Health Care: The Good, The Bad and The Political

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Things are a little slow around TIME’s New York office this week, with some of our staff still stranded elsewhere thanks to the blizzard of 2010. The week between Christmas and New Year’s is also notoriously slow in the news business, with the President out of town and Congress out of session.

All of which makes it a perfect time to recap some important health care news.

First, The Good

The Los Angeles Times finds evidence that some small businesses previously offering no health insurance to their workers are reversing course, in part, due to new tax breaks in the Affordable Care Act. When a September report from the Kaiser Family Foundation showed a sharp uptick in coverage offered by small businesses, I was skeptical it was due to the new law. But the L.A. Times has done good legwork – calling individual insurers and brokers to gather anecdotal and data-driven proof that the new law is having this positive effect.

Small business employees are among the most likely to be uninsured and small business owners who do offer coverage bear the brunt of rising insurance premiums. With tiny risk pools, their premiums are unstable and high, which is why the new reform law included tax breaks to help the smallest businesses buy coverage.

Next, The Bad

The new insurance program intended to cover the most vulnerable Americans is not working very well. Under the Affordable Care Act, people with pre-existing conditions were supposed to immediately get new welcome coverage in “high-risk pools” run by states or the federal government. (These people are routinely turned away by private insurance companies or sold policies that exclude coverage for their pre-existing health problems.) Problems with the high-risk pools are making rollout pretty rough. Most people who would be eligible for these plans don’t know about them or are turned off by cost.

Reports the Washington Post:

In the spring, the Medicare program’s chief actuary predicted that 375,000 people would sign up for the pool plans by the end of the year. Early last month, the Health and Human Services Department reported that just 8,000 people had enrolled. HHS officials declined to provide an update, although they collect such figures monthly, because they have decided to report them on a quarterly basis.

“Like the rest of the country, we thought we’d have pretty much a stampede. That obviously hasn’t materialized,” said Michael Keough, executive director of North Carolina’s plan. With nearly 700 participants, it is among the nation’s largest so far, but it has one-third of the people expected by now.

According to interviews with administrators of nine of the state-run plans, only one – Colorado’s – is close to its forecast enrollment. Maryland, the only jurisdiction in the Washington area that has created a plan, has 97 participants, compared with 19,000 in an older state high-risk pool, according to Kent McKinney, who directs both. HHS’s November report said that Virginia had 75 participants in the federal plan. The District had none.

As for cost, it’s no surprise that health insurance plans specifically for sick or recently sick people would be expensive. The Affordable Care Act included $5 billion funds to subsidize these plans, but many experts I’ve talked to say this isn’t enough to keep the plans up and running smoothly until full reform kicks in in 2014 – unless, of course, the plans continue to have incredibly low enrollment.

And Finally, The Political

The New York Times reported over the weekend that the Obama Administration is flexing its regulation-writing muscles to pay Medicare doctors for chatting with patients about end of life care. A provision doing about the same thing was included in an early version of Democratic health care reform, but was abandoned once Republicans began (dishonestly) saying it would lead to “death panels,” with government bureaucrats deciding which seniors would get care and which ones would be left to die. As Robert Pear makes clear in his article on the provision, included in new Medicare rules set to take effect in January, Democrats were hoping to pass the regulation under the radar, knowing it could be political kryptonite.

Several Democratic members of Congress, led by Representative Earl Blumenauer of Oregon and Senator John D. Rockefeller IV of West Virginia, had urged the administration to cover end-of-life planning as a service offered under the Medicare wellness benefit.

(snip)

After learning of the administration’s decision, Mr. Blumenauer’s office celebrated “a quiet victory,” but urged supporters not to crow about it.

“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”
Moreover, the e-mail said: “We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ — e-mails can too easily be forwarded.”

The e-mail continued: “Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.”

In the interview, Mr. Blumenauer said, “Lies can go viral if people use them for political purposes.”

The White House, none too pleased to see the regulation splashed across the pages of the Times, tried to soften the blow, telling the Wall Street Journal that the end of life counseling rule was not really new.

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