Health Care Reform Articles - February 6, 2015

The Supreme Court at Stake

Overturning Obamacare Would Change the Nature of the Supreme Court

by Linda Greenhouse - NYT

In the first Affordable Care Act case three years ago, the Supreme Courthad to decide whether Congress had the power, under the Commerce Clause or some other source of authority, to require individuals to buy health insurance. It was a question that went directly to the structure of American government and the allocation of power within the federal system.

The court very nearly got the answer wrong with an exceedingly narrow reading of Congress’s commerce power. As everyone remembers, Chief Justice John G. Roberts Jr., himself a member of the anti-Commerce Clause five, saved the day by declaring that the penalty for not complying with the individual mandate was actually a tax, properly imposed under Congress’s tax power.

I thought the court was seriously misguided in denying Congress the power under the Commerce Clause to intervene in a sector of the economy that accounts for more than 17 percent of the gross national product. But even I have to concede that the debate over structure has deep roots in the country’s history and a legitimate claim on the Supreme Court’s attention. People will be debating it as long as the flag waves.

But the new Affordable Care Act case, King v. Burwell, to be argued four weeks from now, is different, a case of statutory, not constitutional, interpretation. The court has permitted itself to be recruited into the front lines of a partisan war. Not only the Affordable Care Act but the court itself is in peril as a result.

At the invitation of a group of people determined to render the Affordable Care Act unworkable (the nominal plaintiffs are four Virginia residents who can’t afford health insurance but who want to be declared ineligible for the federal tax subsidies that would make insurance affordable for them), the justices have agreed to decide whether the statute as written in fact refutes one of the several titles that Congress gave it: “Quality, Affordable Health Care for All Americans.”

If the Supreme Court agrees with the challengers, more than seven million people who bought their insurance in the 34 states where the federal government set up the marketplaces, known as exchanges, will lose their tax subsidies. The market for affordable individual health insurance will collapse in the face of shrinking numbers of insured people and skyrocketing premiums, the very “death spiral” that the Affordable Care Act was designed to prevent.

http://www.nytimes.com/2015/02/05/opinion/overturning-obamacare-would-change-the-nature-of-the-supreme-court.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

G.O.P. Lawmakers Propose Alternative to Obamacare

by Robert Pear - NYT

WASHINGTON — Three influential Republican members of Congress unveiled a comprehensive proposal on Wednesday to replace President Obama’s health care overhaul with an alternative that would halt the expansion of Medicaid and scale back subsidies for middle-income people to buy private insurance.

The plan, drafted with encouragement from Republican leaders in the Senate and the House, would retain some consumer protections in theAffordable Care Act, but would reduce federal regulation of insurance policies. States would have more authority to specify the “essential health benefits” that must be provided by insurance. As an example, the federal government would no longer require insurance policies to include coverage for maternity care.

The proposal was devised by Senator Orrin G. Hatch of Utah, the chairman of the Finance Committee; Representative Fred Upton of Michigan, the chairman of the Energy and Commerce Committee; and Senator Richard M. Burr of North Carolina, a member of the Finance and Health committees.

In documents sketching their proposal, Republicans said their “blueprint” would lower costs and rebut criticism from Democrats who say the Republicans have no ideas on health care.

Republicans said the need for such an alternative had become more urgent because they now control both houses of Congress, and the Supreme Court could upend the president’s health care law with a ruling later this year.

Their plan includes a potentially explosive proposal: Workers would have to pay federal income tax on the value of employer-provided health benefits that exceed certain annual thresholds — $12,000 for individuals and $30,000 for families. Health benefits above those levels would be treated and taxed as regular income for the employee. The thresholds would increase over time.

Employers could still take tax deductions for the cost of employee health benefits as an incentive to continue providing coverage, Republicans said. Moreover, a summary of the proposal says that “economists across the political spectrum largely agree” that the current tax break for employer-provided insurance is fueling the growth of health costs.

Employees and employers have been vocal in their objections to proposals that would limit the tax break.

http://www.nytimes.com/2015/02/05/us/politics/gop-lawmakers-propose-alternative-to-obamacare.html?smprod=nytcore-iphone&smid=nytcore-iphone-share

Partners looks to mend ties, tame costs

New CEO says system will reexamine expansion plans

By Robert WeismanGLOBE STAFF  FEBRUARY 05, 2015

Partners HealthCare System is rethinking its expansion plans in Massachusetts as it seeks to repair relations with competing hospitals and government officials, its newly appointed chief executive said Thursday.

