The Rough Road To Implementation

 Health Care, Wonkery  No Responses »
Jul 032013
 

The Obama administration announced yesterday that it would delay implementation of the employer insurance mandate until 2015, which prompted Republicans to squeal in glee and remind Americans yet again that Obamacare will be the nation’s downfall. The mandate requires employers with more than 50 full-time employees to provide health insurance or pay a penalty. Ezra Klein points out that the employer mandate is an ill-conceived policy that encourages businesses to reduce worker hours to dodge the penalty.

The mandate is largely symbolic and delaying it won’t undermine the law’s core purpose: to provide health coverage to the uninsured. It’s easy to view this as a cave to the business community, but the administration may have decided that it’s better to ensure that the exchanges are running smoothly before focusing on less critical provisions of the law.

Nobody talks much now about the rocky implementation of the Medicare prescription drug benefit a few years ago. I expect the same will hold true of Obamacare.

Unsportsmanlike Conduct

 Health Care, Politics  No Responses »
Jul 012013
 

Congressional Republicans are warning professional sports leagues to stay away from any involvement in promoting Obamacare. Jonathan Cohn rightly accuses the GOP of trying to keep people in the dark about public benefits that will be available to them; benefits that were passed into law and affirmed by the Supreme Court. It’s clear that the GOP still can’t accept the legitimacy of Obamacare to the point where they are openly interfering with its implementation.

There are plenty of other ways to get the word out. Advocates and grassroots organizations will make sure of that. But this is just further evidence that Republicans are no longer a party of opposition. They are a syndicate whose only tools of persuasion are fear and intimidation.

Is Don Draper Available?

 Health Care  No Responses »
Jun 242013
 

Remember when I expressed skepticism last week that the NFL would participate in Obamacare outreach efforts? Kaiser Health News reports today that the Administration is courting the NFL to participate in a nationwide publicity campaign to get people signed up for health coverage. The league isn’t commenting, so it’s difficult to discern how serious these discussions are. It seems clear that the Administration has ambitious plans to get the word out, which is encouraging. We should also remember that several non-profit organizations and individual states will be conducting their own outreach campaigns, which will hopefully augment the administration’s efforts. Most people still don’t understand what the law does, so it’s critical that any messaging be both informative and persuasive.

 

And Now, An Important Message from LeBron James

 Health Care  1 Response »
Jun 202013
 

The White House may partner with the NBA to get the word out about Obamacare. It’s not a bad idea, considering that young men need to sign up for health insurance for the exchanges to remain solvent. The NFL would probably have a broader reach, but it’s always struck me as a more Republican-leaning entity unlikely to partner with this president on anything. The Obama political machine had better have the resources for an extensive media campaign that employs the same finely tuned targeting strategies used in the ’12 election. If the indestructibles remain unpersuaded, the whole initiative will be on shaky ground.

Plus Ca Change

 Health Care  No Responses »
Jun 182013
 

Economist Aaron Carroll compares the current Republican doomsaying about the Medicaid expansion with reactions to Medicaid’s debut in the 1960s and finds that not much has changed. Back then, conservatives were convinced that Medicaid would bankrupt the nation and health care providers would abandon the program in droves. Sound familiar?

He concludes:

It’s easy to scream that the sky is falling. Remember when Ronald Reagan told us that Medicare was the death of freedom? At some point, though, you have to look around and realize that things just ain’t that bad. We’ve heard these arguments before. They didn’t come to pass. States have all embraced Medicaid. The feds never broke the bargain. Docs made a fortune in the 80′s. There are more medical school applicants than ever before. At some point, we have to stop giving these arguments so much weight.

Obamacare will not be perfect. Neither will the Medicaid expansion. We’ll need to fix them. But neither will bring about the end of the republic, just as no health care reform in any other country resulted in the end of democracy itself.

All of these quotations were from 40-50 years ago. Not only is Medicaid thriving, but just last year, the Supreme Court decided it was so “apple pie” that threatening to take the program away was coercive. I think it’s more likely that’s how we’ll think about the ACA 40-50 years from now, than that any of the doomsday scenarios will come to pass.

