Arkansas: Caving In or Standing Up to Obamacare?


Almost two years ago, our colleague Linda Gorman was cautiously optimistic about Arkansas attempted Medicaid waiver. Instead of just expanding Medicaid, the state would take the federal funds that Obamacare offered, but use them to subsidize the newly eligible to buy commercial insurance on the Obamacare exchange.

Two years later, a new governor wants to do something a little different. The new governor, Asa Hutchinson, appears to have confused a lot of people in a recent speech about Medicaid, the joint state-federal welfare program for poor people’s health coverage.

According to the Washington Post’s Jason Millman, “Republicans are finally learning they can’t undo Obamacare“, because the governor wants to do something different to Medicaid than what his Democratic predecessor wanted. Politicos’ Sarah Heaton, on the other hand, reports that the new governor wants to “end his state’s Obamacare Medicaid experiment.”

Obamacare’s Rose-Colored Short-Sighted Vision


A similar version of this Health Alert appeared at Forbes.

Last summer, my colleague Devon Herrick accused the Centers for Medicare & Medicaid Services of looking at Medicare’s solvency through rose-colored glasses. Well, CMS has passed those shiny spectacles to another government agency.

In the January 2015 Budget and Economic Outlook, the Congressional Budget Office (CBO) has pronounced that Obamacare’s future costs will be seven percent less than were projected in April 2014. Looking even further back in the rear-view mirror, the CBO itself has an even more exciting story to tell:

In March 2010, CBO and JCT projected that the provisions of the ACA related to health insurance coverage would cost the federal government $710 billion during fiscal years 2015 through 2019 (the last year of the 10-year projection period used in that estimate). The newest projections indicate that those provisions will cost $571 billion over that same period, a reduction of 20 percent (p. 129).

Table 1 decomposes this $139 billion of reduced costs over the five-year period. It shows that $5 billion are due to higher tax receipts than originally projected, while $134 billion are due to reduced costs.


Source: Author’s calculations from CBO’s March 2010 estimate (Table 4) and January 2015 estimate (Table B-1)

Under Obamacare, Will America Keep Winning the War on Cancer?


A similar version of this Health Alert was posted at Forbes.

The American Cancer Society (ACS) has just released its annual Cancer Facts and Figures. The announcement describes how successful the war on cancer has been:

Annual statistics reporting from the American Cancer Society shows the death rate from cancer in the US has fallen 22% from its peak in 1991. This translates to more than 1.5 million deaths from cancer that were avoided.

There are a number of explanations for this success. The most important appears to be the reduction in smoking in the population. Lung cancer is still very deadly. However, because fewer people are diagnosed, the death rate from lung cancer has dropped dramatically since the early 1990s for men and turned around for women starting about 2005.

As shown in the two graphs below, deaths from lung cancer had actually increased dramatically for men since the 1930s and for women since the 1960s, so a reduction is a welcome break in the trend. Still, almost one in three cancer deaths in the United States in 2015 will be due to smoking.


image2 Are English-Speakers’ Civil Rights Being Violated?


This blog has not written about the U.S. Department of Health & Human Services weekly enrollment data for a couple of weeks, when we noted that they had “slowed to a trickle“. Well, Obamacare enrollment is booming again, hitting 7.1 million enrolled on January 16.


Electronic Health Records and Adolescents’ Privacy


This blog has written about complaints from both physicians and nurses regarding the costs and time devoured by using Electronic Health Records, which have been imposed on practices despite not adding value.

In a JAMA article published earlier this month, three physicians discuss EHRs’ challenge to adolescents’ and parents’ privacy. So-called minor consent laws permit adolescents to secure health care services without parental consent for drug use, pregnancy and pregnancy preventions, STDs and mental health. These laws underscore the professional consensus that absent confidentiality, adolescents will be reluctant to seek care for sensitive health issues.

With paper records, care provided under minor consent laws was segregated from other medical records and difficult to access. Because EHRs aggregate information for all health care provided within a so-called integrated system, parents have the means to electronically access confidential information, often facilitated by web portals to the records.

The NCPA Fact Checks Obama’s Health Policy Address during SOTU


Paid Family and Sick Leave for Workers

The president emphasized the plight of the 43 million American workers who do not have paid sick leave. Many of them feel they cannot afford to take a sick day to convalesce after an illness or to care for a sick child. He proposes to mandate that employers provide seven days of paid sick leave to workers each year.

The president didn’t mention that an estimated 100 million workers who have paid sick leave likely don’t get seven days annually. He also didn’t mention that his own advisor Jonathan Gruber has research showing workers themselves wind up paying the cost of mandatory benefits through lower wages.

