KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Viewpoints: Romneycare And Cutting Workers; Fla.’s Surprising Ruling On Malpractice Reform

The New York Times: 'Romneycare' And The 29ers
Health reform in Massachusetts in 2006 did not cause many workers to have their work hours cut, but that is no comfort for those workers nationwide who will begin to experience this side effect of the federal Affordable Care Act (Casey B. Mulligan, 3/19). 

Los Angeles Times: Sanity On 'Malpractice Reform' – From Florida, Of All Places
"Tort reform"--read that as "shutting the courthouse door to malpractice victims"--again is rearing its ugly head as a means to reduce healthcare costs, most recently as a plank in the recent GOP healthcare proposals. So it's refreshing to see the rationales for malpractice reforms authoritatively eviscerated, and even more refreshing to see that done by the heavily Republican Supreme Court of Florida (Michael Hiltzik, 3/19). 

The Washington Post: HHS, Playing Selective With Obamacare Enrollment Numbers
The federal Department of Health & Human Services (HHS) scored on Monday with a cheery press release on Obamacare. "Marketplace Enrollment Hits 5 Million Milestone," noted the release .... The HHS announcement had an improvisational, ad hoc feel to it. Unlike the more comprehensive monthly Obamacare reports, it was more of an update, a celebration of a key milestone in the drive to promote Obamacare. ... In other words, precisely the sort of incremental disclosures that HHS officials months ago said they wouldn't be providing (Eric Wemple, 3/19). 

The Washington Post: James Blumstein On Halbig V. Sebilius
Next week, the U.S. Court of Appeals for the D.C. Circuit will hear oral arguments in Halbig v. Sebelius, a challenge to the legality of an IRS rule purporting to authorize tax credits and cost-sharing subsidies in federal exchanges. Below is a brief commentary on the issues in Halbig by James F. Blumstein, university professor of constitutional law and health law and policy and director of the Health Policy Center at Vanderbilt University (Jonathan H. Adler, 3/19). 

Bloomberg: Obamacare's War Of Leaks
The Obama administration has said it expects premium increases for health insurance next year to be considerably slower than the pace before implementation of the Affordable Care Act. That's not what insurance industry executives told the Hill ... One executive, described as being "from a populous swing state," expects his company to triple the rates on next year’s exchange policies. Time to freak out about a death spiral? Not yet (Megan McArdle, 3/19).

Lincoln (Neb.) Journal Star: Time For A Rule Change
Now that a minority of state senators has beaten back the attempt to expand Medicaid in Nebraska, perhaps next year the Legislature will be more open to lowering the number of votes required to end a filibuster. Supporters of expansion were able to muster only 27 votes on Wednesday in favor of ending the filibuster, far short of the 33 votes required under the Legislature's current rules (3/20).

Milwaukee Journal Sentinel: Expanding Medicaid Helps Wisconsin Children As Well
You may wonder why pediatricians are writing in support of accepting federal funding under the Affordable Care Act to expand Medicaid to higher eligibility levels. ... Our interest in expanding health coverage is based on the very simple fact that children live in families. Due to proposed changes announced last year by Gov. Scott Walker, parents of children will lose their coverage. These changes will increase the number of childless adults eligible for BadgerCare — but at the cost of removing an almost equal number of working parents from coverage. While this may seem an even exchange at worst, parenting can be challenging under the best of circumstances. When a parent suffers from untreated chronic illness, both the parent and child suffer (Drs. Dipesh Navsaria, Gail S. Allen, Elizabeth J. Neary And Ellen R. Wald, 3/19).

Des Moines Register: There Are Good Reasons For 'Estate Recovery'
Among the challenges states like Iowa face in implementing the Affordable Care Act: reconciling the new law with existing laws. Obamacare encourages states to expand their Medicaid programs to cover more low-income Americans. Decades-old federal law requires states to try to recover money from the estates of deceased Medicaid enrollees (if there is any money or assets) that the government paid for their health bills. ... It's likely the vast majority of states are not invoking the estate-recovery policy for people on expanded Medicaid programs because this is all so complicated. But that does not mean Iowa should entirely abandon the effort (3/19).

