Health Care Reform Articles - July 14, 2014

Andrew Dreyfus: The last health care reform optimist

As CEO of Blue Cross Blue Shield of Massachusetts, Dreyfus is convinced medical costs can be reined in. And, yes, in a way that both political parties can agree on.

ANDREW DREYFUS stands at the front of a Washington, D.C., hotel ballroom. He’s spelling out how his state crafted the nation’s first universal health coverage law and is now tackling the even tougher challenge of rising medical costs. This is, to be clear, not a rapt throng of Apple fanatics hanging on every word from a stage-pacing CEO about the latest iPhone tweaks. This is a sober audience of buttoned-down insurance barons listening to a wonkish peer talk about Massachusetts policy. And he could not be more enthusiastic.

“We forged an enduring agreement on some of the thorniest and most challenging issues in health care,” he tells the gathering.

Is this guy serious?

While the US health care overhaul is under attack from critics who want it dismantled and his state is grappling with the highest health costs in the nation, Dreyfus is unfazed. He may just be the last health care reform optimist amid the partisan free-for-all. His message to colleagues in other states: We’re making it work. You can, too. “We have a health care system in Massachusetts where nearly everyone is covered, and we’re making significant progress on that Holy Grail of better care and lower cost,” he says in an earnest tone.

He is not exactly an unbiased voice. But he is a confident one. Dreyfus is the 55-year-old chief executive of Blue Cross Blue Shield of Massachusetts, the largest health insurer in the state that paved the path to Obamacare. Dreyfus has honed his “how we do it in the Bay State” talk through repetition. He’s given variations to congressional leaders on Capitol Hill, hospital and medical technology chiefs in Atlanta, directors of a renowned New York research foundation, and graduate students at Harvard, Princeton, and the University of Pennsylvania. At a time when President Obama’s new health care law is still playing out and November’s midterm elections may turn on its results, Dreyfus is out there like a brainy but fervent cheerleader for a team that’s struggling to find its identity.

http://www.bostonglobe.com/magazine/2014/07/10/andrew-dreyfus-the-last-health-care-optimist/er2Afoww7epyBCAeHWQMwO/story.html?s_campaign=email_BG_TodaysHeadline

A Two-Page Form Spawns a Contraceptive Showdown

By ROBERT PEARJULY 12, 2014

WASHINGTON — A two-page federal form has provoked a titanic clash between the government and many religious organizations.

The form allows some religious organizations to opt out of providing contraceptive coverage, which many insurers and group health plans are required to provide under the Affordable Care Act and related rules.

The opt-out sounds like a way to accommodate religious beliefs. But many religious employers like Wheaton College and the Little Sisters of the Poorare unwilling to sign the form. By signing it, they say, they would authorize their insurers or plan administrators to pay for contraceptives, including some that they believe may cause abortion.

Fights over the form are playing out in dozens of courtrooms around the country. In a separate case, the Supreme Court ruled on June 30 that family-owned for-profit corporations like Hobby Lobby Stores were not required to provide insurance coverage of contraceptives to employees if the companies objected on religious grounds. The Senate planned to take up legislation to reverse that decision this week.

http://www.nytimes.com/2014/07/13/us/a-two-page-form-spawns-a-contraceptive-showdown.html?hpw&action=click&pgtype=Homepage&version=HpHedThumbWell&module=well-region&region=bottom-well&WT.nav=bottom-well&_r=0

Convenience, fixed prices boost demand for doctor visits via Web, text

LISA ZAMOSKY

Mary Castaneda had a sinus infection that just wouldn't go away, and she was feeling awful. She knew she needed to see a doctor, but her timing was off.

"It was after-hours so I couldn't get in to see my doctor," says the 35-year-old Mission Viejo real estate agent.

She'd recently heard about a new service that would quickly connect her with a doctor by video via her smartphone, and she decided to give it a shot.

She downloaded the app and after just a few minutes was connected with a board-certified doctor. Fifteen minutes later, she had a prescription to ease her symptoms and a list of tips from the doctor about how to fight off future infections.

"The doctor was amazing," Castaneda said. "He was as thorough, or even more thorough, than my regular physician."

http://www.latimes.com/business/la-fi-healthcare-watch-20140713-story.html#page=1

UnitedHealth Group sues California over fine

CHAD TERHUN

Setting up a major legal fight, UnitedHealth Group Inc. has sued California's insurance commissioner to block his attempt to fine the insurer $173.6 million for violations during a botched 2005 acquisition.

The lawsuit, filed Thursday in Orange County Superior Court, is the latest twist in a long-running political drama. Four years ago, California sought a jaw-dropping fine of nearly $10 billion against UnitedHealth, the nation's largest insurer. The penalty related to problems handling medical claims and policyholder applications after the insurer bought Cypress-based PacifiCare.

