• Commentary

Checking Up On Health: January 27, 2015



Upcoming event with Attorney General Sam Olens and updates about ObamaCare, telehealth and the EPA.

Health Policy News and Views
By Benita M. Dodd

BENITA DODD
BENITA DODD

As the U.S. Supreme Court mulls a ruling in Halbig v. Burwell – over the IRS subsidies and tax credits for ObamaCare enrollees in the federally run health care exchanges – the Georgia Public Policy Foundation has scheduled a Leadership Breakfast event on March 18, featuring Georgia Attorney General Sam Olens.

The topic for the event, which includes a look at ObamaCare, is “Federalism, The Rule of Law and Regulatory Excess.” Foundation events are open to the public and you can register here by March 16.

I was doing my own mulling on the Halbig v. Burwell case last week. Challengers argue that the IRS rule subsidizing enrollees in the federally run exchanges is illegal, basically because the law only authorizes tax credits and subsidies for the purchase of insurance on exchanges “established by the State,” and the law defines “State” as one of the 50 states or the District of Columbia.

Supporters, argue that the intent was to cover all enrollees – an argument that came after 31 states declined to establish their own exchange, or “marketplace.”

Anyway, I posted my view of the argument on my Facebook page:

It occurs to me that if the U.S Supreme Court operated like divorce court, this debate over whether state exchange means federal exchange would’ve been over a long time ago.

“So, Mrs. Jones, you say your divorce agreement says that you may not remove your children from the State of New York without the permission of the father of your children or you’ll lose custody? And you plan to move to Hawaii?”

“Yes, Your Honor, because as I told you, I read the agreement after I signed it and by ‘from the State’ I actually meant ‘from the Nation’ and therefore I am entitled to move to Hawaii with my little darlings.”

“Yes, of course, Mrs. Jones. It was the spirit of the agreement that matters. And I hereby order Mr. Jones to pay all relocation costs related to the move.”

Said no court ever.

Book a trip to the ER on your smartphone: If you think telehealth is “inferior” care, you haven’t yet ordered from PapaJohn’s online pizza ordering Web site. Or made a restaurant reservation through OpenTable. Or used Lyft and Uber. Because convenience is growing. The latest, greatest telehealth opportunity allows patients with non-life-threatening ailments to schedule a doctor’s office visit or ER trip online or on their smartphones. The scheduling services are free for patients; doctors are charged $200-$300 a month. One such service is Atlanta-based ER Express, a startup that books reservations for more than 150 ERs and urgent care centers in nearly 30 states. It served more than 40,000 patients in 2014, up 300 percent from 2013. Source: Associated Press

Baby steps to Medicaid alternatives: The Obama administration, which stubbornly stuck to its version of health care solutions, has now approved a Medicaid waiver for Indiana that begins the transformation of the program toward a consumer-directed model, writes Grace-Marie Turner of the Galen Institute in Forbes magazine. Governor Mike Pence is tweaking the Healthy Indiana Plan (HIP) created by former Governor Mitch Daniels in 2007. Healthy Indiana 2.0 will require contributions from all able-bodied participants, even those at the lowest income eligibility levels. An Employer Benefit Link will provide a Medicaid contribution for recipients who are eligible and participating in employer-sponsored health insurance plans. Recipients who do not make their required contributions toward their health benefits can be locked out of the program for six months. There also are penalties for unnecessary visits to emergency rooms. “By winning approval of these changes through a Medicaid waiver, other governors have a much stronger platform to move toward other changes that will work for their states,” Turner writes. That’s promising news, because the Georgia Public Policy Foundation has had a Medicaid alternative waiting in the wings for a while now, and some traction would be welcomed.

It’s about the children: My least favorite topic is the Environmental Protection Agency. I have an avid dislike of its posturing, its faux science and its record of overregulation and overreach. It’s a bureaucracy steeped in fairy dust and unicorns. I’ve testified a few times when the EPA brought its hearings to Atlanta, and I might as well have beat my head against the wall. Or used essential oils, for all the good it did.

But my main beef about the agency is that it stifles business opportunity and takes money out of the pockets of American taxpayers that we could use to improve our quality of life and our families’ health with much greater benefits than EPA’s fabrications. Chris Horner of the Competitive Enterprise Institute, who was in Atlanta a few years ago to talk about global warming hype at a Foundation event (watch it here), has doggedly investigated the scandals surrounding the EPA, including fake e-mail addresses, and finally succeeded in obtaining some astounding information under the Freedom of Information Act. As Horner writes in his blog:

What the memo demonstrates is the recognition by EPA at the outset of the Obama administration that the agency needed to move its global warming campaign away from the failed shrill tactics of discredited Big Green pressure groups and their icons (such tactics are “an unpersuasive argument to make,” per the memo). In it we see the birth of the breathtakingly disingenuous “shift from making this about the polar caps [to] about our neighbor with respiratory illness…”

So much for the children: Is THIS OK because the EPA funded it? (And have you heard this in the mainstream media?) In experiments conducted between 2003 and 2010 and funded by the EPA, children as young as 10 years of age were exposed to diesel exhaust, despite well-established warnings against diesel exposure. CFACT reported it first, but they’re “just” climate change skeptics, you know, so why would the mainstream media pay any attention to them?