The Milwaukee Journal Sentinel: How Not To Market Obamacare To Millennials
The White House is desperate to sign up Wisconsin's millennials for Obamacare. With the March 31 enrollment deadline closing fast, the latest figures show that only 19% of the state's Obamacare sign-ups are between ages 18 and 34. That's a far cry from the 40% that the White House wants. Blame the Obamacare marketing team. Since the health care exchanges launched last October, their attempts to convince us to sign up have been inappropriate, incoherent and simply insulting (Evan Feinberg, 3/19).

The Star Tribune: MNsure Made Me Cry. My Three-Month Quest For Health Insurance
As a self-employed, small business owner, I had high hopes for the Affordable Care Act.  I was giddy at the thought of lowering my premium costs, which now total $6,000 a year for an individual policy with a very high deductible. Obamacare, as it is usually called, was passed in spring 2010, but didn't go into effect until this year.  I couldn't wait to sign up. If only it were that easy (Nancy Wurtzel, 3/19).

And on other health issues -

The New York Times' Opinionator: A Wedding In Intensive Care
There wasn't going to be a happy ending. The patient had metastatic cancer and had just gone through her third unsuccessful regimen of chemotherapy. Now it seemed that everywhere we looked, we found disease. ... I was just setting the clipboard aside when she raised a hand and told me, in a moment of lucidity: "Doc, do everything you can. I need to make it to my daughter's wedding." ... In today’s outcome-driven, efficiency-obsessed medical world, it's easy to forget that healing patients isn't just about treating diseases and relieving symptoms. There are things doctors and nurses can do, meaningful interventions — like helping patients fulfill final goals or spend quality time with their families — that cannot be documented in a discharge summary or be converted into a blip on a screen (Haider Javed Warraich, 3/19).

Bloomberg: Psychotic? Homicidal? You Can Still Buy A Gun
Let's say your mental landscape is similar to that of Colby Sue Weathers back in 2012: suicidal, homicidal, paranoid, schizophrenic. Oh, and with a drug and alcohol problem. You are too disabled by mental illness -- schizophrenia was diagnosed in 2011 -- and recurring hospitalizations to work. You are not great about maintaining your psychotropic drug regimen, which you administer inconsistently and sometimes to woozy excess. And you have an occasional hankering, occasionally satisfied, to consume a fifth of liquor. In other words, your life is utterly out of control. One trouble you probably don't have -- provided you live in the U.S. -- is gaining access to a lethal firearm (Francis Wilkinson, 3/19).

The Washington Post: Relative Value Health Care: Some Obstacles
Last week I put up two posts (Health-care costs and the 'moral hazard' problem; Relative-value health insurance) about my idea of relative value health insurance ("RVHI"). RVHI could help control health-care cost inflation by providing consumers with the opportunity to purchase insurance that would cover only medical treatments that satisfy a specified cost effectiveness standard rather than all treatment with any expected medical benefit regardless of the size of that benefit or its cost. The government would facilitate a market by rating medical interventions provided for different conditions on a scale of 1 (most cost effective) to 10 (least cost effective). This would allow private insurers to offer, and consumers to purchase, insurance coverage of different "depths" at different prices. Today I’m going to discuss some of the most significant challenges to implementing such a system (Russell Korobkin, 3/19).

WBUR: Emergency Care 'Insult To Injury': Medical Bills That Make You Say What?!
I knew there were scads of financial horror stories out there that would make my $446 bill for an ear rinse look like chump change. But when I wrote about it last week — Lesson Of The $446 Ear Rinse: Medical Bills That Make You Say 'What?!' — little did I know that The Tampa Bay Times had just published a fabulous series documenting some truly astronomical-beyond-all-reason trauma center charges. … On a smaller scale, many readers' responses to the ear-rinse pricetag sounded a similar ER theme. One — whose cut knuckle didn't need stitches and so was treated with Neosporin and a Bandaid — was charged $600 (Carey Goldberg, 3/19).

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