As health law regulations are released with more frequency, there’s plenty for bloggers to digest including developments in health information technology rules, abortion coverage and the Center for Medicare and Medicaid Innovation.
New rules announced this week about what health information technology practices and services will be considered “meaningful use” and make doctors and hospitals eligible to receive federal grants inspired plenty of commentary. Margalit Gur-Arie of the Health Care Blog analyzes “the good”, “the bad” and “the inconsequential,” and then sums it up: “what was bound to become a typically painful bureaucratic attestation for physicians, is now a rather straightforward process.”
Brian Ahier provides a detailed run-down of the provisions, and notes: “A major shift is the move away from an all-or-nothing approach, where providers had to meet every single measure to be eligible for payments. Instead, there’s now a set of must-have core requirements and an a la carte menu of discretionary options. There are 15 core requirements for physicians and 14 for hospitals. Health care providers can then choose five of 10 menu options to meet phase one of meaningful use. This strategy will enable a great many hospitals and small practices in rural and underserved areas to have a shot at cashing in on incentive payments.”
And the Wall Street Journal’s Katherine Hobson rounds up various association group and health IT company responses to the rules.
Several bloggers look at coverage of abortion in the new high-risk pool programs.
Julie Rovner on NPR’s Shots Blog reports on a fight in Pennsylvania: “Abortion opponents say the administration is already breaking the promise it made as part of the new health law not to fund elective abortions. … The National Right to Life Committee, Family Research Council, and House Minority Leader John Boehner, (R-OH) are up in arms about what they contend is Pennsylvania’s plan to provide abortion coverage to people who sign up for the state’s new high-risk health insurance plan. … Only there’s one problem. Both Obama Administration and Pennsylvania officials say the NRLC’s interpretation is simply incorrect — elective abortions will NOT be allowed in the new program.”
Wonk Room’s Igor Volsky thinks the legal language doesn’t include prohibition of abortion coverage: ”But as I pointed out yesterday, the Nelson abortion amendment in the health care law and President Obama’s subsequent executive order place restrictions on federal funding within the exchanges and the community health centers, but says nothing of the moneys appropriated to the temporary high risk pools or other programs like reinsurance for early retirees or the small business tax credits.The federal legislative language seems to contradict the state’s interpretation.” Volsky then posts a statement from HHS spokeswoman Jenny Backus, who said: “As is the case with FEHB plans currently, and with the Affordable Care Act and the President’s related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.”
Insure Blog’s Henry Stern responds to the events by critiquing Rep. Bart Stupak, D-Mich., who authored a strict ban on abortion coverage in the House version of the health overhaul bill, “We previously made the point that anything not specifically excluded would be covered; Rep Stupak’s cowardly retreat made this development inevitable.”
The Daily Beast’s Dana Goldstein looks at another aspect of the debate: labeling contraceptives as preventive care, which would make them available without cost-sharing under the new health law. Goldstein reports: “many conservative activists, who spent most of their energies during the health-care reform fight battling to win abortion restrictions and abstinence-education funding, are just waking up to the possibility that the new health care law could require employers and insurance companies to offer contraceptives, along with other commonly prescribed medications, without charging any co-pay.”
Georgetown’s Jocelyn Guyer of the Say Ahh! blog points to a study that found a significant portion of children lose their health coverage when a parent loses a job. Many of those families look to Medicaid and the CHIP program to cover the youngsters. Guyer adds: “At the end of this year, the extra [Medicaid] help the federal government has given states is slated to expire even though state budgets continue to be battered by rising demand for services. Without a short-term continuation of the extra help, states will be under enormous pressure to scale back Medicaid and CHIP, including children’s coverage. … If this happens, the reality … that children often lose their private coverage when their parents lose a job will translate into more and more uninsured children.”
The Heritage Foundation’s Kathryn Nix, in her “Side Effects of ObamaCare” series, also talks about Medicaid. But she sees a different issue: “As more and more doctors withdraw from Medicaid, more and more Medicaid patients are having trouble finding a physician to treat them. It’s hard to see how the program can possibly deliver health care to an additional16 million patients dumped into the mix by Obamacare.”
On the Health Affairs blog, Carol Levine examines the health law’s requirement to set up a Center for Medicare and Medicaid Innovation. Levine is concerned that the center does not have to consider when funding projects whether they are “patient-centered” and focus on care coordination. She says, “these should not be optional priorities.”
In a separate Health Affairs post, John Goodman thinks the health overhaul could lead to ER overcrowding: “One of the most oft-repeated arguments for health reform is that uninsured patients make costly and delayed trips to the ER when they do not have a health plan that pays for care at physicians’ offices. Insure the uninsured, it is said, and they will decrease their reliance on the ER and get prompter, less costly care elsewhere. Yet this has not been the experience in Massachusetts and it is unlikely to be the experience nationwide under the new health reform legislation. In fact, far from seeing a decline in ER visits, the number of such visits is more likely to soar.”
The New Health Dialogue’s Tony Cardona takes a look at legal action surrounding the Healthy San Francisco program, which requires employers with more than 20 workers to help cover cost of health care services. Cardona writes, “Play-or-pay models may continue to be an option for states and local governments to provide insurance for individuals not covered under federal law (such as undocumented workers.) But the Supreme Court’s denial of review of Healthy San Francisco was tantamount to an announcement that such models are no longer germane in reshaping the larger health care debate.”
The Washington Post’s Ezra Klein is also talking about Healthy San Francisco because of a new National Bureau of Economic Research study of employer reaction to the program. Klein calls the results “encouraging,” focusing on business approval of the law (at 64 percent) then adds, “I guess in San Francisco, even the private businesses are run by socialists.”
The National Journal’s Megan McCarthy asks the health policy experts if a recess appointment of Dr. Donald Berwick to head the agency that oversees Medicare and Medicaid was “necessary.” James Gelfand, Newt Gingrich, John Goodman, Bruce Lesley, Larry McNeely and Gail Wilensky respond. Reaction ranged from “inexcusable” and “shameful” to “superb.”
Speaking of Berwick, The Apothecary’s Avik Roy lists problems with Britain’s National Health Service then argues: ”These problems are not an accidental side effect of socialized medicine—they are inherentto socialized medicine. Liberals who believe that technocratic experts can rationally allocate health care resources ignore the real-world examples, like Britain’s, of how that model fails in practice. The American health care system has its flaws, and real reform is urgently needed. But the reason why Obamacare is so unpopular is that most people would never trade our approach, warts and all, for that of Donald Berwick’s NHS.”
Cato’s Michael Cannon points to news that Republican lawmakers are pressing Supreme Court nominee Elena Kagan to recuse herself from any case about the new health care law. Cannon predicts: “That would also be the worst possible outcome for the administration. In fact, universal coverage is so important to the Leftthat if Kagan would leave them with one less pro-ObamaCare vote on the Court, I wouldn’t be surprised to see President Obama withdraw her nomination. He could then appoint someone as ideologically reliable as Kagan, but who could actually defend the president’s signature accomplishment. This could get interesting.”
Elsewhere, a few bloggers react to the new National HIV/AIDS strategy released by the administration on Tuesday.
Health Beat’s Maggie Mahar calls the strategy “promising” then adds, “But we must make sure that in the short-run we are not abandoning the very people we purport to help; the vulnerable groups who depend on ADAP for their medications.”
The Nation Review Online’s Tevi Troy has five observations, including, “The major conservative objections to the policy will be in the areas of the endorsements of needle exchange, condom distribution, and sex education, which are neither news nor surprising in any way. After 15 months of study, the administration does not appear to have broken much new ground on this issue. No wonder the Left appears disappointed.”