Health Care

Health Reform's Next Test

AP Photo/Jim Mone
AP Photo/Jim Mone In St. Paul, Minnessota, for shoppers scramble to finalize health coverage before the new year. F ailure, flop, fiasco—however you describe it, the Obama administration’s rollout of Healthcare.gov will go down as one of the most embarrassing episodes of public mismanagement in recent history. In principle, the defects of the website have nothing to do with the merits of the Affordable Care Act. As a practical matter, however, the two have become intertwined, and the big question is how much damage the flawed rollout will do to the political survival of the ACA as well as those in Congress who voted for it. In the short run, Healthcare.gov’s problems have undermined trust in both the law and liberal government. They have created a general impression not just of incompetence but of failed promises, obliging the president to adopt an apologetic tone and shaping the media narrative about the ACA. Public approval of the law has dropped significantly as support has fallen...

Say Thanks to a Republican Idea Day

Don't be afraid. (Flickr/House GOP Leader)
When John McCain ran for president in 2008, he offered up a health-reform plan. Nobody paid all that much attention to it, because it was pretty clear that health care was an issue McCain didn't care about at all, and much like the "patient's bill of rights" George W. Bush had touted when he ran for president eight years earlier, it would be forgotten as soon as he took office. Four years later, Mitt Romney had something resembling a health-care plan too, but once again, nobody paid much attention to what it contained, because any time health care came up, the only question was how Romney could square his stated position that the Affordable Care Act was a poisonous hairball of misery coughed up by the Prince of Darkness himself, while the plan it was modeled after, often referred to as "Romneycare," was a wonderful thing that everyone in the state where it was implemented seems to like. Both McCain's and Romney's plans were mostly an amalgam of ineffectual half-measures and truly...

The Year in Preview: Pot's Uncertain Future

A fter the triumphs of marijuana reform in 2012—culminating in two successful ballot initiatives which made Washington and Colorado the first places in the world legalize the possession and sale of small amounts of weed—it was almost inevitable that 2013 would be a let-down. It wasn’t an unproductive twelve months for supporters of more lenient marijuana politics: New Hampshire and Illinois legalized pot for medical use, and Vermont decriminalized the possession of small amounts of marijuana. The residents of cities in Maine and Michigan also cast (mostly symbolic) votes in favor of pot legalization. But a third state has yet to join the two earliest adopters in sanctioning the possession and sale of pot, which remains illegal under federal law. Part of the problem was that so few state elections were held this year. For the past fifteen years, voter initiatives have set the tone for marijuana reform, beginning with the passage of ballot measures legalizing medical pot in the late...

Out of Birth Control—At Least the Long-Term Kind

Press Association via AP Images
Beleaguered fans of the Affordable Care Act (ACA) got some encouraging news on Wednesday morning: The contraceptive mandate is working. A study released by the Guttmacher Institute, a think tank that supports abortion rights, revealed that the number of privately insured women who paid nothing out of pocket for birth-control pills nearly tripled since the fall of 2012, from 15 percent to 40 percent. More women are also getting the vaginal ring at no cost. This financial bonus is courtesy of an ACA rule requiring private insurance companies to cover preventive care—like contraceptive products, procedures, and counseling—at no cost to the patient. Although some insurance plans are still “grandfathered in,” which means they don’t need to conform to the ACA’s requirements for now, millions of women became eligible for no-cost birth control at the beginning of the year, and they’re taking advantage of it. There is some bad news sandwiched in with the good. Although the number of women who...

The Year in Preview: Taking the Offensive on Reproductive Rights

(AP Photo/Pablo Martinez Monsivais
Read our earlier "Year in Preview" pieces on the media and voting rights here. Check back tomorrow for previews on the 2014 Supreme Court schedule and poverty politicking from the right. AP Photo/Eric Gay T he four horsemen haven’t appeared on the horizon yet, nor has the sea turned to blood, but you’d be forgiven for thinking that when it comes to reproductive justice in the United States, the end times are just around the corner. In 2013 alone, states enacted gobs of restrictions on early access to abortion. From Texas to Ohio to Iowa, dozens of clinics shut their doors. The courts are abortion-rights advocates’ best hope for stemming the tide of regressive legislation, but as Scott Lemieux has extensively documented here at the Prospect , their judgments have been decidedly mixed. In this ever-growing maelstrom of incursions on abortion rights, pro-choice politicians have stayed on the defensive, clinging to the standards established by Roe v. Wade even as conservatives whack...