“If we’re perceived as a bully or we’re perceived as arrogant through our actions, I don’t want that,” Dr. David Torchiana said in an interview. “We know we have to soften our external relations and get ourselves out of this place of being a miscreant in Massachusetts. It’s not a place we aspire to be.”

Torchiana also said that Partners intends to focus on controlling medical costs by operating more efficiently and better coordinating care.

Fears of higher health care costs were at the root of opposition to Partners’ recently rebuffed plans to acquire South Shore Hospital in Weymouth and two Hallmark Health hospitals north of Boston.

A state judge cited rising health care costs when she rejected a settlement in late January that would have allowed the takeover of the hospitals, as did Attorney General Maura Healey, when she said she would sue to stop the mergers should Partners proceed with them.

Torchiana said the state’s largest hospital and physicians network hasn’t yet determined whether to press ahead with the proposed mergers. “We’ve been chastened,” said Torchiana, 60, the day after he was named to Partners’ top job. “We’ve been brought to a firm stop by the events of the last few weeks. We’re going to reevaluate.”

Torchiana is well known within the medical world in Boston and nationally, but little known outside of it.

He is a veteran cardiothoracic surgeon at Partners-owned Massachusetts General Hospital, where he has led its 2,000-doctor physicians group for the past 12 years.

A native of Evanston, Ill., he is a graduate of Yale University and Harvard Medical School, where he is an associate professor of surgery.

Boston-based Partners operates 10 hospitals, including Harvard-affiliated Mass. General and Brigham and Women’s. It has a worldwide reputation for the quality of its care. But it is also the state’s most expensive health system.

Torchiana said he understands how rising health costs have crowded out public spending on other priorities while making it difficult for businesses to expand and compete.

“In Massachusetts, there is an almost overwhelmingly singular focus on cost because access has already been addressed” through the state’s 2006 universal health care law, he said.

“I don’t think that’s going to change any time soon,” Torchiana added.

Torchiana said he recognized that Partners’ aggressive expansion plans frayed relations with policy makers and other health care providers. One of his goals, he said, will be to reach out to state government and rival hospitals that banded together to oppose the mergers.

He said he was concerned that the reputation of Partners’ teaching hospitals as leaders in high-quality care and research was tarnished by a perception that the health system was attempting to use its market dominance to push up prices.

HTTP://WWW.BOSTONGLOBE.COM/BUSINESS/2015/02/05/NEW-PARTNERS-CHIEF-SAID-REASSESS-HOSPITAL-TAKEOVERS-FOCUS-COST-AND-REPAIRING-RELATIONS/DGNMTJL9V7ANBYVEPDD80H/STORY.HTML?S_CAMPAIGN=EMAIL_BG_TODAYSHEADLINE

Rand Paul Is Linked to Doctors’ Group That Supports Vaccination Challenges

By JEREMY W. PETERS and BARRY MEIERFEB. 4, 2015

WASHINGTON — Back in 2009, when Rand Paul was pursuing his long-shot bid to win Kentucky’s Republican Senate primary, he spoke to a small physicians’ association that has publicized discredited medical theories, including possible links between vaccines and autism and between abortion and an increased risk of breast cancer.

At the time, Mr. Paul, an ophthalmologist, was no stranger to the group, the Association of American Physicians and Surgeons. He boasted at its annual meeting that he had been a member for more than two decades and that he relied on its research, statistics and views about the role of government in medicine.

“I am not a newcomer to AAPS,” Mr. Paul said, referring to the group.

On Monday, Mr. Paul helped set off an uproar when he said amid a national measles outbreak that parents should be allowed to decide whether their children needed to be vaccinated, and that he had heard from parents whose children had suffered “profound mental disorders” after being vaccinated.

In doing so, he was echoing the views of the head of the association, which has also lobbied in recent years for state laws permitting parents to opt out of mandatory inoculation programs based on their beliefs.

On Tuesday, Mr. Paul sought to clarify those comments, inviting a New York Times reporter to accompany him to the Capitol physician’s office to watch him receive a hepatitis A booster vaccination. During the visit, Mr. Paul said he believed that the science was definitive on the matter and that vaccines were not harmful.

