Affordable Care Act

In Wonkblog yesterday, Sarah Kliff highlighted an important aspect of immigration reform: Undocumented immigrants who gain legal status will also gain access to the Affordable Care Act’s options for getting health insurance. The Congressional Budget Office estimated that the ACA would reduce our nonelderly uninsured by 32 million, but 23 million people would remain without health insurance – and one-third of those people would be undocumented immigrants. The ACA has two main mechanisms for offering affordable coverage to the uninsured: 1) expansion of Medicaid eligibility to all legal…
by Kim Krisberg When it comes to good health, America is far from top dog. Yes, we may spend the most, we may have some of the most advanced medical technologies and we may produce some of the best doctors. But when it comes to the ultimate measure of a health care system's success — the health of people and populations — it seems we are losing a winnable battle. "There's hardly anything more consequential than Americans dying earlier and being sicker," Dr. Steven Woolf, chair of the Institute of Medicine's and National Research Council's Panel on Understanding Cross-National Health…
This is the part of President Obama's 2013 inaugural address that resonated with me the most: We, the people, still believe that every citizen deserves a basic measure of security and dignity. We must make the hard choices to reduce the cost of health care and the size of our deficit. But we reject the belief that America must choose between caring for the generation that built this country and investing in the generation that will build its future. For we remember the lessons of our past, when twilight years were spent in poverty, and parents of a child with a disability had nowhere to turn…
In looking back at the year 2012, one of the most momentous occasions was the Supreme Court decision on the Affordable Care Act. Here are a few of our posts on the topic: Broccoli, Coercion, and Severability: Three days of SCOTUS arguments on the Affordable Care Act: Liz summarized the legal issues the Court was considering: the constitutionality of the law's individual mandate, whether the federal government could force states to expand their Medicaid programs as a condition of continuing to participate in Medicaid, and whether the law as a whole could stand if a single provision were to be…
by Kim Krisberg At Palm Beach Groves in Lantana, Fla., a small, seasonal business that ships fresh citrus nationwide, employees have regularly voted between getting a raise or keeping their employer-based health insurance. Health coverage always wins, as many employees' ages and pre-existing conditions would have made it nearly impossible to get coverage on their own. In her 12 years with Palm Beach Groves, general manager Louisa McQueeney has seen insurance premiums go up anywhere from 12 percent to 32 percent a year. Coverage for her family alone — herself, her husband and daughter — was $1…
Monday was the start date for an Affordable Care Act provision aimed at reducing high rates of hospital readmission among Medicare patients. This year, hospitals determined to have excess readmissions for patients with acute myocardial infarctions, heart failure, and pneumonia can lose up to one percent of their Medicare reimbursements for the year -- and in future years, the list of applicable conditions will get longer and the percentage of payments at risk will rise to three percent. But to what extent are readmissions under hospitals' control? First, a bit of background: Readmissions are…
The extent to which the Affordable Care Act succeeds in making affordable health insurance more widely available depends to a great degree on the success of the state-based health insurance exchanges that are currently being developed. A piece by Ewout van Ginneken and Katherine Schwartz in the latest New England Journal of Medicine offers some advice and cautions about the exchanges, based on the experiences of the Netherlands and Switzerland. Both those countries rely extensively on private insurers plus substantial government involvement. Risk adjustment is one key to exchanges' success.…
Millions of people will gain insurance under the Affordable Care Act, but will they be able to get appointments with healthcare providers? Coverage doesn't automatically translate into access, and some newly insured individuals will struggle to find physician practices that will take them on as patients. In particular, states that adopt the (now optional) Affordable Care Act Medicaid expansion, which extends eligibility to adults up to 133% of the poverty level, may encounter a severe shortage of providers willing to accept new Medicaid patients. Although Medicaid reimbursement levels vary…
by Kim Krisberg Legislative attacks on women's health care are so commonplace these days that they make proposals that don't include a state-mandated vaginal probe seem moderate. In fact, so many legislators are introducing proposals under the guise of protecting women's health (2011 marked a record number of reproductive health restrictions), that it was pretty refreshing to read how the Affordable Care Act will actually protect women's health. Like, for real. Last week, the Commonwealth Fund released a report finding that the health reform law is already making a difference in the lives of…
Joe Paduda at Managed Care Matters has posted the second of two parts in the special edition of Health Wonk Review responding to the Supreme Court's decision on the Affordable Care Act: Part I is here, and Part II is here. I'm delighted with the Court's decision to uphold the law as a whole, but concerned about its making the Medicaid expansion optional. One Slate article and two posts on the Health Affairs Blog (one of which was included in Part I of the special-edition HWR) are especially helpful in thinking about the Medicaid aspect of the decision: Darshak Sanghavi explains in Slate that…