Americans Suddenly Discovering How Insurance Works

Flickr/Eric Allix Rogers
It's been said to the point of becoming cliche that once Democrats passed significant health-care reform, they'd "own" everything about the American health-care system for good or ill. For some time to come, people will blame Barack Obama for health-care problems he had absolutely nothing to do with. But there's a corollary to that truism we're seeing play out now, which is that what used to be just "a sucky thing that happened to me" or "something about the way insurance works that I don't particularly like"—things that have existed forever—are now changing into issues , matters that become worthy of media attention and are attributed to policy choices, accurately or not. Before now, millions of Americans had health insurance horror stories. But they didn't have an organizing narrative around them, particularly one the news media would use as a reason to tell them. The latest has to do with the provider networks that insurance companies put together. This is something insurance...

Bishops May Not Be the Crooks This Time

AP Images/Luca Zennaro
T amesha Means was only 18 weeks pregnant on the morning of December 1, 2010, when her water broke. In a haze of pain, she called a friend for a ride to the only hospital in her central Michigan county. She had no idea that the hospital, Mercy Health Partners, was part of a Catholic health system. She just knew she needed help. What happened next, contend the plaintiffs in a new lawsuit filed by the ACLU on Means’s behalf , was not just the fault of a doctor, emergency room staff, or even the hospital. The blame goes right to the top—to the U.S. Catholic bishops. According to the lawsuit, over the course of the next 36 hours, Means was never told that her fetus had little chance of surviving. Nor was she told—as she would have been in a secular hospital—that doctors could induce labor or terminate her pregnancy. Instead, Means was twice sent home with painkillers and told to return only if she was having contractions three to four minutes apart. Unaware of the risks of continuing the...

$2,229.11 for Three Stitches? Behold the Wonder of the Free Market.

Eight stitches? That'll be $4,000. (Flickr/Sarah Korf)
Twenty years ago I had my first knee surgery, after tearing some cartilage while skying for a thunderous dunk on the basketball court (or it might have been just falling backward while getting faked out on defense—who remembers the details?). Although I had insurance, I was responsible for a substantial copay, and I vividly recall the one item that stood out among the dozens on the bill. For the two steri-strips that covered an incision—tiny pieces of tape that even today cost about 20 cents retail, and which hospitals buy in bulk so surely cost them just a couple of pennies—I and my insurance company were charged $11, or $5.50 per strip. A miniscule amount in a five-figure bill, but it struck me as the most absurd, since it represented a markup of approximately 10,000 percent, if not more. More recently, I was getting some physical therapy for the same knee, and in what turned out to be a session that wasn't covered by my insurance, a therapist put a piece of kinesio tape around my...

Pot Shots Fired: Recreational vs. Medicinal in Washington State

AP Images/Elaine Thompson
A s Washington begins to accept applications for the state’s first regulated recreational pot shops, cries of protest about its plans for medical marijuana are coming from unexpected quarters: the left. A year after voters put their state on track to become one of the only places in the world where marijuana can be legally owned and sold for purely recreational use, the state legislature still has to decide what to do with its rickety, fifteen-year-old medical-marijuana system. With the Department of Justice’s hawkish eyes trained on the state—determined to ensure that the drug, which is still illegal under federal law—remains under strict control, some bureaucrats and lawmakers are afraid that Washington’s unregulated medical-marijuana system could doom the whole experiment. In October, a working group commissioned by the legislature recommended that lawmakers should fold regulation of medical marijuana into the new recreational system, with a tax break for patients but few other...

The Death Panels Are Coming

Now that Healthcare.gov seems to be working reasonably well (at least on the consumer end), Republicans are going to have to find something else they can focus on in their endless war against the Affordable Care Act. So get ready for the return of "death panels." They never really went away. Those who aren't immersed in the fantasy world in which conservatives move were reminded of that last week, when chronicler of changed games Mark Halperin, the embodiment of most everything that's wrong with contemporary political journalism, did an interview with the conservative news organization Newsmax . When the interviewer mentioned "death panels, which will be coming," Halperin responded, "I agree, it's going to be a huge issue, and that's something else about which the President was not fully forthcoming and straightforward." Halperin didn't explain what lie he imagines Obama told about death panels (perhaps he thinks that when Obama said the government wouldn't declare your grandmother...

