New Pitch for Health Initiative: Mind Your Mom. Get Insured.
By KATIE THOMAS
As the Obama administration’s health overhaul sputters in its opening weeks, insurers and advocacy groups are pursuing a new strategy in the quest to get millions of young people to sign up for health insurance: They’re appealing to their mothers.
In one cheeky campaign, AARP is urging mothers to send e-cards to their children reminding them to sign up. One e-card reads, “As a reward for signing up for health insurance, I’ll defriend you on Facebook.” Another group, Organizing for Action, is seeking to steer holiday conversations toward health care by encouraging parents to have “the talk” with their adult children. And a Colorado group is promoting an ad featuring a hapless young man who calls his mother from the golf course: “Yo, Mom, do I got insurance?”
Recruiting enough young people is a major goal of the Obama administration because insurers need healthy customers to offset the cost of caring for those with expensive medical needs.
The goal carries even more urgency now that insurers are considering a proposal by President Obama to let people, many of them healthy, stay on their existing policies for another year. If fewer of those people buy insurance in the new marketplaces, signing up young people without insurance will be even more crucial. Young people also account for a major chunk of the uninsured. About 40 percent of the estimated 41 million uninsured people nationwide who are eligible for coverage are between the ages of 18 and 35, according to the administration.
Even as supporters are enlisting mothers in the effort to sign up their adult children, critics have mounted an equally aggressive and well-funded campaign urging young people to “opt out” of coverage. Opponents use many of the same marketing tools as the law’s supporters, reaching out to young people on social media and through web videos.
Advocacy groups and insurers are expected to make a major marketing push beginning in early December, when the Obama administration has said it expects the malfunctioning federal health care website to be working better. They have their targets set on two major deadlines: Dec. 23, when insurance must be purchased for coverage beginning on Jan. 1, and March 31, when the open enrollment period will end.
Beneath the marketing campaigns’ playful language is a deeper truth: When it comes to making major life decisions, many people — especially young adults — still turn to their mothers for help. More broadly, women make about 80 percent of the health care decisions for their families, according to the federal Labor Department.
Bumps in the Road to New Cholesterol Guidelines
By GINA KOLATA
It was supposed to be a moment of triumph. An august committee had for the first time relied only on the most rigorous scientific evidence to formulate guidelines to prevent heart attacks and strokes, which kill one out of every three Americans. The group had worked for five years, unpaid, to develop them. Then, at the annual meeting of the American Heart Association, it all went horribly awry.
Many leading cardiologists now say the credibility of the guidelines, released Nov. 14, is shattered. And the troubled effort to devise them has raised broader questions about what kind of evidence should be used to direct medical practice, how changes should be introduced and even which guidelines to believe.
“This was a catastrophic misunderstanding of how you go about this sort of huge change in public policy,” said Dr. Steven Nissen, a Cleveland Clinic cardiologist who is a past president of the American College of Cardiology. “There will be a large backlash.”
What went wrong? Some critics say the drafting committee mistakenly relied only on randomized controlled clinical trials, the gold standard of medical evidence, but ignored other strong data that would have led to different conclusions. The group’s efforts were severely underfunded. And it announced fundamental changes in medical practices without allowing a public debate before its guidelines were completed.
“A lot of people expect they can come up with guidelines as a pure scientific discourse and present them to the public,” said Dr. J. Sanford Schwartz. a committee member and a professor at the University of Pennsylvania. “That’s what we did here, but the world has changed.”
When the new guidelines were released, many doctors were shocked that they were suddenly being told to stop their decades-long practice of monitoring levels of LDL cholesterol, the kind that increases the risk of heart attacks and strokes, after patients begin taking statin medicines.
Others were stunned when a pair of Harvard medical professors offered evidence within days of the guidelines’ release that its new online risk calculator greatly overestimated a person’s chance of having a heart attack or stroke.
The committee writing the guidelines made a critical, early decision to consider only evidence from clinical trials, a marked departure from how previous guidelines were made. Some independent experts provided with an advance draft of the guidelines, including Dr. Roger S. Blumenthal of Johns Hopkins and Dr. Antonio M. Gotto Jr., a former president of the heart association, objected. They said a wealth of genetic and populations data indicated that lower cholesterol levels are better, especially for high-risk patients. The same critique would loom large after the guidelines were released.
Health Law Is Dividing Republican Governors
By JONATHAN MARTIN
SCOTTSDALE, Ariz. — Republicans are planning to use the troubled health law against Democrats in next year’s midterm elections, but the Affordable Care Act is increasingly dividing their party, too.
At the annual meeting here of the nation’s Republican governors, the ones who are eyeing presidential runs in 2016 say they oppose the health care law. But there is sharp disagreement among those who have helped carry out the law and those who remain entrenched in their opposition.
These early divisions reveal not only the difficult calculations of ambitious Republican politicians as they look to the next presidential campaign, but also the complexities of being a governor rather than a lawmaker at a time when the party’s base is hostile to those who cooperate with Democrats.
The governors who refused the Medicaid expansion money that is part of the health care law — believing they had found a wedge issue — are already boasting about it.
“I said no,” Gov. Scott Walker of Wisconsin said, “because if I took the Medicaid expansion I’d be dependent on the same federal government that can’t get a basic website up and going even after two and a half years to come through with payments for Medicaid in the future when they start weaning off paying for 100 percent of coverage.”
Under the new law, the federal government pays the entire cost of Medicaid expansion for three years and 90 percent after that.
Mr. Walker, who is seen as a candidate who can potentially bridge the differences between the Tea Party and the Republican establishment, said conservatives would have long memories on how the law was carried out.
“I don’t think it’s a deal-breaker, but I think it’s pretty high on the importance list for a lot of voters out there,” he said.
Obamacare update: Consumers see progress but insurers smell trouble
By Sandhya Somashekhar and Amy Goldstein,
As the Obama administration closes in on its self-imposed deadline to fix the troubled online health insurance marketplace, consumer advocates say it is becoming easier for people to sign up for coverage but insurers warn that critical flaws continue to hinder participating health plans.Administration officials have promised that HealthCare.gov will be working smoothly for most people by Saturday and are citing evidence indicating progress toward that goal. Workers helping people sign up for coverage have noticed that the site has been running better over the past two weeks, with consumers experiencing shorter wait times and fewer crashes.
But the online system is still marred by defects that will create havoc for insurance companies if a significantly larger volume of applicants starts to sign up in coming weeks. Among them are the error-riddled reports that insurers are receiving about who has enrolled, a problem that could be disastrous if not fixed soon.
There is little room for error at this point. People seeking to take advantage of the new coverage that kicks in Jan. 1, or whose health insurance policies are being canceled at the end of the year, have until Dec. 23 to choose a plan and until Dec. 31 to pay their first month’s premium. Some congressional Democrats, uneasy about the messy rollout of the exchange, have expressed a willingness to dismantle parts of the law if problems continue.
“If they get this fixed, it’s a chapter in somebody’s book. If they don’t get this fixed, it’s a chapter in history,” said Michael O. Leavitt (R), a former Utah governor who served as secretary of the Department of Health and Human Services during the tumultuous rollout of Medicare Part D, which added prescription drug coverage to Medicare. “They will need to demonstrate fairly soon that there’s improvement, or they will lose the support of their own party.”
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