Health Policy: the Obama Era

Physician and policy commentary on health care under the Obama administration, covering the Affordable Care Act, insurance reform, and the political decisions that reshaped American medicine.

Obamacare: What will the administration back off on next?

Robert Laszewski

Health Policy

February 21, 2014

I recently asked if Obamacare was unraveling.

The Obama administration announced that they are delaying the employer mandate again.

In the announcement, they said that large employers, those with at least 100 workers, will only have to cover 70% of their otherwise eligible workforce in 2015 and 95% in 2016 and beyond.

The administration also said that employers with 50 to 100 workers will have their mandate to provide affordable health …

Obamacare supporters shouldn’t cast a blind eye to its faults

Bob Doherty

Health Policy

February 19, 2014

Even the best of families have skeletons: the uncle who had some shady business dealings, the cousin in drug rehab, brother with the messy divorce and custody fight, or the adult kids who are maxed out on their credit and behind in their mortgage payments but have to “keep up appearances” with their expensive suburban lifestyle. When these things happen, there is a tendency to “keep it all in the …

Does Obamacare really kill jobs?

Brad Wright, PhD

Health Policy

February 12, 2014

A primary criticism of the Affordable Care Act is that it creates incentives for employers to hire fewer full-time employees. One of the House’s attempts to repeal the ACA even referenced it as the “job-killing healthcare law.” It’s true that there are some provisions in the ACA that employers may exploit in order to minimize the cost of doing business.

At the same time, it’s also true that the ACA protects …

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Does Obamacare really kill jobs?

The Affordable Care Act is here and the sky has not fallen

Brad Wright, PhD

Health Policy

January 28, 2014

The Affordable Care Act was enacted all the way back in 2010. But, even before then, critics were asserting that this new law would more or less destroy the American economy, insert Uncle Sam squarely between patients and providers, and initiate the end of freedom as it ushered in socialized medicine. That was nearly 4 years — and 40 repeal attempts — ago, and yet, the sky remains intact above …

How should we define the success of the Affordable Care Act?

Brad Wright, PhD

Health Policy

January 15, 2014

In recent months, news reports focused on the number of new enrollees as a key test of the law. Although the troubled performance of the Healthcare.gov website during October and November delayed enrollment for hundreds of thousands of potential subscribers, Obama administration officials and congressional Democrats hailed a surge in enrollment at the end of the year as proof that the law would fulfill its promise of providing affordable coverage to …

Why Obamacare isn’t at risk for a death spiral anytime soon

Robert Laszewski

Health Policy

January 14, 2014

If the Obamacare health insurance exchanges are not able to get a good spread of risk — many more healthy people than sick — the long-term viability of the program will be placed in great jeopardy.

Given the early signs — far fewer people signing up than expected, enormous negative publicity about website problems, rate shock, big average deductibles, narrow provider networks, and a general growing dissatisfaction over the new health …

What can physicians expect from Obamacare in 2014?

Bob Doherty

Health Policy

January 7, 2014

Tthe ACA will now begin to transform how millions of Americans get health insurance coverage. Most of us will find that the plans offered by our employers are mostly unchanged because they measure up to federal standards. To the extent that some employers are imposing “negative changes, which include higher premiums, co-pays and deductibles, they’ve all been happening for more than a decade” because of employers wanting to …

On the heels of the Obamacare rollout comes ICD-10

Kevin R. Campbell, MD

Health Policy

January 6, 2014

Due to the ineptness of the Obamacare team and the debacle that has ensued, the botched rollout of the Affordable Care Act has dominated the political and medical headlines since October.

However, other health care changes are on the horizon (and have gone virtually unnoticed by the public) that have the potential to further disrupt our ability to treat patients. In fact, the technical and time consuming aspects of …

Is Obamacare finally on track and moving toward success?

Robert Laszewski

Health Policy

January 1, 2014

After the disastrous launch of Obamacare the enrollment of 1.1 million people in the 36 state exchanges run by the feds is a major accomplishment. It is likely that the enrollment in the 14 state-run exchanges will take total Obamacare’s private insurance enrollment to near 2 million for the year.

Does this mean that Obamacare is finally on track and moving toward success?