The Media Need to Do More to Help People Navigate Obamacare

Thanks, Fox Business Channel!
Yesterday, Tim Noah made a point in an MSNBC appearance that I think deserves a lot more attention. Media outlets have been doing lots of reporting on the problems of the Affordable Care Act rollout. What they haven't done is provided their audiences with practical information that could help them navigate the new system. Of course, most Americans don't have to do anything, since they have employer-provided insurance. But for all the attention we've been paying to the individual market, media outlets haven't done much to be of service. " The New York Times has published the URL for the New York exchange exactly twice," Noah said, "both before October first." My experience in talking to journalists about the publication of this kind of thing—unsexy yet useful information, whether it's how to navigate a new health law or understanding where candidates stand on issues—is that they often think that addressing it once is enough. When you ask them about it, they'll say, "We did a piece on...

The Affordable Care Act v. Supreme Court, Round 2

AP Photo/Tony Gutierrez
AP Photo/Carolyn Kaster Y esterday, the Supreme Court agreed to hear two cases questioning the Affordable Care Act's contraception mandate: Conestoga Wood Specialties Corp. v. Sebelius and Sebelius v. Hobby Lobby Stores, Inc . These rulings could have potentially major implications for the rights of American women. Let's consider the issues at hand, one at a time: Does the contraceptive mandate violate religious freedom? The key question in both cases is whether the contraceptive mandate violates the Religious Freedom Restoration Act. This legislation requires any policy placing a "substantial burden" on religious Americans prove that said burden serves a compelling government interest. Both Conestoga Wood and Hobby Lobby contend that the Affordable Care Act's demand that they offer contraception coverage to their employees does not pass the Religious Freedom Restoriation Act's test. But, as the Prospect 's Amelia Thomson-DeVeaux asks , is the mandate actually violating the religious...

The Contraception-Mandate Cases Aren’t Really About Contraception

Ap Images/Tony Gutierrez
Earlier today, the Supreme Court announced that it would hear not one, but two challenges to the Obama administration’s contraception mandate; they’ll be heard together in an action-packed hour of oral arguments sometime in the spring. Both cases deal with conservatives’ ever-growing penchant for anthropomorphizing corporations—this time, the justices will decide whether companies can be exempted from the mandate to provide birth control at no cost to employees because of the owners’ religious beliefs. Oddly enough, neither of the business owners involved are Catholic, even though the first objections to the contraception mandate were raised by Catholic leaders, who didn’t want religiously affiliated hospitals and schools to provide birth control, which the Catholic hierarchy considers taboo. One case— Sebelius v. Hobby Lobby Stores , documented extensively for the Prospect by Sarah Posner earlier this summer —deals with an arts-and-crafts chain owned by evangelical Christians. The...

Are the Obamacare Clouds Breaking?

Flickr/Sean MacEntee
This morning, I was listening to NPR—because yeah, I'm an effete pointy-headed liberal and that's how I roll—and I heard a story about people in California who got insurance cancellation notices, but then wound up getting better coverage and couldn't be happier about it. And the other day there was this story in The Washington Post about droves of poor people in rural Kentucky getting insurance for the first time in their lives—free, through Medicaid—because of the Affordable Care Act. In other words, after spending weeks telling the tales of people losing their health coverage (who in truth could get other health coverage), the media are finally putting at least some attention on the people who are benefiting from the ACA. And encouraging news seems to be breaking out all over. Ezra Klein and Evan Soltas ask , "Is Obamacare Turning the Corner?", noting that Healthcare.gov seems to be working pretty well, at least on the front end. States with well-functioning web sites like New York...

No, the Failure of Obamacare Would Not Lead to Single-Payer

Flickr/Public Citizen
More than a few conservatives are of the opinion that should the Affordable Care Act fail to achieve its goals, it would make the adoption of single-payer health insurance in the United States more likely. The reasonable ones who believe this argue that their side hasn't done enough to come up with ideas to address the very real problems in the health-care system, so if the ACA doesn't work, they don't have much to offer in response. If the question is, "Well now what?" and their response is, "How about making it impossible for you to sue your doctor if he cuts off the wrong leg? And can I interest you in a health savings account?", the American public may well turn to the big-government solution instead. I've spoken to conservatives who think that scenario is a real possibility. Carnival barkers like Rush Limbaugh, on the other hand, are telling the rank and file that the rocky rollout of the ACA was all part of the secret plan: things would go wrong, and then the socialist in the...

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