Viewpoints: 'Mixed signals' on employee benefits; Michigan debates Medicaid expansion; malpractice awards drive safety

Aug 27 2013

The New York Times: Mixed Signals On Employee Health Insurance
It is hard to know whether to rejoice or lament two striking if somewhat conflicting messages last week about the costs of employer-sponsored health insurance. An authoritative survey found that premiums for family and individual coverage at work -; including both the company's and the worker's share -; have gone up only moderately for the second year in a row. ... On the other hand, United Parcel Service told its white-collar workers that in an effort to reduce its health care costs, it will no longer cover some 15,000 spouses who can obtain coverage through their own employers (8/25).

Detroit News: Get Ready To Pay More For Health Care
A new study by the Kaiser Family Foundation further highlights the costs that will be heaped on individuals under Obamacare. Some Americans will get help from the government to pay for their health insurance. But just as many will pay more. Whether President Barack Obama likes to admit it or not, prices are going up under his championed health care law (8/26).

Detroit Free Press: Now's Not The time To Double Down On Health Law
The GOP-led state Senate may vote as early as Tuesday to accept an expansion of the federal Medicaid program and throw Michigan's weight behind the national health care law that some call Obamacare. Any benefits of a bigger Medicaid program would be short-lived and far outweighed by long-term economic and health harms. The Senate should proceed with great caution and skepticism (Joseph G. Lehman and Clifford W. Taylor, 8/25).

MLive: Sen. Patrick Colbeck On Medicaid Expansion: There Is A Better Alternative
Michigan is on the verge of adding another long-term entitlement obligation onto the backs of our taxpayers – Medicaid Expansion. Incredulously, proponents of Medicaid Expansion claim that an increase of over $1.5B in government spending will actually "save" us money. How can this be so? Simple. They claim that we will be spending "federal" money not "state" money. The last time that I checked, both "federal" and "state" money come from the same source – taxpayers. Despite being only one of the provisions buried within the 2,409 pages of statute and almost 20,000 pages of regulations known as Obamacare, the Medicaid Expansion provision is one of the most significant. It is the path to a single payer system controlled by the federal government that will be devoid of free market pressures to drive down price and improve the quality of care for our citizens (Sen. Patrick Colbeck, 8/25).

MLive: Gov. Rick Snyder On Medicaid Expansion: Healthy Michigan Would Improve Lives Of 470,000 Michiganders
Talk to people without health insurance and you'll hear one moving story after another. One woman told me about selling her car to pay for cancer treatments. ... I heard these stories and many more as I traveled around the state this summer to make the case for Healthy Michigan. That plan would provide health care coverage to 470,000 Michiganders, most working but earning less than $15,000 a year. While Healthy Michigan is a public policy issue or political question to some, it could be a matter of life and death for these hard-working people (Michigan Gov. Rick Snyder, 8/25).

Sioux Falls Argus Leader: Expand Medicaid Coverage In South Dakota
South Dakota should expand Medicaid coverage as intended under the federal Affordable Care Act. ... Gov. Dennis Daugaard decided against expansion last year, instead saying he wanted a committee to study the issue thoroughly and report back the advantages and disadvantages of making the move. That committee has wrapped up its work and is finalizing its report for Daugaard and the Legislature this month. At stake is health care coverage for an estimated 48,000 now-uninsured South Dakotans (8/24).

The Washington Post: Questions And Answers About Health Insurance Marketplaces
I've had health-care coverage throughout my working life. The most I've had to contend with has been the increasing amount of co-payments. And even then, they've been affordable. But having insurance hasn't kept me from understanding the plight of people whose employers don't offer coverage. ... Right now a lot [about the health law] hasn't been worked out. Still, HHS has done a good job walking people through the law considering how complicated it is. But be patient. The most important information you want to know -; how much your insurance will cost -; isn't posted yet (Michelle Singletary, 8/25). 

The Washington Post: Obamacare Endangers Obamacare
The best thing opponents of Obamacare have going for them is Obamacare. The implementation glitches and the ensuing delays have created a perverse system: Individuals must purchase insurance with no out-of-pocket cost cap while employers are under no obligation to provide insurance. Aside from the gross unfairness and the difficulty in rolling out the plans (e.g. exchanges aren't set up, there is no guarantee personal information will be protected, the centrality of a corrupted IRS) Obamacare's debut is bringing home several unpleasant realities (Jennifer Rubin, 8/25).

JAMA: How Serious Are The ACA Delays?
The 2014 election will be important, but with a Democratic president who regards the ACA as his signature legislation, even the election of a Republican Senate won't make it possible to change the dynamics just described. At some point, Republicans need to start thinking about how to modify the ACA to minimize its negative effects and move it in a more positive direction (Gail Wilensky, 8/23).

