans would block any funding attempts. According to one former administration official, [Health and Human Services Secretary Kathleen] Sebelius simply could not scrounge together enough money to keep a group of people developing the exchanges working directly under her.
So, the federal exchange that Republicans said wouldn’t work ended up not working because it was starved of the money needed to help make it work.
A larger number of states than expected were signaling that, under Republican pressure, they would refuse to build their own online insurance marketplaces and would rely on the federal one. The more states in the federal exchange, the more complex the task of building it. Yet, according to several former officials, White House staff would not let this fact be included in the specifications. Their concern, one former official said, was that Republicans would seize on it as evidence of a feared federal takeover of the health-care system.
So, the federal exchange that Republicans said wouldn’t work ended up not working because the GOP pressured Republican governors to not form their own state exchanges. This made the federal task more complex and difficult, thus ensuring its failure.
Of course, foot dragging by a ’fraidy cat White House aided the failure. But after reading The Post story on the debacle that is the Obamacare debut, what the GOP gleefully calls a train wreck was a self-fulfilling prophesy courtesy of Republican sabotage.
Is competition really good for health care?
There’s little evidence to support the model, this author postulates
By Leigh Dolin, M.D.
The Lund Report (Portland, Ore.), Oct. 28, 2013
The Lund Report (Portland, Ore.), Oct. 28, 2013
Competition is supposed to be good for health care. Only with competition, it is said, will we get the highest quality health care at the lowest cost. But is this true? Where’s the evidence?
In the 1990’s capitated managed care was supposed to prove the benefits of competition. Insurance companies would compete with each other to keep people healthy and by keeping them healthy, they would make money. But unfortunately, the bottom line of the insurance companies was not the health of its customers, but profit. They competed with each other to avoid caring for the sickest patients and to deny coverage for treating illness.
And now we have the Affordable Care Act -- Obamacare -- which is based on the same principles of competition. To be sure, there are some benefits to Obamacare. More people will have access to health insurance and coverage can’t be denied for preexisting conditions. But once again, the insurance companies are in charge, and we know what their ultimate goal is.
In pursuit of profit maximization, they expend enormous amounts of money on bloated salaries for their executives and on advertising to lure customers from each other. Moda (the insurance company previously known as ODS -- how much was spent to have someone think up that more appealing name?) paid $40 million for the naming rights to the Rose Garden. How much medical care could that have paid for? How much was added to the monthly premiums of its customers so that the Rose Garden could be called the Moda Center?
The bronze and silver policies that most people will select under Obamacare have enormous deductibles so that people are discouraged from seeking routine medical care and from getting the companies to provide something in return for the premiums. And the companies will continue their efforts to avoid caring for the sickest patients and to deny coverage whenever possible. The “choice” in the “health care marketplace” is limited to policies of companies whose bottom line is not patient care, but profit. (The “not for profit” companies have the same bottom line as those that are “for profit” -- they just have to call it something else.)
The other reason for health website chaos
By David Freudberg
The Huffington Post, Oct. 28, 2013
Advocates of a single-payer health system have long touted what they see as its cost-saving advantages. In light of the recent Obamacare rollout, they would be justified in citing another benefit as well: simplified sign-up.
An easy shorthand for single-payer is Medicare for All. The concept is to take a health coverage system that is highly popular and generally works well and just expand it. Without reinventing the wheel, simply lift the age restriction for Medicare eligibility.
Instead of covering only seniors, single-payer champions urge allowing everyone to be covered by a federal system -- the way health care is provided in basically every other industrialized nation.
For example, in Canada's single-payer system, you select your own doctor (and if unsatisfied, you pick a new one). There are some limitations on what services a patient can get when, but they're apparently not seen as too drastic: A Gallup Poll showed a majority of Canadians to be "satisfied" or "very satisfied" with their system.
And for Americans, of course, there are limits to coverage from private insurers as well. Just ask anyone who has recently braved healthcare.gov and studied the fine print of competing private policies offered on the new exchanges. Or anyone who has had the unpleasant experience of being denied medical care by an American insurer.
I'm not sure which is more incomprehensible: the ham-handed launch of registration for the Affordable Care Act (ACA) or the system's mind-numbing complexity. But the two are related.
Failing to beta-test a national site with this many moving parts til two weeks before the liftoff date would strike most IT professionals I know as webmaster malpractice or at least dereliction of management at HHS.
But that doesn't clarify why so many moving parts were needed in the first place. What explains the system's convolution is the numerous powerful health care industry lobbies. Their behind-the-scenes influence before the ACA was passed by Congress in 2010 produced one of the least healthy foods on the planet: legislative sausage.