“It just annoys me that I’m being characterized as someone who’s against vaccines,” he said as he rolled up his T-shirt sleeve before the shot. “That’s not what I said. I said I’ve heard of people who’ve had vaccines, and they see a temporal association and they believe that.”

http://www.nytimes.com/2015/02/05/us/politics/rand-paul-linked-to-association-of-american-physicians-and-surgeons.html?smprod=nytcore-iphone&smid=nytcore-iphone-share

How to Handle the Vaccine Skeptics

By SAAD B. OMERFEB. 6, 2015

ATLANTA — THE alarming number ofmeasles cases — a record 644 last year, and 102 last month, the most since the disease was declared eliminated in the United States in 2000 — has focused scrutiny on parents who refusevaccinations for their children. There are some who want state and local governments to sue, or even criminally charge, such parents. A bill in California would end all nonmedical exemptions to immunization requirements.

For epidemiologists like me, eliminating exemptions may seem satisfying, but it is not the wisest policy for protecting kids. Instead, we should borrow a concept from behavioral economics, and use administrative rules and procedures to “nudge” parents to immunize their kids, rather than trying to castigate or penalize these parents.

Currently, all states allow medical exemptions, since some children — for example, those getting chemotherapyor who have certain types of immune disorders — cannot safely receive vaccines. All but two states (Mississippi and West Virginia) allow exemptions for religious reasons. Nineteen states allow exemptions based on personal (or “philosophical”) beliefs. Such beliefs are increasingly cited by parents whose misplaced skepticism is not really principled but premised, rather, on false notions like that of a link between autism and themeasles vaccine.

So shouldn’t all states follow the example of Mississippi and West Virginia, and ban all nonmedical exemptions? The courts have generally upheld such bans, but the political backlash is great, as history shows. After the smallpox vaccine was made compulsory in England and Wales in 1853, there were years of protests, until a commission exempted those with conscientious objections.

http://www.nytimes.com/2015/02/06/opinion/how-to-handle-the-vaccine-skeptics.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 story of the U.S. measles outbreak, as the rest of the world might see it

By Catherine Rampell

Paranoia and fear have spread throughout this human-resource-rich but politically dysfunctional nation, allowing a disease once nearly eradicated to return and ravage large swaths of the U.S. population.

Measles, a highly communicable and potentially deadly illness, has been mostly preventable since a vaccine was developed more than 50 years ago. And for decades this North American superpower — like other Western nation-states — had near-universal immunization rates. In recent years, though, locals have become increasingly distrustful of Western medicine. Many have opted for alternative methods to ward off illness, relying on dietary supplements, frantic Google searches and advice from former Playboy models.

As superstitions and anti-elite conspiracy theories have taken hold, measles outbreaks have flared up around the nation in the past few years. The epidemic reached a fever pitch in December after it infiltrated one of the country’s holiest sites: a national shrine honoring a singing rodent who serves pilgrims fried dough in exchange for alms. (Pious natives refer to the site as “Disneyland.”) Unsuspecting wayfarers were reportedly exposed to measles while queuing for a popular worship site involving whirling teacups, revered for its ability to purify and purge believers’ insides by inducing vertigo; infected visitors brought the disease back to their home towns, whence it spread to unvaccinated communities around the country.

Foreign leaders, fearful for the health of the United States’ most vulnerable ethnic groups (particularly those already suffering from the recent gluten-allergy epidemic), have urged the U.S. government to start mandating immunizations. But although American statesmen have almost uniformly treated their own offspring to such preventive measures, they are reluctant to force modern medicine upon their unruly and independent-minded constituents.

Indeed, some American politicians have been fomenting distrust of the government’s public health initiatives. They seem to fear losing the coveted Anti-Science vote, a growing demographic expected to play a key role in deciding the next presidential election.

http://www.washingtonpost.com/opinions/catherine-rampell/2015/02/05/53b4a134-ad7a-11e4-ad71-7b9eba0f87d6_story.html?hpid=z3

China suspected in major hacking of health insurer

By Drew Harwell and Ellen Nakashima February 5 at 8:35 PM

The massive computer breach against Anthem, the nation’s second-largest health insurer, exposes a growing cyberthreat facing health-care companies that experts say are often unprepared for large attacks.