Eating Fish While Pregnant: In babies of women who consumed a lot of fish while pregnant, the benefits of n-3 polyunsaturated fatty acids in the fish outweighed the potential adverse effects of mercury exposure. The study took place in the Republic of Seychelles, where people consume an average of eight meals per week containing fish – significantly more than most other nations around the world, making it an opportune place to study the association between mercury exposure and child development, according to Medscape.

In brief:

Burnout: More physicians are reporting burnout, according to the 2015 Medscape Physician Lifestyle Report. It found 46 percent of physicians surveyed felt burned out in 2014, compared to slightly less than 40 percent in 2013. Highest burnout rate was in critical care (53 percent) and the lowest was dermatology (37 percent.) Source: Becker’s Hospital Review

Doc strike: In the first strike by fully licensed physicians in 25 years, about 125 doctors and dentists at the University of California’s student health centers staged a one-day strike on 10 UC campuses, according to a Los Angeles Times report. The issues are reported to be the UC system’s alleged refusal to provide financial information on student health services during contract bargaining and physicians’ concerns in regard to staffing levels.

Quotes of note

“While the administration touts the swelling numbers of Medicaid covered patients – nearly 68 million currently – I suspect access to quality care will soon become an issue.  Just as with every other manipulation of the ACA over the last two years, legacy and political agendas have taken precedent over what really should matter: providing quality medical care and prompt, easy access to care for the formerly uninsured.” – Dr. Kevin R Campbell

“The process now is estimated to take an average of 4.5 years for a new device to complete pilot and pivotal clinical phases with average costs of $30 million for low-to-moderate risk devices and a whopping $91 million for higher risk devices. For new drugs, the costs are in the hundreds of millions of dollars.” – Dr. Kevin Stone

 

 

Health Policy News and Views
By Benita M. Dodd

BENITA DODD

BENITA DODD

As the U.S. Supreme Court mulls a ruling in Halbig v. Burwell – over the IRS subsidies and tax credits for ObamaCare enrollees in the federally run health care exchanges – the Georgia Public Policy Foundation has scheduled a Leadership Breakfast event on March 18, featuring Georgia Attorney General Sam Olens.

The topic for the event, which includes a look at ObamaCare, is “Federalism, The Rule of Law and Regulatory Excess.” Foundation events are open to the public and you can register here by March 16.

I was doing my own mulling on the Halbig v. Burwell case last week. Challengers argue that the IRS rule subsidizing enrollees in the federally run exchanges is illegal, basically because the law only authorizes tax credits and subsidies for the purchase of insurance on exchanges “established by the State,” and the law defines “State” as one of the 50 states or the District of Columbia.

Supporters, argue that the intent was to cover all enrollees – an argument that came after 31 states declined to establish their own exchange, or “marketplace.”

Anyway, I posted my view of the argument on my Facebook page:

It occurs to me that if the U.S Supreme Court operated like divorce court, this debate over whether state exchange means federal exchange would’ve been over a long time ago.

“So, Mrs. Jones, you say your divorce agreement says that you may not remove your children from the State of New York without the permission of the father of your children or you’ll lose custody? And you plan to move to Hawaii?”

“Yes, Your Honor, because as I told you, I read the agreement after I signed it and by ‘from the State’ I actually meant ‘from the Nation’ and therefore I am entitled to move to Hawaii with my little darlings.”

“Yes, of course, Mrs. Jones. It was the spirit of the agreement that matters. And I hereby order Mr. Jones to pay all relocation costs related to the move.”

Said no court ever.

