health law

During law school I did research about various efforts to put patients in charge of their own care, whether their issue is addiction, a disability or mental health. So I was very interested to read a piece that Newsworks' Laura Benshoff published about a pilot program in a Philadelphia suburb to put Medicaid patients with mental health issues in charge of decisions about their care: "It gives patients the option to redirect that money towards a 'freedom fund,' saving for something that improves quality of life. In addition, participants make decisions about care with a certified peer specialist as a recovery coach."

However, putting people in charge of their health care did not reduce costs. The first two years of the program showed that costs went up from $6,800 to $7,500 because "participants who had gotten used managing their symptoms tended to opt for more, off-plan services through the program – such as gym memberships – rather than cut back," Benshoff reports.

The U.S. Supreme Court has taken up another existential challenge to Obamacare. The plaintiffs in King v. Burwell allege that the Affordable Care Act doesn't allow the federal government to provide tax credits and subsidies to low-income and moderate-income consumers shopping for insurance on the federally-run insurance exchange, The Huffington Post's Jeffrey Young reports. The Obama administration argues that Congress intended to provide tax credits to people shopping for health insurance whether an exchange is state-run or federally run, but the plaintiffs allege the Affordable Care Act only allows subsidies for insurance bought on an "'exchange established by the state,'" Young also reports.

If the Supreme Court rules in favor of the plaintiffs, "absent financial assistance, many fewer people would be able to afford coverage and likely would drop their insurance or never purchase it. Higher prices also would discourage healthy people who are cheaper to insure from buying policies, leaving a sicker pool of customers on insurers' books," Young further reports.

Jason Millman, writing in the Washington Post's Wonkblog, says that the Republican victory in several gubernatorial races means that Medicaid expansion under Obamacare may not happen in several states: "Fifteen of the 23 states that hadn't yet expanded Medicaid held gubernatorial elections last night, and it looks like only Alaska will elect a candidate who campaigned for the Medicaid expansion." There might even be a real chance of undoing Medicaid expansion in Arkansas.

But Millman also notes that several Republican governors have said they might explore expanding their Medicaid coverage and "Medicaid expansion has support from hospitals, which hold considerable political clout and have a lot to lose without the infusion of federal funds from the expansion."

Oracle Corp. has asked legislative leaders to defund a lawsuit Oregon has brought over the failed health insurance website the company built for the state, the Associated Press reports. Oracle contends that the insurance portal Cover Oregon failed because of mismanagement by the state. The state is suing Oracle for false claims and other causes of action, while Oracle has sued for state for breach of contract and alleged violations of its copyrights, the AP further reports.

Kaci Hickox, who is back in her home state of Maine after treating Ebola patients in West Africa, won a court victory in her home state against having her movements curtailed, The Washington Post reports. A judge ruled she "should continue daily monitoring and coordinate any travel with public-health officials," the Post further reports. When Hickox was forcibly quarantined by New Jersey after treating Ebola patients, claimed she was deprived of her liberty in violation of the due process clause of the 14th Amendment.

Eugene Kontorovich, writing on the Volokh Conspiracy blog, comments that constitutional challenges to mandatory Ebola quarantines are unlikely to succeed. Lawyers for Kaci Hickox, a nurse forcibly quarantined by New Jersey after treating Ebola patients in West Africa, claimed she was deprived of her liberty in violation of the due process clause of the 14th Amendment. But Kontorovich says "brief review of the cases suggests it extremely difficult to challenge such an action without a clear showing of medical unreasonableness, or discriminatory application. Indeed, I found no cases in which a quarantine has been lifted due process grounds (though there have been some successful challenges to conditions of quarantine)."

Hickox's quarantine was reversed by New Jersey Gov. Chris Christie today, USA Today reports. She will now be quarantined at her home.

Companies are going to face fines next year if they don't comply with a mandate to provide health insurance to employees. In order to avoid $2,000 penalties per employee, some companies are trying to enroll low-wage employees in Medicaid or to offer "skinny" plans that cover preventive care but exclude major benefits like hospital coverage, the Wall Street Journal reports. Employers, however, can face a different $3,000 fine for workers who opt out of the "skinny plans" and get federally subsidized plans through an insurance exchange. Other employers are reducing the number of workers who are eligible by keeping their hours below 30 a week.

Jeff John Roberts, writing in GigaOM, writes about how we don't have rules yet to govern the Internet connections that have been brought to physical devices--the so-called "internet of things": "The first murder through the internet of things will likely take place in 2014, police service Europol warned this month. The crime could be carried out by a pacemaker, an insulin dosage device, a hacked brake pedal or myriad others objects that control life-and-death functions and are now connected to the internet." He notes that there are completely open questions on whether manufacturers of Internet-connected devices are going to face liability for privacy breaches: "In the future, judges may start asking if the concept of 'privacy by design' should become a safety standard, and even require internet companies to adopt the same pre-cautions as auto makers or playground designers."

Al Tompkins, writing in Poynter, discusses the struggle between reporting on the Ebola epidemic and respecting HIPAA, the law protecting patients' privacy: "A health story of national proportions like the Ebola story pits the role of journalism against HIPPA rules. HIPAA (American Health Insurance Portability and Accountability Act of 1996) restricts patient information to doctors, direct caregivers, insurance companies and others expressly named in the Act." 

HIPPA privacy rules do allow hospitals to release general information about a patient without releasing their names, such as where an infected person traveled, Tompkins reported. Dr. Art Caplan, head of the Division of Bioethics at New York University Langone Medical Center, told Tompkins that a national health crisis allows public officials to get information in order to be able to trace the contacts a patient had with others. But that loophole doesn't apply to journalists.

Laurie Garrett, writing in Foreign Policy, has an interesting an piece suggesting that Obamacare may be the key to stopping an Ebola epidemic in the United States. She notes that uninsured Americans are the "greatest vulnerability" because they "routinely tough out the flu, fever, aches, and pains because seeking medical care is prohibitively expensive. If they become sick enough to feel desperate, the uninsured and underinsured of America go to public hospital emergency rooms for care, where waiting times in often-crowded settings can stretch on for hours." No one suffering from the primary symptoms of Ebola should be turned away from care because they lack insurance, she says.