Hackers gained access to the private data of 80 million former and current members and employees of Anthem in one of the largest medical-related cyber-intrusions in history.

Authorities said the breach, which was discovered late last month and disclosed this week, did not involve private health records or credit card numbers but did expose Social Security numbers, income data, birthdays, and street and e-mail addresses.

Investigators suspect Chinese hackers may be responsible for the breach, according to a person briefed on some aspects of the probe. There are also some indications that other health-care companies may have been targeted, said the individual, who spoke on the condition of anonymity to discuss the ongoing investigation.

Security experts said health care has become one of the ripest targets for hackers because of its vast stores of lucrative financial and medical information. Health insurers and hospitals, they added, have often struggled to mount the kinds of defenses­ used by large financial or retail companies, leaving key medical information vulnerable.

While medical records, such as treatment details or test results, were not compromised in what Anthem called “a very sophisticated attack,” experts say the breach underlines the worrying potential for hackers to steal private health data that is valued on the black market as tools for extortion, fraud or identity theft. Medical information could be exploited, for example, to file false insurance claims and buy prescription drugs, and attackers could extort cash from policyholders desperate to keep their private medical data under wraps.

“Health-care records are the new credit cards,” said Ben Johnson, chief security strategist at cybersecurity firm Bit9 + Carbon Black. “If someone gets your credit card number, you cancel it. If you have HIV, and that gets out, there’s no getting that back.”

http://www.washingtonpost.com/business/economy/investigators-suspect-china-may-be-responsible-for-hack-of-anthem/2015/02/05/25fbb36e-ad56-11e4-9c91-e9d2f9fde644_story.html?hpid=z4

I lost my MaineCare coverage, and it might make me sick

By Heather Denkmire, Special to the BDN

Posted Feb. 04, 2015, at 12:46 p.m.

Imagine this. You make an appointment with a doctor. You arrive, show your insurance card, and take a seat in the waiting area. You have your appointment. You leave. You pay nothing. You never receive a bill from an insurance company. You never have to call the doctor’s office or the insurance company — and wait on hold endlessly — to straighten out billing or reimbursement paperwork errors. You simply go to your doctor and receive medical care.

Now, also imagine that you pay no monthly premiums at all for health insurance. There are no deductibles. There are no co-pays. You choose your doctor. There are no “out of network” issues to consider. And, best of all, the insurance company won’t deny coverage, refuse to pay, and stick you with the bill.

For the last three years, I have used a version of “single payer health care” called MaineCare. Sure, there were a few bumps in the road. Some specialists had very limited hours available for MaineCare patients. A couple receptionists turned visibly cold, downright rude in one case, immediately after learning that I was a MaineCare patient. And, MaineCare did insist that I try less expensive alternatives before agreeing to pay for an absurdly expensive medication — $1,500 a month! — to treat my psoriasis.

Other than those minor inconveniences, how I paid for my health care hasn’t been a concern. I haven’t had to worry about finding the money for co-payments. I haven’t had to spend hundreds or thousands of dollars to meet a deductible. My health care was simply paid for with government funds. Those funds come from taxes, including those I have paid for the last 30 years.

About six months ago, I received a letter from DHHS informing me that I was being put onto “transitional MaineCare.” This meant my income would need to be verified more frequently to determine my continued eligibility. I immediately thought about how what was now a paperwork hassle would have been a devastating challenge just a few years ago when things were really tough personally and financially. On Jan. 10, I received a letter indicating my MaineCare coverage would end Jan. 31.

It’s been scary. I’ll admit I put off going to healthcare.gov to find health insurance because I didn’t want to face the fact that I will now have a dramatic increase in my monthly expenses. Suddenly I have monthly premiums. I will have to pay for doctor visits. I will have to pay for about 60 percent of much of my care until I meet my new plan’s deductible.

It’s true that the Affordable Care Act has made the costs lower than before. But there is nothing low about going from paying nothing to paying about $200 a month just for insurance. Remember my $1,500-a-month medication? No matter how much the new insurance covers, you can be sure I’ll have to spend up to my new insurance’s $1,500 maximum annual out-of-pocket amount. That’s $200 a month, co-pays, co-insurance until I meet the $500 deductible, and likely up to $1,500 because of the expensive medication. From $0 to $3,900 or more for one year.