Book a trip to the ER on your smartphone: If you think telehealth is “inferior” care, you haven’t yet ordered from PapaJohn’s online pizza ordering Web site. Or made a restaurant reservation through OpenTable. Or used Lyft and Uber. Because convenience is growing. The latest, greatest telehealth opportunity allows patients with non-life-threatening ailments to schedule a doctor’s office visit or ER trip online or on their smartphones. The scheduling services are free for patients; doctors are charged $200-$300 a month. One such service is Atlanta-based ER Express, a startup that books reservations for more than 150 ERs and urgent care centers in nearly 30 states. It served more than 40,000 patients in 2014, up 300 percent from 2013. Source: Associated Press

Baby steps to Medicaid alternatives: The Obama administration, which stubbornly stuck to its version of health care solutions, has now approved a Medicaid waiver for Indiana that begins the transformation of the program toward a consumer-directed model, writes Grace-Marie Turner of the Galen Institute in Forbes magazine. Governor Mike Pence is tweaking the Healthy Indiana Plan (HIP) created by former Governor Mitch Daniels in 2007. Healthy Indiana 2.0 will require contributions from all able-bodied participants, even those at the lowest income eligibility levels. An Employer Benefit Link will provide a Medicaid contribution for recipients who are eligible and participating in employer-sponsored health insurance plans. Recipients who do not make their required contributions toward their health benefits can be locked out of the program for six months. There also are penalties for unnecessary visits to emergency rooms. “By winning approval of these changes through a Medicaid waiver, other governors have a much stronger platform to move toward other changes that will work for their states,” Turner writes. That’s promising news, because the Georgia Public Policy Foundation has had a Medicaid alternative waiting in the wings for a while now, and some traction would be welcomed.

It’s about the children: My least favorite topic is the Environmental Protection Agency. I have an avid dislike of its posturing, its faux science and its record of overregulation and overreach. It’s a bureaucracy steeped in fairy dust and unicorns. I’ve testified a few times when the EPA brought its hearings to Atlanta, and I might as well have beat my head against the wall. Or used essential oils, for all the good it did.

But my main beef about the agency is that it stifles business opportunity and takes money out of the pockets of American taxpayers that we could use to improve our quality of life and our families’ health with much greater benefits than EPA’s fabrications. Chris Horner of the Competitive Enterprise Institute, who was in Atlanta a few years ago to talk about global warming hype at a Foundation event (watch it here), has doggedly investigated the scandals surrounding the EPA, including fake e-mail addresses, and finally succeeded in obtaining some astounding information under the Freedom of Information Act. As Horner writes in his blog:

What the memo demonstrates is the recognition by EPA at the outset of the Obama administration that the agency needed to move its global warming campaign away from the failed shrill tactics of discredited Big Green pressure groups and their icons (such tactics are “an unpersuasive argument to make,” per the memo). In it we see the birth of the breathtakingly disingenuous “shift from making this about the polar caps [to] about our neighbor with respiratory illness…”

So much for the children: Is THIS OK because the EPA funded it? (And have you heard this in the mainstream media?) In experiments conducted between 2003 and 2010 and funded by the EPA, children as young as 10 years of age were exposed to diesel exhaust, despite well-established warnings against diesel exposure. CFACT reported it first, but they’re “just” climate change skeptics, you know, so why would the mainstream media pay any attention to them?

Eating Fish While Pregnant: In babies of women who consumed a lot of fish while pregnant, the benefits of n-3 polyunsaturated fatty acids in the fish outweighed the potential adverse effects of mercury exposure. The study took place in the Republic of Seychelles, where people consume an average of eight meals per week containing fish – significantly more than most other nations around the world, making it an opportune place to study the association between mercury exposure and child development, according to Medscape.

In brief:

Burnout: More physicians are reporting burnout, according to the 2015 Medscape Physician Lifestyle Report. It found 46 percent of physicians surveyed felt burned out in 2014, compared to slightly less than 40 percent in 2013. Highest burnout rate was in critical care (53 percent) and the lowest was dermatology (37 percent.) Source: Becker’s Hospital Review

Doc strike: In the first strike by fully licensed physicians in 25 years, about 125 doctors and dentists at the University of California’s student health centers staged a one-day strike on 10 UC campuses, according to a Los Angeles Times report. The issues are reported to be the UC system’s alleged refusal to provide financial information on student health services during contract bargaining and physicians’ concerns in regard to staffing levels.

Quotes of note

“While the administration touts the swelling numbers of Medicaid covered patients – nearly 68 million currently – I suspect access to quality care will soon become an issue.  Just as with every other manipulation of the ACA over the last two years, legacy and political agendas have taken precedent over what really should matter: providing quality medical care and prompt, easy access to care for the formerly uninsured.” – Dr. Kevin R Campbell

“The process now is estimated to take an average of 4.5 years for a new device to complete pilot and pivotal clinical phases with average costs of $30 million for low-to-moderate risk devices and a whopping $91 million for higher risk devices. For new drugs, the costs are in the hundreds of millions of dollars.” – Dr. Kevin Stone


Benita Dodd is vice president of the Georgia Public Policy Foundation.