There's been a lot of great analysis and commentary since the Supreme Court issued its decision on the Affordable Care Act yesterday. Joe Paduda at Managed Care Matters is graciously hosting a special edition of Health Wonk Review -- check it out a variety of takes on the legal, economic, and healthcare implications of the decision. On the topic of states now getting to choose whether or not to participate in the Medicaid expansion, Sarah Kliff talks to Matt Salo, director of the National Association of Medicaid Directors, about how states will think through their options and runs some of the…
As Kim has already reported, public health advocates are delighted that the Supreme Court has upheld the Affordable Care Act. The law takes important steps toward improving the way we pay for care and invest in prevention, but its most important achievement is in reforming the bizarre US health-insurance system, whose reliance on voluntary employer-sponsored coverage has resulted in millions of people lacking health insurance. By deciding that the law’s Medicaid expansion is optional for states, though, the Court is leaving the fate of 16 million low-income people up in the air. The ACA…
by Kim Krisberg For me, there were few better places to hear about today's 5-4 Supreme Court ruling upholding the Affordable Care Act and its individual insurance mandate than at a meeting of the American Public Health Association (APHA). Here in Charlotte, N.C., for APHA's Midyear Meeting, I was surrounded by hundreds of public health practitioners, researchers and advocates as we all watched the magnified scroll of Scotusblog.com, anxiously waiting for the decision. At 10:08 a.m., the blog declared: "The individual mandate survives as a tax." That was when the cheers (and tears) began. You…
It's good news that the Supreme Court split 5-4 with Roberts (and not Kennedy?!?) as the deciding vote, to uphold the affordable care act. It's interesting that this was controversial, and certainly Roberts led the court to a very safe middle ground making the issue about taxation and saying the commerce clause could not apply. If anything, I wonder if this weakens the previous commerce powers of Congress as defined by Wickard v. Filburn, I'd love to hear what a lawyer thinks. What does this mean? Well in the short term not a whole lot, this healthcare bill requires a very slow roll-out…
As we're waiting to learn whether the Affordable Care Act will survive the upcoming Supreme Court decision, it's a good time to remember what's at stake with the individual mandate -- the part of the law that's least popular with the public and that some Supreme Court Justices seem to find objectionable. I've written before about why the mandate, which requires everyone who can afford it to purchase health insurance or pay a penalty, is a necessary part of the healthcare law and is not the same as requiring everyone to buy broccoli. Now, the Washington Post's Sarah Kliff adds to the…
Just as Republican lawmakers have been hyping the virtues of purchasing private health insurance----versus the evils of "Obamacare"----my husband Jim and I needed to do just that. I had been writing a check for $659 each month to maintain health insurance coverage under my former employer's plan, as provided by COBRA. After 18 months, it was due to expire. The time had come for us to venture into the Republicans' fantasy land of the free marketplace for health insurance. We took a deep breath and dove in. The first thing we learned is that you don't really purchase health insurance. You…
by Kim Krisberg Broccoli. A nutritious green veggie of the cabbage family? Or a symbol of the federal government's over-reaching power grab? Like most things in life, it all depends on your perspective. I've been thinking about that word -- broccoli -- since last month's Supreme Court hearings on the constitutionality of provisions within the Affordable Care Act (ACA). Specifically, I've been pondering this comment from Justice Antonin Scalia during arguments on the ACA's individual insurance mandate: SCALIA: . . . could you define the market -- everybody has to buy food sooner or later, so…
Unless they've deviated from their normal procedure, the Supreme Court justices have now decided on how they'll rule on the Affordable Care Act - but, as the Washington Post's Robert Barnes points out, we'll have to wait until late June to hear their verdict. In the meantime, this is a good opportunity to recap the key issues in the case and highlight some of the more insightful commentary about them. The first issue on which the Court heard arguments was whether it could rule on this case to begin with, since it involves a tax on people who don't have health insurance coverage (or a hardship…
With the Supreme Court hearing arguments for the next three days on the Affordable Care Act, many commentators, including Dahlia Lithwick appear to have so much contempt for the Roberts court that they believe the issue will likely be settled on politics rather than law. The first proposition is that the health care law is constitutional. The second is that the court could strike it down anyway. ... The law is a completely valid exercise of Congress' Commerce Clause power, and all the conservative longing for the good old days of the pre-New Deal courts won't put us back in those days as if…
We've already extensively discussed why it costs twice as much for the US to provide healthcare for it's citizens all the while failing to cover health care for all. Most recently, we discussed the hidden tax of the uninsured and the perverse incentive structure of US healthcare which encourage costlier care, more utilization, and more procedures. To summarize, the US spends more on healthcare compared to other industrialized nations because We deliver it inefficiently Without universality problems present when critical and in the ER Fee-for-service incentives in the form of excessive…