Obama’s Trauma Team: Inside the Nightmare Launch of HealthCare.Gov — Printout — TIME

February 28, 2014

Unknown to a nation following the fiasco, McDonough’s assignment from the President had boiled down to something more dire than how to fix the site. As the chief of staff remembers his mission, it was “Can it be patched and improved to work, or does it need to be scrapped to start over? He wanted to know if this thing is salvageable.”

Yes, on Oct. 17, the President was thinking of scrapping the whole thing and starting over.

via Obama’s Trauma Team: Inside the Nightmare Launch of HealthCare.Gov — Printout — TIME.

Upholding the Law | The Weekly Standard

February 28, 2014

A second option is recourse to the courts. Bringing suit against the president to invalidate his extraconstitutional actions is a reasonable idea. It has the advantage of bringing in a third, neutral party to adjudicate a dispute between the legislative and executive branches. House Republicans have long been wary of this approach, for one good reason: They too support delaying the implementation of Obamacare. Why sue to overturn welcome delays even if wrongly put in place by executive order?

In recent days, more than 100 House Republicans have overcome their hesitation and cosponsored Rep. Tim Rice’s STOP (Stop This Overreaching Presidency) legislation to bring suit against the president. This is a good start, which offers several advantages.

via Upholding the Law | The Weekly Standard.

Bachmann: ‘Lawless’ Obama ‘rules by tweet’ [VIDEO] | The Daily Caller

February 28, 2014

The large number of unilateral changes made to Obamacare morph the law beyond recognition and make navigating legal obligations almost impossible, Bachmann said.

“From morning till night we don’t know the rules of the game,” she said. “When I woke up yesterday morning, I knew that the rules of Obamacare were going to be something. Well, by 4:45 in the afternoon, the president had changed it yesterday. So we don’t even know from moment to moment how to plan.”

The Constitution offers a remedy to an administration has greatly overstepped its lawful bounds: impeachment.

But impeachment proceedings require not just legal action but political will, Bachmann explained.

“The reality is that impeachment is probably more political than legal,” Bachmann said, explaining that while the articles of impeachment originate in the House, it’s up to the Senate to carry them out, and that the Senate did not have the votes to remove former Democratic President Bill Clinton from office.

For impeachment to succeed, voters must pool their support into a campaign that would indict Obama and strip him of office.

“Has he violated the law?” Bachmann said. “In my opinion, yes, the President of the United States has violated the law, but we must have the support of the American people in order to have impeachment.”

via Bachmann: ‘Lawless’ Obama ‘rules by tweet’ [VIDEO] | The Daily Caller.

Kaiser Health Policy News Index: February 2014 | The Henry J. Kaiser Family Foundation

February 28, 2014

The Kaiser Health Policy News Index is designed to help journalists and policymakers understand which health policy-related news stories Americans are paying attention to, and what the public understands about health policy issues covered in the news. This month’s Index finds that the implementation of the Affordable Care Act (ACA) was the most-closely followed health policy news story this month, ranking behind news of the U.S. economy, but ahead of news about the Winter Olympics and President Obama’s State of the Union address in late January. The survey also finds that the news media is by far the public’s top source of information on the ACA, and that more say their impression of the law is based on what they’ve heard in the media than on their own experiences or those of their family and friends. The public continues to say that the media’s coverage of the law has focused more on politics and controversies than the impact on people. A plurality feel coverage is balanced but more feel it is biased against the law than for it.

via Kaiser Health Policy News Index: February 2014 | The Henry J. Kaiser Family Foundation.

Senator Tom Coburn, M.D. | The History of Federal Health Care Spending

February 26, 2014

Regardless of whether policymakers want to see the ACA improved or replaced, both sides can benefit from learning about the health policy experiments of the past. They reveal two valuable lessons:

First, the federal government’s spending on health care programs usually outpaces economic growth.*

This fact presents a significant challenge to policy-makers—as the growth in these programs crowds out other budgetary priorities. It also presents an increasing threat to taxpayers and consumers, who will, as a result, either face higher tax burdens, larger debt, or reduced focus on other important federal priorities.

Second, compared with initial government estimates and outlays, most programs have experienced exponential growth in real terms when compared to initial estimates. Certainly, a variety of modifications to eligibility and benefits have been made in these programs by Congress since their inception. And it is also true over the longer-term, demographic and market changes (like innovations in medical technology and longer life-expectancy) have significantly impacted the growth in spending within these programs. But the historical trend is clear: federal spending on health care programs will increase vastly and outpace economic growth. Moreover, the original estimates of program outlays are relatively poor indicators of actual spending over a longer period of time.

