The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

“E.J. Dionne has a nice column pointing out that while “Obamacare” remains unpopular, most of the provisions are well-liked, and thus Democrats should run on the issue. As regular readers know, I certainly agree that the individual components of reform are far more popular than reform overall. However, the column’s headline — “Obamacare has growing support, even if its name does not” — isn’t really buttressed by the article. Actually, support for key provisions of the law, including coverage of pre-existing conditions, health-insurance exchanges offering subsidies to middle-income policy holders and Obamacare’s Medicaid expansion, have always polled well.
Moreover caution is always in order with issue polling. When these kinds of polls show public opinion fractured, it’s tempting to believe that one side or the other represents voters’ “true” support. That’s the wrong way to interpret such polls. Yes, the ACA polls badly while most of its components poll well. But that doesn’t mean that the ACA is genuinely unpopular (as most opponents suggest) or that it’s genuinely popular (as most supporters contend). There is no underlying truth to be excavated from the results; the best we can do is say that public opinion is inconsistent.”

“The Oregon Department of Justice jousted for nearly two months with Oracle America over the state’s demand for documents from the California software giant relating to the health exchange debacle.
In fact, Oracle flouted state law and stymied the demand, according to DOJ.
The state filed papers in federal court Friday that provide a glimpse into high-stakes jockeying that for months took place largely out of public view.
DOJ filed its federal papers shortly after the state’s lawyers sued Oracle in Marion County Circuit Court on Aug. 22.
In its federal filing, DOJ accuses Oracle of “stalling” and attempting to manipulate the legal system by filing its own federal lawsuit against Oregon on Aug. 8.”

“As federal officials wrestle over whether HealthCare.gov will withstand the weight of millions of new customers and re-enrollees this fall, state brass with Your Health Idaho are looking to detach from the federal health insurance portal.
But they’re going to need help from Idahoans.
The state-run insurance marketplace has begun setting up state-based accounts through its own technology for the 76,000 residents who signed up for health care last year, said spokeswoman Jody Olson.
Idaho used HealthCare.gov’s Web system in its inaugural year, as officials believed accounts could easily be transferred. The federal government, however, continues to “drag its feet, and we still don’t have the data we were told we’d get,” Olson wrote in a release.”

“Responding to ongoing problems at the Washington Healthplanfinder insurance exchange, state Insurance Commissioner Mike Kreidler on Monday instituted a limited special enrollment period for consumers who want to obtain coverage outside the exchange.
From Aug. 27 to Nov. 14, those who have had problems with enrolling or making payments through Healthplanfinder can enroll in coverage outside the exchange either by selecting a different plan with the same carrier or by changing carriers.
“This is a problem that has been around since the end of December,” Kreidler said in an interview. “I am cautiously optimistic that the exchange is doing a much better job right now to resolve the problems, but there is no guarantee that they’re going to be gone as we go into open enrollment.””

“When she was eight weeks old, Ashlyn Whitney suffered a severe respiratory-tract infection that put her in an intensive care unit for 12 days.
“Because she was so young, she couldn’t handle it,” Ashlyn’s mother, Nicole Whitney, recalled. “They had to give her oxygen.”
The baby, now a year old, recovered from her illness, known as respiratory syncytial virus.The bill for her treatment at the West Boca Medical Center in Palm Beach County came to about $100,000 — a sum that included almost $4,000 in fees for her birth and pre- and post-natal care — but every dime of the tab was picked up by a medical bill-sharing organization set up for its Christian membership.
Such religious groups are exempt from the Affordable Care Act’s mandate that most Americans obtain health insurance or pay a penalty. Although as many as 30 million Americans will remain without health insurance by 2016, despite the best efforts of the ACA’s proponents, all but about seven million of them will be spared having to join the new system because of exemptions created by the act itself, according to an analysis by the Congressional Budget Office and the staff of the Joint Committee on Taxation.”

“Todd Park, President Obama’s top technology adviser and an important figure in the emergency effort last year to fix the federal government’s online health care marketplace after a disastrous beginning, is leaving the White House, a person familiar with the matter said Monday.
Mr. Park, 41, who was only the second federal official to hold the title of chief technology officer, will return to Silicon Valley at the end of the month and continue to help the White House recruit engineers, this person said.
Mr. Park, a son of Korean immigrants and a Harvard graduate who was a founder of a health information technology company when he was 24, joined the White House in March 2012 after three years as the top technology official at the Department of Health and Human Services.”