But that record penalty didn't stand. Last year, an administrative law judge rejected much of the state's case and said UnitedHealth should be fined no more than $11.5 million.

Last month, California Insurance Commissioner Dave Jones rejected that ruling in a 220-page decision and imposed the $173.6-million penalty. He ordered UnitedHealth to pay it by July 22.

That drew the lawsuit and a fiery response from UnitedHealth executives Thursday. The insurer, based in Minnetonka, Minn., said Jones was abusing his power and setting a dangerous precedent by seeking such stiff punishment for relatively minor violations.

http://www.latimes.com/business/la-fi-unitedhealth-pacificare-fine-20140711-story.html

Obamacare Fails to Fail

JULY 13, 2014

How many Americans know how health reform is going? For that matter, how many people in the news media are following the positive developments?

I suspect that the answer to the first question is “Not many,” while the answer to the second is “Possibly even fewer,” for reasons I’ll get to later. And if I’m right, it’s a remarkable thing — an immense policy success is improving the lives of millions of Americans, but it’s largely slipping under the radar.

How is that possible? Think relentless negativity without accountability. The Affordable Care Act has faced nonstop attacks from partisans and right-wing media, with mainstream news also tending to harp on the act’s troubles. Many of the attacks have involved predictions of disaster, none of which have come true. But absence of disaster doesn’t make a compelling headline, and the people who falsely predicted doom just keep coming back with dire new warnings.

Consider, in particular, the impact of Obamacare on the number of Americans without health insurance. The initial debacle of the federal website produced much glee on the right and many negative reports from the mainstream press as well; at the beginning of 2014, many reports confidently asserted that first-year enrollments would fall far short of White House projections.

Then came the remarkable late surge in enrollment. Did the pessimists face tough questions about why they got it so wrong? Of course not. Instead, the same people just came out with a mix of conspiracy theories and new predictions of doom. The administration was “cooking the books,” said Senator John Barrasso of Wyoming; people who signed up wouldn’t actually pay their premiums, declared an array of “experts”; more people were losing insurance than gaining it, declared Senator Ted Cruz of Texas.

But the great majority of those who signed up did indeed pay up, and we now have multiple independent surveys — from Gallup, the Urban Instituteand the Commonwealth Fund — all showing a sharp reduction in the number of uninsured Americans since last fall.

I’ve been seeing some claims on the right that the dramatic reduction in the number of uninsured was caused by economic recovery, not health reform (so now conservatives are praising the Obama economy?). But that’s pretty lame, and also demonstrably wrong.

http://www.nytimes.com/2014/07/14/opinion/paul-krugman-obamacare-fails-to-fail.html?hp&action=click&pgtype=Homepage&module=c-column-top-span-region&region=c-column-top-span-region&WT.nav=c-column-top-span-region

The real Medicaid problem

Robert Samuelson

The White House recently put out a 40-page report arguing that the 24 states that have not expanded Medicaid coverage under the Affordable Care Act (ACA or “Obamacare”) are hurting their poor and themselves. It’s an easy case to make, but it’s incomplete and misleading. The further truth is that Medicaid also threatens to crowd out spending for many traditional state and local functions: schools, police, roads, libraries and more.

Indeed, this has been happening for decades. From 1989 to 2013, the share of states’ general funds devoted to Medicaid has risen from 9 percent to 19 percent, reports the National Association of State Budget Officers. Under present law, the squeeze will worsen. The White House report doesn’t discuss this. The paradox is that a progressive program also has unprogressive consequences.

First, some background.

Passed by Congress in 1965 as part of Lyndon Johnson’s Great Society, Medicaid is health insurance for the poor. In 2012, it covered almost 58 million people and spent $432 billion, with costs split between the federal government (about 58 percent) and the states (42 percent). The ACA expanded eligibility for Medicaid to people with incomes below 138 percent of the federal poverty line. In 2014, that’s $16,105 for a single adult and $32,913 for a family of four. Earlier federal eligibility requirements were tighter.

In June 2012, the Supreme Court, while upholding most of the ACA, threw out the Medicaid provisions. The court ruled that the Obama administration couldn’t force all states to accept the Medicaid expansion. It had to give them a choice. Ever since, there’s been a running battle between the administration and the states that have declined. The White House report, done by its Council of Economic Advisers (CEA), is the latest salvo.

http://www.washingtonpost.com/opinions/robert-samuelson-the-real-medicaid-problem/2014/07/13/6a9b82c4-0919-11e4-8a6a-19355c7e870a_story.html?hpid=z3