Health care reform remains precarious in the United States, with intense political disagreement about the Affordable Care Act (ACA). Former Governor Romney vows to “repeal and replace” President Obama's signature domestic achievement.1 Although repeal would face potentially insurmountable political barriers,2 a Republican president could selectively enforce the ACA, effectively blocking full implementation. The president has wide discretion in implementing legislation, so understanding the scope of executive powers is important—not only for the ACA but also for a broad range of social welfare legislation.

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Health Care Waste Deconstructed: Patients Aren't the Problem
Sunday, 28 October 2012 11:59
By Philip Caper, The Bangor Daily News | Op-Ed
If anybody ever tells you we can't afford health care for everybody, consider the following: Every other wealthy country in the world provides health care for all at an average of about half the per-person cost in the United States.
Their health care systems are more popular than ours and get better results for all their people. In those countries, there is no such thing as medical bankruptcies and there is no job-lock due solely to health care coverage.
Last month, the National Academy of Sciences reported that in the U.S. we waste $750 billion on health care, or about one in every three dollars we spend. Apologists for our dysfunctional health care system blame fraud and inadequate prevention — "blame the patient" — for most of that. But those two factors accounted for only 17 percent of the waste, according to the NAS.
http://truth-out.org/opinion/item/12372-health-care-waste-deconstructed-patients-arent-the-problem?tmpl=component&print=1

Nurses, Addicted to Helping People

By ABIGAIL ZUGER, M.D.
When a book is heavy with glossy photographs, you seldom expect too much from its words. In "The American Nurse," though, it's the narrative that hits you in the solar plexus.
Take the comments of Jason Short, a hospice nurse in rural Kentucky. Mr. Short started out as an auto mechanic, then became a commercial trucker. "When the economy went under," he says, "I thought it would be a good idea to get into health care." But a purely pragmatic decision became a mission: Mr. Short found his calling among the desperately ill of Appalachia and will not be changing careers again.
"Once you get a taste for helping people, it's kind of addictive," he says, dodging the inspirational verbiage that often smothers the healing professions in favor of a single incontrovertible point.
Some of the 75 nurses who tell their stories in this coffee-table book headed into the work with adolescent passion; others backed in reluctantly just to pay the bills. But all of them speak of their difficult, exhilarating job with the same surprised gratitude: "It's a privilege and honor to do what I do," says one. "I walk on sacred ground every day."
They hail from a few dozen health care settings around the country, ranging from large academic institutions like Johns Hopkins in Baltimore to tiny facilities like the Villa Loretto Nursing Home in Mount Calvary, Wis., home to 50 patients and a collection of goats, sheep and other animals on a therapeutic farm. Some nurses are administrators, some staff wards or emergency rooms, some visit patients at home. Many are deeply religious, a few are members of the military, and a handful of immigrants were doctors in their home countries.

Insurers nervous over prospect of Romney victory

Major insurers stand to rake in billions of dollars from new customers who'll get health insurance under the law.

Ricardo Alonso-Zaldivar / The Associated Press
WASHINGTON — You'd think health insurance CEOs would be chilling the bubbly with Republican Mitt Romney's improved election prospects, but instead they're in a quandary.
Although the industry hates parts of President Barack Obama's health care law, major outfits such as UnitedHealth Group and BlueCross Blue Shield also stand to rake in billions of dollars from new customers who'll get health insurance under the law. The companies already have invested tens of millions to carry it out.
Were Romney elected, insurers would be in for months of uncertainty as his administration gets used to Washington and tries to make good on his promise repeal Obama's law. Simultaneously, federal and state bureaucrats and the health care industry would face a rush of legal deadlines for putting into place the major pieces of what Republicans deride as "Obamacare."
Would they follow the law on the books or the one in the works? What would federal courts tell them to do?
The answers probably would hinge on an always unwieldy Congress.

Medicaid on the Ballot


By 

There’s a lot we don’t know about what Mitt Romney would do if he won. He refuses to say which tax loopholes he would close to make up for $5 trillion in tax cuts; his economic “plan” is an empty shell.
But one thing is clear: If he wins, Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost, with two-thirds of that difference due to the assault on Medicaid.
So this election is, to an important degree, really about Medicaid. And this, in turn, means that you need to know something more about the program.
For while Medicaid is generally viewed as health care for the nonelderly poor, that’s only part of the story. And focusing solely on who Medicaid covers can obscure an equally important fact: Medicaid has been more successful at controlling costs than any other major part of the nation’s health care system.
So, about coverage: most Medicaid beneficiaries are indeed relatively young (because older people are covered by Medicare) and relatively poor (because eligibility for Medicaid, unlike Medicare, is determined by need). But more than nine million Americans benefit from both Medicare and Medicaid, and elderly or disabled beneficiaries account for the majority of Medicaid’s costs. And contrary to what you may have heard, the great majority of Medicaid beneficiaries are in working families.
For those who get coverage through the program, Medicaid is a much-needed form of financial aid. It is also, quite literally, a lifesaver. Mr. Romney has said that a lack of health insurance doesn’t kill people in America; oh yes, it does, and states that expand Medicaid coverage show striking drops in mortality.

Obamacare divides Maine's candidates for U.S. Senate

The Republican in the field advocates repeal, while his rivals support the law and say even more needs to be done.

