health law

One of the criticisms of the Obamacare rollout is some consumers' health care insurance policies are being canceled because they don't comply with minimum requirements. Replacement policies are more expensive. Self-employed lawyers are among those whose costs are increasing, The Washington Post reports: "If the poor, sick and uninsured are the winners under the Affordable Care Act, the losers appear to include some relatively healthy middle-income small-business owners, consultants, lawyers and other self-employed workers who buy their own insurance. Many make too much to qualify for new federal subsidies provided by the law but not enough to absorb the rising costs without hardship." The costs are going up due to increased benefits and increased coverage for sicker people, The Post also reported.

Due to Obamacare's expansion under the Medicaid program in the states that have opted for it, more people facing criminal charges might have access to health care and might get diverted away from the justice system. According to The Crime Report, "for law enforcement and courts, that could mean a greater ability to quickly identify alternatives to incarceration for those with mental illness and substance abuse issues. Tim Murray, executive director of the Pretrial Justice Institute, said that healthcare and substance abuse counseling is more effective at mitigating risk than jail."

Five Democratic senators have introduced legislation to better define who as American Indians are eligible under Obamacare to not face IRS tax penalties for not carrying coverage. Prince William Sound's Cordova Times' also reported the legislation would rectify "the several definitions of 'Indian'  which led to conflicting interpretations of eligibility for benefits and requirements for coverage."

The New York Times reports on why the health-insurance exchanges have been so buggy: one factor was that the biggest contractor wasn't given specifications right away and only started writing software code this spring. Another factor was not rolling out a piece of the portal instead of the whole shebang at once. A third factor was that the Centers for Medicare and Medicaid Services "assumed the role of project quarterback, responsible for making sure each separately designed database and piece of software worked with the others, instead of assigning that task to a lead contractor." Sources told the NYT that CMS did not have the capacity to take on that role.

The result: "Many users of the federal exchange were stuck at square one. A New York Times researcher, for instance, managed to register at 6 a.m. on Oct. 1. But despite more than 40 attempts over the next 11 days, she was never able to log in. Her last attempts led her to a blank screen."

The RAND Corporation, which was commissioned by the American Medical Association to identify the factors that influence physicians' professional satisfaction, found that those physicians surveyed do not want to go back to paper charting. But they are reporting several issues with the deployment of electronic health records: "Among the key findings of the study was how electronic health records have affected physician professional satisfaction. Those surveyed expressed concern that current electronic health record technology interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work and degrades the accuracy of medical records by encouraging template-generated notes. In addition, doctors worry that the technology has been more costly than expected and different types of electronic health records are unable to 'talk' to each other, preventing the transmission of patient medical information when it is needed."

The Seattle Times reports on the practice of locking people in the middle of mental-illness crises at emergency rooms because there are not enough beds available in the psychiatric system. The crux of this ground-breaking report: "'Psychiatric boarding,' as it is officially called, or 'warehousing,' as it is known to mental-health advocates, has long taken place on occasion in Washington, which ranks at the bottom of the country for psychiatric-treatment beds per capita. But now this once-rare, controversial practice has rapidly become routine here — traumatizing thousands of mentally ill residents, wreaking havoc on hospitals, and wasting millions of taxpayer dollars."

The Washington Post has a great explainer on why the exchanges for American consumers to buy health insurance policies are buggy and having problems since they opened. One issue: "the site needs to interact with a large number of databases operated by various federal and state agencies. If these back-end systems are poorly designed, it could take months or even years to straighten out the mess," The Post reports.

A British study found 1/3 of "British people in their 50s and above said they had experienced age discrimination, researchers reported in the journal Age and Ageing. That included being treated with less courtesy or getting poorer service at restaurants and hospitals," Reuters Health reported. The impact? One researcher said "frequent perceived discrimination may be a chronic source of stress and build up over time, leading to social withdrawal and reluctance to go to the doctor," Reuters Health also reported.

After the U.S. Supreme Court ruled states could not be forced to expand their Medicaid programs for the poor as part of the Obamacare health reform law, that is leaving many of the most impoverished Americans still without health care, The New York Times reports after a detailed analysis of census data. Among its findings: "The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides."

On a personal note, I still have hope the states that resisted expanding Medicaid will do so in the future. I attended a health law conference last winter, and a Pennsylvania lobbyist for health care pointed out that all the states eventually adopted programs like Medicaid and Medicare, when first created, even if they resisted for several years. He also arged that healthcare providers will lobby to get the expansions in order to control their costs. This is no consolation for any one person who can't get coverage today, but it's systemic hope for the success of correcting the healthcare marketplace.