Based on a review of the facts, readers have solid ground for concluding the federal government has a poor track record of constraining health care spending over time. Accordingly, in light of the reality of past trends, concern about the trajectory of the future health care spending – whether in the ACA, Medicare, Medicaid, or other programs—is well placed.

Full report.


Halbig v. Sebelius: Roundup Of Pro-Plaintiff Amicus Briefs In “The Most Significant Existential Threat” To ObamaCare

February 26, 2014

Halbig v. Sebelius and three related cases are, in the words of one prominent ObamaCare supporter, “probably the most significant existential threat to the Affordable Care Act.” The goal of these lawsuits is to stop the IRS from creating a $700 billion entitlement without Congress. If  ObamaCare cannot survive without such egregious executive overreach, perhaps it does not deserve to survive.

Here’s an overview of the issue.

The Halbig plaintiffs have appealed an adverse ruling by the U.S. District Court for the District of Columbia to the U.S. Court of Appeals for the D.C. Circuit. (In one of the related cases, King v. Sebelius, plaintiffs have appealed an adverse ruling by the District Court for the Eastern District of Virginia to the Court of Appeals for the Fourth Circuit.) Oral arguments in the Halbig appeal take place on March 25.

What follows is a roundup of amicus briefs that have been filed in support of the Halbig plaintiffs.

via Halbig v. Sebelius: Roundup Of Pro-Plaintiff Amicus Briefs In “The Most Significant Existential Threat” To ObamaCare.

Top 10 Healthcare Services Excluded Under Obamacare – Healthpocket

February 26, 2014

With the release of the new Affordable Care Act health plans, HealthPocket examined what medical services were most frequently excluded from health insurance coverage in 2014 and compared the results to the most common exclusions in the pre-reform health insurance market. HealthPocket found that 80% of exclusions were the same between the 2013 and 2014 lists of medical services most frequently not covered by plans in the individual health insurance market.

via Top 10 Healthcare Services Excluded Under Obamacare – Healthpocket.

Health reform law posed cybersecurity challenges | Modern Healthcare

February 26, 2014

As the Obama administration raced to meet its self-imposed deadline for online health insurance markets, security experts working for the government worried that state computer systems could become a back door for hackers.

Documents provided to The Associated Press show that more than two-thirds of state systems that were supposed to tap into federal computers to verify sensitive personal information for coverage were initially rated as “high risk” for security problems.

Back-door attacks have been in the news, since the hackers who stole millions of customers’ credit and debit card numbers from Target are believed to have gained access through a contractor’s network.

via Health reform law posed cybersecurity challenges | Modern Healthcare.

Study Questions Benefits of ‘Medical Home’ Programs for Chronically Ill – WSJ.com

February 26, 2014

Health-policy experts often talk up the notion of a “patient-center medical home”—in which a medical practice actively manages patients’ chronic conditions to improve their health and avoid hospitalizations—as the ideal model for transforming the U.S. health-care system.

But a study of one of the earliest and largest medical-home pilots found that after three years, patients’ health improved in only 1 of 11 measures. There was no change in hospital or emergency-room use, and no significant cost savings.

“There are folks who believe the medical home is a proven intervention that doesn’t even need to be tested or refined. Our findings will hopefully change those views,” said Mark W. Friedberg, a researcher at RAND Corp. and lead author of the study, published Tuesday in the Journal of the American Medical Association.

via Study Questions Benefits of ‘Medical Home’ Programs for Chronically Ill – WSJ.com.

Improvements in Health Status after Massachusetts Health Care Reform

February 26, 2014

Context: Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts relative to that in other New England states.

Methods: We used a quasi-experimental design with data from the Behavioral Risk Factor Surveillance System from 2001 to 2011 to compare trends associated with health reform in Massachusetts relative to that in other New England states. We compared self-reported health and the use of preventive services using multivariate logistic regression with difference-in-differences analysis to account for temporal trends. We estimated predicted probabilities and changes in these probabilities to gauge the differential effects between Massachusetts and other New England states. Finally, we conducted subgroup analysis to assess the differential changes by income and race/ethnicity.

Findings: The sample included 345,211 adults aged eighteen to sixty-four. In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%). Massachusetts residents also reported significant relative increases in rates of Pap screening (2.3%), colonoscopy (5.5%), and cholesterol testing (1.4%). Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.

Conclusions: Health care reform in Massachusetts was associated with improved health status and the greater use of some preventive services relative to those in other New England states, particularly among low-income households. These findings may stem from expanded insurance coverage as well as innovations in health care delivery that accelerated after health reform.

Full study.