Since I started working on this stuff a few years ago and discussed it with friends and acquaintances, I’ve been made acutely aware of just how brief our collective memory is. We recycle the same arguments and the same fears about health care reform every couple decades. Those arguments will probably continue long after the ACA is implemented, but at least more people will have better access to health care.

Profiles In Courage

 Health Care  No Responses »
Jun 132013
 

Here’s a sentence I didn’t think I would be writing: Congratulations to Arizona Governor Jan Brewer for pushing an expansion of Medicaid through the state legislature. At least on this issue, she ignored the rantings of her fellow conservatives and did the right thing for her constituents. Perhaps other Republican governors will realize that they won’t turn into pillars of salt if they choose to give health care coverage to poor people. Then again, that might asking too much of someone like Rick Perry.

The Price Of Saying “No”

 Health Care, Wonkery  No Responses »
Jun 042013
 

Those Republican governors who still refuse to participate in the Medicaid expansion may be inflicting long-term financial damage on their states. A new RAND study finds that not only will these states will pay out nearly $1 billion more in uncompensated care and forfeit several billion more in federal Medicaid dollars, but they will also have more uninsured residents. Some conservative governors have concluded that expanding Medicaid is the best option for both their constituents and their budgets, but others (Texas Governor Rick Perry, for instance) remain committed to blocking the expansion on ideological grounds.

The RAND probably won’t persuade any of these leaders to change course. Not in the short term, anyway. But once 2014 arrives and other states implement the expansion without much fuss, the holdouts may decide the practical benefits of joining them may outweigh any political considerations. And if they don’t, their beleaguered local hospitals and medical providers will ramp up their lobbying efforts. That kind of political pressure may be difficult to resist.

The Personal Benefits Of Health Care Reform

 Health Care  No Responses »
May 302013
 

This is the time of year when I have to assemble the paperwork for my semiannual Medical Assistance renewal. Thanks to the Affordable Care Act, I’ll only have to do this annually beginning next year. And eventually, I’ll be able to submit everything via the web. But right now, I have to find a pen and genuflect before the Altar of Bureaucracy.

Bad Medicine

 Disability, Health Care  1 Response »
May 272013
 

The Times examines the reasons why people with disabilities continue to receive substandard medical care. Most outpatient clinics are ill-equipped to serve patients with disabilities, particularly those of us who have limited or zero mobility. The staff have little training on how to safely transfer people with disabilities and the exam rooms lack accessible equipment. As a result, people with disabilities may only receive partial exams that may overlook potential problems.

I experienced this firsthand a couple months ago when I went to see my doctor with what turned out to be a urinary tract infection. The exam room lacked a table that would allow me to lie prone, which made it difficult for the doctor to examine me. She nearly sent me home to collect a urine sample, which would have only delayed my diagnosis and treatment. It might have made more sense for me to simply go to the emergency room, but I shouldn’t be forced to visit the ER to receive adequate care for a relatively minor issue.

That Medicaid Study Everyone Is Talking About

 Health Care, Wonkery  No Responses »
May 032013
 

Conservatives are seizing upon a new study that shows Medicaid recipients tend to consume more health care while their overall health remains unimproved as proof that the forthcoming expansion of Medicaid under the Affordable Care Act is a waste of money. It’s a willfully stupid conclusion for the following reasons:

  • People on Medicaid have low incomes. People with low income tend to have more chronic health conditions. So it’s no surprise that they would consume more health care once they receive access to affordable health care.
  • The study in question tracked people for only two years. It’s unlikely that a huge improvement in a chronic condition is going to show up after a couple years. And some conditions may never improve. Does that mean health care is wasted on such people? Is it wasted on me?  If we focus only on measurable improvement as the yardstick for justifying public health care expenditures, we’d better be prepared to have some really difficult conversations with our elderly and disabled.
  • The study did show that Medicaid recipients were substantially less likely to experience depression, which can be as debilitating as any physical impairment.
  • That lower incidence of depression might be related to the finding that Medicaid recipients experience far less financial stress.

Expanding Medicaid is undoubtedly a cost to society. But this study does nothing to undermine the basic assertion that Medicaid makes a real and positive difference in people’s lives.

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