Philly.com: Let's  Blame Obamacare For Everything
Two major organizations announced significant changes in their health insurance benefits last week. They will no longer cover the spouses of employees who are eligible for benefits from their own employer. United Parcel Service will implement the change for white-collar workers. The University of Virginia will implement it for everyone. The reason given for the moves? Obamacare, of course (Robert I. Field, 8/26).

The New York Times: Public Policies, Made To Fit People
It makes sense for social scientists to become more involved in policy, because many of society's most challenging problems are, in essence, behavioral. ... One reason for high health care costs is that patients fail to follow their treatment regimen. A good way to approach this problem is via a behavioral assessment, identifying obstacles to that compliance. ... for some highly effective treatments, there should be no co-payment at all. That's a good place to start (Richard H. Thaler, 824).

Los Angeles Times: Don't Cut Welfare Benefits, Make It Easier To Get A Job
Michael Tanner's provocative Op-Ed in The Times on Thursday tries to make the case that welfare benefits are too generous because they leave the recipients better off than they would be if they held a job. His argument is undermined by a number of important factors he leaves out of his calculations, such as the benefits available to low-income workers. Still, he (unwittingly) makes a good case for the provisions in the 2010 healthcare law that make insurance coverage more available and affordable to low-income Americans (Jon Healey, 8/24). 

The Washington Post: The Hospital Prince George's Deserves
Of the 32,000 Marylanders who leave the state each year to seek medical care elsewhere, about three-quarters are from Prince George's County. One reason is a "pull" factor: the abundance of health-care facilities in the District and Northern Virginia. The other reason is a "push": the paucity of high-quality health-care options in Prince George's itself (8/25). 

Bloomberg: $130 Million Verdicts Don't Raise Medical Costs
A jury in one of New York's most conservative counties recently returned a $130 million verdict in a medical-malpractice case, the second-largest in the state's history. Lawyers for the losing hospital decried a "jury out of control" and called for more tort reform. Before the case went to trial, their offer of an $8 million settlement was turned down. What the defense lawyers seemed not to realize is that tort reform hasn't worked for 25 years. And large verdicts may be the most effective drivers in making health care safer (Steve Cohen, 8/25).

Bloomberg: When Government Says 'No' To Rising Costs
Health care and education pose the same basic threat to the economy: How do you keep costs down for a product that consumers must purchase? Saying "no," after all, is how consumers typically restrain costs. ... But you can't walk out on medical care for your spouse or education for your child (Ezra Klein, 8/22).

New Orleans Time-Picayune: Disabled Louisianians Need Medicaid Program To Help Them Stay In Their Homes
If you're a disabled person with limited resources who needs health care and other services to be able to stay in your home, you're probably out of luck in Louisiana. The Jindal administration last week withdrew its application for a federal Medicaid program set up to encourage more in-home care for developmentally disabled residents with low incomes. State officials said the cost is too high and the rules are too inflexible. But it's hard to believe the decision isn't political (8/25).

MedPage Today: Affording Care: A Medical Student's Story
For the 2014 academic year, "grandfathered" student health plans, which started between July 1, 2012 and Sept. 23, 2012, can continue to set an annual payout limit of $100,000. If the policy began on or after Sept. 23, 2012, it can have a $500,000 annual limit. Payment for prescription drugs and mental health benefits are included in these annual limits. If my university plan had a $100,000 annual limit, I would owe more than $500,000 in out-of-pocket expenses for my cancer treatment. This is why it's essential to have adequate healthcare -- even for medical students (Dr. Ben Hartman, 8/25).

Health Policy Solutions (a Colo. news service): The Tragedy Of Medical Ethics
The difficulty of medical ethics and culture is that it allows, indeed it makes morally obligatory, practices and behaviors that increase health care spending without regard to other public priorities that get crowded out by the incessant demands of health care. To the extent medical ethics drive resource use, they do not give adequate moral guidance to the larger distributional decisions faced by government and other third party payers. Ironically to the extent that  medical ethics drive marginal spending, they actually lower both the quality of life and well-being of the community (Richard Lamm, 8/24).

Bloomberg: Why Has Medicare Cost Growth Slowed Down?
Recently, Medicare has been growing more slowly than its historical average. The Congressional Budget Office decided to investigate why, and the answers will probably surprise you. If you had to guess why Medicare was growing more slowly, you'd probably come up with one of two answers: "Obamacare" or "the recession." (No bonus points for guessing which party prefers which answer.) But the CBO largely rejected both those answers (Megan McArdle, 8/23).

The Seattle Times: AG Affirms Women's Right To Abortions
The state attorney general's important opinion last week on reproductive-health care is a reminder that elections matter. In this case, the general election of 1991, when Washington voters affirmed, in the unambiguous language of Initiative 120, a woman's right to abortion (8/25).