“Devin Payne had gone years without health insurance – having little need and not much money to pay for it.
Then Payne, who had a wife and four children, realized she could no longer live as a man.
In her early 40s, she changed her name, began wearing long skirts and grew out her sandy blond hair. And she started taking female hormones, which caused her breasts to develop and the muscle mass on her 6-foot one-inch frame to shrink.
The next step was gender reassignment surgery. For that, Payne, who is now 44, said she needed health coverage. “It is not a simple, easy, magical surgery,” said Payne, a photographer who lives in Palm Springs. “Trying to do this without insurance is a big risk. Things can go wrong … not having the money to pay for it would be awful.”
Payne learned in the fall that she might qualify for subsidies through the state’s new insurance marketplace, Covered California, because her income fell under the limit of $46,000 a year. She eagerly signed up in March for a Blue Shield plan for about $230 a month, and began making preparations for the surgery that would change her life.”

“Those who favor women being guaranteed no-cost birth control coverage under their health insurance say the new rules for nonprofit religious organizations issued by the Obama administration simply put into force what the Supreme Court suggested last month.
A demonstrator holding up a sign outside the Supreme Court in Washington in June 2014. The Obama administration announced new measures last week to allow religious nonprofits and some companies to opt out of paying for birth control for female employees while still ensuring those employees have access to contraception. (Photo by Pablo Martinez Mosivais/AP)
“We interpret what [the administration] did to be putting into effect that order,” said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center. She’s referring to the controversial Supreme Court order in a lower court case involving Wheaton College, a Christian school in Illinois.
The unsigned order agreed to by six of the nine justices said Wheaton College need not fill out and send to its insurance company a form opting out of offering the coverage. Instead, it could merely inform the government of its objections.
The new rules unveiled Friday require those with religious objections to providing some or all FDA-approved contraceptives to do exactly that – notify the government rather than their insurance carriers that they cannot provide the coverage. Many religious organizations had complained that filing the form to their insurance companies, which would then provide the coverage using other funds, would make them “complicit” in providing the benefit. Under the new regulations, the government would subsequently be responsible for notifying insurers, which would then arrange contraceptive coverage.”

“As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t.
The move is prompted by concerns that offering free or discounted care to low-income, uninsured patients might dissuade them from getting government-subsidized coverage. It also reflects hospitals’ strong financial interest in having more patients covered by insurance as the federal government makes big cuts in funding for uncompensated care.
If a patient is eligible to purchase subsidized coverage through the law’s online marketplaces but doesn’t sign up, should hospitals “provide charity care on the same level of generosity as they were previously?” asks Peter Cunningham, a health policy expert at Virginia Commonwealth University.
Most hospitals are still wrestling with that question, but a few have changed their programs, Cunningham says.”

“Listing to a panel discussion sponsored by the Greensboro Chamber of Commerce Tuesday morning, I heard reference to a metaphor for the Affordable Care Act that I’ve heard a number of time before — the three-legged stool.
Describing the different core components of the health care reform law, three primary tenets offer their support to the law, with, each complementing and reliant upon the others, and the stool falling over if one of the legs falters.
They are: guaranteed issue and community rating (meaning an insurer can’t deny coverage or charge astronomical rates coverage because of pre-existing conditions), the individual mandate (everyone must have coverage or face a fine) and subsidies (financial assistance from the federal government to help low-income consumers can pay for coverage).
I’ve sat in on numerous, similar discussions, and had heard the metaphor before. But it wasn’t until comments from panelist Mark Hall, a professor at Wake Forest University School of Law and a leading health care policy scholar specializing in health care reform, that I realized I was missing a key part of that image.
Those are the three legs — what’s the seat represent?
As Hall noted, if you go by what the law is called, the “Affordable Care” Act, you’d be mistaken.
“One thing it doesn’t do is it doesn’t make care more affordable,” Hall said said during the discussion, which was organized by Pilot Benefits. “Mistake number one was to call it that. It doesn’t change in any significant way how doctors and hospitals are paid.”
As Hall noted, while many opponents might criticize the bill for not reducing health care spending, “the main point is it does not affect how health care is delivered or paid for. … That point is lost on about half of the population.'”