With about 50 million Americans, including many children, uninsured at the time of President Obama's first election, the time had come to do something to foster greater fairness in health care. But the awkward compromise reached, dubbed the Affordable Care Act, left no one fully satisfied.
As the legislative machinery kicked into gear in the spring of 2009, Senate finance committee chair Max Baucus, who led the deliberations, famously declared that single-payer coverage was "off the table."
http://www.pnhp.org/print/news/2013/october/the-other-reason-for-health-website-chaos
The Huffington Post, Oct. 28, 2013
Advocates of a single-payer health system have long touted what they see as its cost-saving advantages. In light of the recent Obamacare rollout, they would be justified in citing another benefit as well: simplified sign-up.
An easy shorthand for single-payer is Medicare for All. The concept is to take a health coverage system that is highly popular and generally works well and just expand it. Without reinventing the wheel, simply lift the age restriction for Medicare eligibility.
Instead of covering only seniors, single-payer champions urge allowing everyone to be covered by a federal system -- the way health care is provided in basically every other industrialized nation.
For example, in Canada's single-payer system, you select your own doctor (and if unsatisfied, you pick a new one). There are some limitations on what services a patient can get when, but they're apparently not seen as too drastic: A Gallup Poll showed a majority of Canadians to be "satisfied" or "very satisfied" with their system.
And for Americans, of course, there are limits to coverage from private insurers as well. Just ask anyone who has recently braved healthcare.gov and studied the fine print of competing private policies offered on the new exchanges. Or anyone who has had the unpleasant experience of being denied medical care by an American insurer.
I'm not sure which is more incomprehensible: the ham-handed launch of registration for the Affordable Care Act (ACA) or the system's mind-numbing complexity. But the two are related.
Failing to beta-test a national site with this many moving parts til two weeks before the liftoff date would strike most IT professionals I know as webmaster malpractice or at least dereliction of management at HHS.
But that doesn't clarify why so many moving parts were needed in the first place. What explains the system's convolution is the numerous powerful health care industry lobbies. Their behind-the-scenes influence before the ACA was passed by Congress in 2010 produced one of the least healthy foods on the planet: legislative sausage.
With about 50 million Americans, including many children, uninsured at the time of President Obama's first election, the time had come to do something to foster greater fairness in health care. But the awkward compromise reached, dubbed the Affordable Care Act, left no one fully satisfied.
As the legislative machinery kicked into gear in the spring of 2009, Senate finance committee chair Max Baucus, who led the deliberations, famously declared that single-payer coverage was "off the table."
http://www.pnhp.org/print/news/2013/october/the-other-reason-for-health-website-chaos
Buffett: Scrap Obamacare and Start All Over
By Money Morning Staff Reports
When asked, "Are you in favor of scrapping [Obamacare] and going back to start over?", famed investor Warren Buffett said on CNBC March 1, 2010, "I would be — if I were President Obama.”
Buffett insisted that without changes to America's health system average citizens will suffer.
"We have a health system that, in terms of costs, is really out of control," he added. "And if you take this line and you project what has been happening into the future, we will get less and less competitive. So we need something else."
Three debate-ridden years later, millions of Americans still agree.
But now that the exchanges are open, Obamacare has finally kicked off.
The government program, which some economists call the biggest tax increase ever in the United States, is also one of the most hated bills in history.
Ask millions of Americans what they think about the new law, and chances are they're ready to pop a jugular.
Critics heavily oppose the mandate requiring them to purchase health insurance. They're also furious at all the new taxes, fees, and higher premiums they'll be stuck paying, thanks to Obamacare.
Yet, while millions of Americans loathe every facet of The Affordable Care Act, as it's officially titled, another group of Americans see it as a once-in-a lifetime opportunity to get rich: Investors.
Obamacare may cost Americans 25% of their paycheck or more on January 1st. Are you at risk? Find out here.
According to Wall Street expert and Money Map Press Chief Investment Strategist, Keith Fitz-Gerald, Obamacare will create unheard of riches for investors who tap into the right companies.
"Obamacare is one of the single biggest wealth creation opportunities to hit the markets in decades," says Fitz-Gerald. "That's because huge amounts of money - trillions - will be spent as Obamacare gets rolling."
"And trillions more will be reallocated," he adds.
Not all companies will benefit - but a select few are primed for higher returns on a scale that was simply unimaginable before this legislation was passed.
These companies, and their investors, are set to make a fortune in the next several months - and years - as the full Obamacare plan gets underway.
Fitz-Gerald says main street investors will have a chance to reap big paydays - provided they know which sectors stand to benefit most.
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