At least the front-end of Healthcare.gov is now clearly …

The cheapest form of health care is to let sick people die

John F. Hunt, MD

Health Policy

December 21, 2013

If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation.

Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the …

Is it racist to oppose Obamacare?

Peter Ubel, MD

Health Policy

December 17, 2013

It is pretty easy to be against Obamacare these days.

The federal government can’t come up with a working website to help people buy health insurance. The president misled people about whether they could hold onto their old insurance plans. And come next tax day, the least popular provision of the Affordable Care Act — the individual mandate — will be implemented for the first time.

Lost amidst all this controversy is …

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Is it racist to oppose Obamacare?

Healthcare.gov is fixed, or is it?

Robert Laszewski

Health Policy

December 6, 2013

From 27,000 enrollments in October to a reported 100,000 enrollments in November, the Affordable Care Act’s website is apparently working better and getting more people signed up.

But is it fixed well enough to handle the expected wave of at least many hundreds of thousands of people eager to get guarantee issue health insurance for the first time or replace a canceled policy by January 1?

Here are some of the press …

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Healthcare.gov is fixed, or is it?

You can now keep your plan: What does this mean for you?

Brad Wright, PhD

Health Policy

November 18, 2013

The president, by his own admission, did “fumble the ball” on the rollout of the major elements of health reform implementation. Not only is Healthcare.gov not functioning as it should, but people in the individual market are having their health insurance coverage cancelled–despite repeated assurances that if they liked their current coverage, they could keep it.

While that is absolutely a problem, it needs to be put into perspective. For …

Is Obamacare paternalistic?

Bob Doherty

Health Policy

November 18, 2013

Dr. Bob Centor, author of the always provocative and thoughtful DB’s Medical Rants, suggests that the deep divide over the Affordable Care Act is based on “a major philosophic disagreement” over the respective roles of government and of individuals in choosing what is best for them:

The administration and their supporters believe that government’s job is to protect citizens from their bad choices. They want to decide what the people need and …

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Is Obamacare paternalistic?

California offers clues to the future of the Obamacare exchanges

Robert Laszewski

Health Policy

November 18, 2013

Covered California, the state-run Obamacare health insurance exchange, announced recently that 59,000 people have so far signed up for health insurance.

Given that California amounts to about 10% of the nation’s population, this would suggest a smooth running federal exchange might well have enabled the Obama administration to have met its national first month goal of 500,000 sign-ups.

But the California enrollment also points to the real challenge Obamacare faces.

In the first …

3 reasons to be against Obamacare

Margalit Gur-Arie

Health Policy

November 12, 2013

If you are a staunch conservative who believes that free markets should solve health care, or that poor people should work harder and have more skin in the game, or that governments should stick to building armies, you don’t need to read this post, unless of course you enjoy being aggravated by liberals.

If you are one of the talking heads posing as a progressive, while repeating the slogans of Obamacare …

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3 reasons to be against Obamacare

A meeting with Kathleen Sebelius about Obamacare

Manoj Jain, MD, MPH

Health Policy

November 12, 2013

Recently, I was among a dozen people who sat privately to talk about the Affordable Care Act (ACA), aka Obamacare, with the embattled Health and Human Services Secretary, Kathleen Sebelius. Dressed in a light green blazer, sitting alongside Memphis Mayor AC Wharton and Congressman Steve Cohen, who had nudged her to visit Memphis, Secretary Sebelius listened to our feedback and shared her insights.

First and foremost, addressing the issue of the …

Obamacare covers screening colonoscopies, with a catch

Stephen C. Schimpff, MD

Conditions and Diseases

October 25, 2013

“An ounce of prevention” we all know is good medicine. An example is colonoscopy. It was time for mine so after some lengthy procrastination I called and set up an appointment which I soon found a perfectly good reason to postpone for a few weeks. A common occurrence. The government wants me (and you) to not procrastinate, at least not because of the cost. The Affordable Care Act (or Obamacare) …

Medical students may find themselves without a job

Christy Duan

Medical Education

October 12, 2013

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“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of …

I support the Affordable Care Act, but not Obamacare

Kenneth Lin, MD

Health Policy

October 7, 2013

More than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.

Let me admit that I’ve never had particularly …