Thus, if employers are forced to provide seven paid days off of work for every worker, employers will adjust worker pay to compensate for the cost. This will inhibit pay raises, and it will impact paid vacation days. It could even harm the employment prospects of workers most likely to stay home and care for a sick child.

The president should have called for expanding Health Savings Accounts (HSAs) to all workers, allowing them to set aside funds for medical needs. The president could have also proposed allowing workers to use HSAs to compensate for income lost to sick days.

Currently, workers who have HSAs can use funds from their accounts to replace income lost due to sick days. However, this is considered a non-medical use and exposes workers to a penalty of 20 percent, plus ordinary income taxes.

Are Employers Who Dump Workers Onto Medicaid Corporate Welfare Queens?


There have been a lot of predictions about the future of employer-based health benefits under Obamacare. Reports suggest that increasing numbers of small businesses are dropping health benefits and sending their employees to Obamacare’s insurance exchanges, where they are partially subsidized.

Other businesses have found a bigger cost-shifting approach. BeneStream, a new benefits advisor, advises employers how to make their workers dependent on Medicaid, a welfare program fully funded by taxpayers. And businesses are taking advantage of its advice.

So: Are these employers corporate welfare queens?

Moving Beyond the Heliocentric Doctrine of Health Insurance


A similar version of this Health Alert appeared at The Daily Caller.

Whether you have job-based health benefits, are in an Obamacare exchange or are on Medicare, you have likely recently gone through the difficult experience called open enrollment. As a result, you may have lost access to your physician or nearby hospital. Think about how little sense this makes. Did you change anything else in your life for the sole reason that the calendar turned a page? I’ll bet you’ve had the same car insurance and homeowner’s insurance for years. If you rent your business premises, your lease can cover whichever period you and your landlord negotiate.

I call this the Heliocentric Doctrine of health insurance: Designing coverage around the period of time the earth takes to revolve around the sun, instead of patients’ health status. It has harmful consequences.

Consider two identical twins, recently diagnosed with the same catastrophic illness last June. They both have the same health insurance. Whether it is through their employer or an Obamacare exchange or Medicare does not really matter.

They have been diagnosed with the same cancer. It is genetically determined: There is nothing that either of them could have done to avoid it. It will require many months of treatment by drugs and surgery, and the treatment will evolve as oncologists observe how the twins’ cancers respond to different therapies.

Generally speaking, both twins have been healthy up to now. All of a sudden, in the second half of 2014, they entered that small minority of patients who, in any period of time, account for a large share of health spending.

Hospitals Only Accounted for 15 Percent of Health Job Growth in 2014


Last Friday’s employment report demonstrated once again that Obamacare is not having the effect that the health services industry overall hoped for: Employment in health care is increasing at pretty much the same pace as in the rest of the economy. There is no evidence of an Obamacare jobs bump.

As shown in Table 1 and Table 2, the monthly increase in health jobs for December was 0.23 percent (34 thousand jobs), which is slightly greater than the 0.17 percent increase in non-health, nonfarm payroll. However, those figures are just reversed from November. In the twelve months since December 2013, the rate of growth in health jobs has been exactly the same as non-health jobs.


Asian Firm to Launch Innovative TeleMedical Service in U.S.


An American entrepreneur has spent two years building a telemedicine business in Singapore and is ready to enter the U.S. market. RingMD is a web-based physician referral, telemedicine website and smartphone application. Prospective patients select doctors by viewing physicians’ profiles, locations, insurance acceptance, ratings or specialties. The software draws information from 543 medical conditions to connect patients with physicians from 17 different specialties. Patients just enter their symptoms (and preferences), and the website app will list qualified physicians who meet their criteria.

Participating physicians charge for consultations by the minute, and their prices vary. Some providers only charge $1 per minute, while others charge $5 per minute. It’s a competitive market with dynamic pricing. Patients select a provider and only pay for the time they need. Currently, most of RingMD’s physicians are based in Asia, but the firm is adding doctors from all over the world.

The 22-year-old CEO of the organization reports he is now considering entry into the U.S. market. But the question remains: Why did a Silicon Valley entrepreneur choose to start his Health Tech venture in Singapore? The Singapore government was impressed enough with the idea that it invested $500,000 through its National Research Foundation to help fund the tech startup. But there must be other reasons.

The Singapore health care system is often touted by conservatives as a model for health reform in this country. Singaporeans have been required to set aside a portion of their income into a Medisave account (6.5 percent – 9 percent) to fund their current and future health care needs since 1984.  Medisave accounts are a type of health savings account (HSA), while MediShield is an insurance scheme that functions similar to a major medical or high-deductible plan.