“Under the Affordable Care Act, insurance plans are required to give new mothers equipment and services to enable them to breast feed. What that means in practical terms for most moms is that insurers have to cover the cost of a breast pump – either a rental or a new one. What the law doesn’t say, however, is what kind of pump has to be provided. It is left to the insurance companies, following doctors’ recommendations, to decide whether to cover the cost of an electric or a manual pump.”

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“The Pioneer accountable care organizations have asked the Center for Medicare and Medicaid Innovation to revise quality benchmarks the ACOs have to meet to qualify for Medicare bonuses, threatening to drop out of the program otherwise. The Pioneer ACOs note 19 of 31 quality measures were set without anchoring methodology, reflecting a lack of data, according to a letter sent Feb. 25 and posted online by The Washington Post.”

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“The Beige Book, which paints a picture of the economy by drawing on the contacts maintained by regional Fed banks with their local business communities, was prepared this time around by the Kansas City Federal Reserve. It’s not usually considered to have any partisan tilt, although obviously the views it reports are those of the business sector (rather than, say, the labor unions). ‘Employers in several Districts cited the unknown effects of the Affordable Care Act as reasons for planned layoffs and reluctance to hire more staff,’ the report says.”

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“For states, it’s the medium to long-term fiscal picture that presents the biggest worry. The long-term politics of federal budgeting make short-term state policy choices rather dicey: Who knows what Congress will do as the cost of government health programs rise and the already bad budget situation grows worse? Cost shifting to states may not be inevitable, but it’s quite likely, which means that even if expanding Medicaid is essentially free now, it almost certainly won’t be in the future.”

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“Most health plans provide some prescription drug benefits. Drug coverage will become more prevalent as more uninsured families gain health insurance as a result of the 2010 Patient Protection and Affordable Care Act (ACA)… As drug coverage has become widespread, so have calls to impose additional regulations on drug plans and the firms that manage them. In the guise of protecting consumers, there are frequent calls for state and federal lawmakers to enact laws that hamper efficient management of prescription drug benefits. These efforts are short-sighted.”

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“The architects of Obamacare designed the scheme without much thought to how its overlapping incentives would discourage competition on the price of the new coverage. Health plans will try to drive down costs by offering very narrow networks of providers that they can more easily control. It will be a race to the bottom to see which plan can offer the cheapest benefit, while still meeting minimum standards. But it won’t be a race to the bottom on price.”

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“But the quality measures built into ObamaCare’s ACOs aren’t working so well yet either. Indeed, last week, virtually all of the health providers that Medicare has dubbed ‘Pioneer ACOs’—the program’s leaders and examples—sent a letter to Medicare officials overseeing the program in which they threatened to drop out. The reason is that the Pioneers feel that the performance and quality metrics aren’t up to snuff—and the data doesn’t yet exist to determine what the metrics should look like.”

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“On Friday, HHS all but admitted that at least one element of the exchanges won’t be entirely ready on time: the Small business Health Options Program (SHOP) — the health insurance exchanges ObamaCare set up to serve small employers. The SHOP exchanges were supposed to be fully in place by January 1, 2014. But newly released regulations propose delaying a key part of the small business exchanges for a year: the employee choice provisions that were arguably the most significant feature of the program.”

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“When Obamacare was being debated 2009, proponents banked heavily on its transformative potential. When skeptics caviled about the costs, the reformers pointed out that there were all sorts of pilots, and delivery system reforms like these ACO demonstration projects, that hadn’t gotten scored as cost-saving by the Congressional Budget Office… So far, pretty much every one of those promised improvements has underwhelmed, and the skeptics have been vindicated.”

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“In some cases we’ve heard about, a local McDonalds has hired employees to operate the cash register or flip burgers for 20 hours a week and then the workers head to the nearby Burger King BKW -2.82% or Wendy’s to log another 20 hours. Other employees take the opposite shifts. Welcome to the strange new world of small-business hiring under ObamaCare.”

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