By John Richardson jrichardson@mainetoday.com
State House Bureau
Two of the major candidates for Maine's open U.S. Senate seat support the Affordable Care Act. The third would repeal the act.
Democrat Cynthia Dill and independentAngus King back the law, although Dill says she would like to move to a government-sponsored single-payer system.
Republican Charlie Summers, meanwhile, says he wants to replace the law with market reforms and increased competition.
The Affordable Care Act, also known as Obamacare, is the 2010 law designed to make health insurance available to an estimated 30 million uninsured Americans, including nearly 130,000 Mainers.
The law includes incentives and mandates for employers to cover more workers and requires most uninsured adults to buy private coverage starting in 2014. Subsidies will be available to people who cannot afford to buy the insurance, under the law.
The law has a variety of other mandates, such as requiring insurance companies to cover pre-existing conditions and banning them from cutting off coverage when chronically ill patients exceed lifetime limits on benefits.

Election may determine fate of sick, uninsured Americans

President Obama's healthcare law guarantees all Americans access to coverage, starting in 2014. Mitt Romney has pledged to repeal the law and let states decide what to do with the uninsured.

By Noam N. Levey, Los Angeles Times
October 28, 2012


MURFREESBORO, Tenn. — Jode Towe was driving his big rig across the New Mexico desert in April when he noticed an odd sensation at the back of his throat.
"It was like something was growing there," he recalled.
When Towe, 41, went to a clinic, he got bad news. He might have cancer. Doctors recommended a biopsy. If the results confirmed their suspicions, surgery and chemotherapy might follow.
But Towe and his wife, who live in this small city near Nashville when they aren't hauling freight across the country, don't have health insurance. Nor do they have $4,000 for the tests to get an accurate diagnosis. For now, they're waiting as the growth in Towe's neck swells.
"I always worked hard. I never took it easy," Towe said, his voice trailing off. "But they said I might die."

U.S. Set to Sponsor Health Insurance

By 
WASHINGTON — The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.
These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.
The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.
Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide. The personnel agency has earned high marks for its ability to secure good terms for federal workers through negotiation rather than heavy-handed regulation of insurers.
John J. O’Brien, the director of health care and insurance at the agency, said the new plans would be offered to individuals and small employers through the insurance exchanges being set up in every state under the 2010 health care law.
No one knows how many people will sign up for the government-sponsored plans. In preparing cost estimates, the Obama administration told insurers to assume that each national plan would have 750,000 people enrolled in the first year.

Feds likely to manage Maine’s health insurance exchange

By James McCarthy, Mainebiz
Posted Oct. 29, 2012, at 2:56 p.m.
AUGUSTA, Maine — The Affordable Care Act set a Nov. 16 deadline for states to declare whether they intend to establish their own health insurance exchange. It’s a key provision of the act, one that is intended to provide affordable insurance to uninsured individuals and small-business employees starting Jan. 1, 2014.
While Maine has not formally announced its intention, it is so far behind in preparing its own exchange that the federal model will likely be adopted by default.
When asked for confirmation that Gov. Paul LePage won’t be pursuing a state-run exchange, his press secretary, Adrienne Bennett, told Mainebiz she had nothing to report on the subject and that the state “is currently assessing options.”
But Mitchell Stein, policy director for the Augusta-based Consumers for Affordable Health Care, says even if LePage declares in the next month that Maine intends to create a state-run exchange, that’s only one step in the process.
The federal government has a 27-page checklist of steps that must be followed in order for a state to be certified as being on track to meet the ACA’s October 2013 enrollment period and the Jan. 1, 2014, opening of the exchange. And on that front, Stein says, Maine will have a tough job convincing the federal government it will be ready to open its own exchange a little more than a year from now — given that LePage, in an April 18 letter, informed the federal Department of Health and Human Services he was turning back a $5.8 million grant that was to help pay for many of the federal government’s set-up requirements.
“There’s a tremendous amount of work to be done,” Stein says, citing as one example the required integration of the exchange’s eligibility systems with existing Medicaid eligibility systems to ensure a low-income enrollee who’s eligible for Medicaid gets referred to that program instead.

Rockport doctor to test new heart-healthy diet

By Stephen Betts, BDN Staff
Posted Oct. 27, 2012, at 12:24 p.m.
ROCKLAND, Maine — An overflow crowd filled the Good Tern Natural Foods Store Oct. 10 as Dr. Ralph Hamill unveiled a new diet that he hopes will control cholesterol and reduce the nation’s high rate of cardiovascular disease.
Hamill, a cardiologist at Pen Bay Medical Center in Rockport, spoke for more than an hour to about 50 people who crammed into the health food store to hear about his new diet that focuses on eating more tree nuts, dark chocolate, tomatoes, certain yogurts and extra virgin olive oil.
A normal 40-year-old man in the United States has a 5 percent risk of heart disease within 10 years and 43 percent in his lifetime, Hamill said.
“Forty-three percent and that’s considered normal,” Hamill said.
The average total cholesterol level in the United States is 208, nearly twice what it should be, Hamill said.
He noted in Africa, where diets are much healthier, cardiovascular disease hardly exists.
To try to provide further proof that people in the United States can lower their levels of bad cholesterol and increase the presence of good cholesterol, Hamill is proposing a clinical trial of his diet.
The goal of the diet is not to lower weight, he said, but to lower the bad type of cholesterol, known as low-density lipoprotein, or LDL.
Originally, the study was going to involve only 10 people, but Hamill said the company that provides some blood testing supplies for Pen Bay Medical Center has agreed to cover the cost of blood tests for 70 participants. Laboratory employees at the hospital also have volunteered their time to perform the blood tests to check participants’ cholesterol levels before and after the four-week diet.
Each participant will be given a diary to write down what they ate.
Pen Bay approved the clinical trial this month, Hamill said.