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Posts Tagged ‘healthcare’

As the ACA Stands Up, Can Programs for the Uninsured Stand Down?

March 25th, 2014

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It is clear that HealthCare.Gov is working better. Enrollment figures are climbing. Over 5 million Americans have selected a plan through the federal and state marketplaces, and another 6.3 million are getting coverage through Medicaid. While problems remain, the level of interest in getting coverage has grown—to as many as 2 million visits to the federal website in one day.

But amid these public proof points will be another less obvious measure of success—a decline in the need for a patchwork of programs designed to help the poor who continue to lack coverage despite the Affordable Care Act (ACA).

One of those programs, called the 340B Drug Pricing Program, however, shows no signs of slowing down. The 340B program supports clinics and hospitals that serve a high proportion of low-income and elderly patients. 340B requires drug manufacturers to provide discounts to hospitals and clinics that generally serve low-income patients or other groups like HIV-AIDS patients. The program allows hospitals and clinics to dispense the drugs purchased through 340B to their patients who may have their own private insurance coverage and pocket the difference between their deeply discounted purchase price and the amount that a health plan reimburses for the drug. For example, hospitals like Denver Health, which is the public safety-net provider for the city, have used 340B to expand services for at-risk patients. The discounts range from 20% to 50% off the cost of drugs. Those discounts are often bigger than the discounts required of drug manufacturers for Medicaid patients. Federal auditors have found that Denver Health is compliant with program requirements. But they also have found many other facilities to be out of compliance under current federal policy. Moreover, current law and regulations may be inadequate to ensure 340B is truly helping vulnerable Americans.

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2014: Another Election About Obamacare

December 23rd, 2013

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Here we go again.

2014 will be the third election in a row in which Obamacare is the central issue. The Affordable Care Act, which President Barack Obama signed into law in March 2010, contributed to a fierce voter backlash against Democrats in November 2010. After the Supreme Court upheld the law in June 2012, the issue seemed to be settled by Obama’s re-election that November.

But no.

The botched Obamacare rollout this year has again thrust the issue to the top of the political agenda. Republicans are counting on opposition to Obamacare to propel them to a majority in the Senate next year. A conservative group is already running an ad attacking Senator Jeanne Shaheen (D-N.H.) for supporting Obamacare: “Next November, if you like your senator, you can keep her. If you don’t, you know what to do.”

2013 came to a close with two big political stories. The government shutdown in October was immensely damaging to Republicans. So damaging that House Republicans defied their conservative base and voted for a compromise budget deal last week. Speaker John Boehner (R-Ohio) attacked the Tea Party, accusing them of pushing congressional Republicans “into this fight to defund Obamacare and shut down the government.” A fight Boehner said all along was unwinnable.

The message was, “No more shutdowns.” Republicans didn’t want to step on the second big political story, one immensely damaging to Democrats: the rollout of Obamacare.

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Cut Medical Mistakes in Half by 2017 to Save Lives and Money

May 23rd, 2012

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This piece was originally posted on the Atlantic.

Medical mistakes are dangerous, costly, and often hidden until it’s too late. Patients do their best not to think about them, because of their need to trust in their doctors. Who wants to study a surgeon’s error rates right before going under the knife? For their part, doctors don’t like to admit they erred, especially when they might get sued. But a culture that avoids confronting mistakes will only perpetuate them.

Medical leaders and patient groups have made some progress reducing one type of error: infections contracted in hospitals. Organizations like the Institute for Healthcare Improvement and medical schools like Johns Hopkins University have engaged and educated doctors and nurses about preventing these infections. Consumers Union and other patient groups have won enactment of legislation in 30 states to require hospitals to report how often their patients contract a preventable infection. Congress has provided funds for additional infection reporting in the Affordable Care Act (ACA). As a result of all of this effort, infection rates are declining. The Centers for Disease Control and Prevention has found declines of as much as 58 percent for various hospital infections over the last several years. Read the rest of this entry »

Eliminating the Tax Penalty on Gay-Friendly Businesses

September 12th, 2011

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Our corporate tax code dates back to 1986, before the internet and when China was “red.” It is hopelessly out of date with the goings on of the rest of the world, but there is one area where it is completely antiquated with changes in America: dealing with employee benefits for gay couples.

There are nearly one million gay couples living in the United States, according to the Census Bureau. Today, jurisdictions allowing gay couples to either marry or form legal unions are now home to about 150 million people—up from less than 15 million people fifteen years ago. And two-thirds of Fortune 1000 companies provide benefits like health care to gay couples. But if companies provide these benefits under the same tax formulation as they would for straight married couples, they are in violation of the law—and so are their employees.

Here’s the problem. While employer-provided health care is treated as a tax-free benefit for everyone else, the IRS counts it as taxable income for gay domestic partners and spouses. That means businesses like Target, IBM, and Nabisco who provide coverage to partners of their gay employees must go back and add “imputed income” to their employees’ pay stubs for the cost of that benefit. Read the rest of this entry »