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Governors: No Clear Plan If Health Care Subsidies Fall

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President Barack Obama’s health care system could be receiving a massive overhaul. If the Supreme Court sides with opponents of the current system, millions of people could lose health insurance subsidies in the coming months. Reported by cbs4.com 5 hours ago.

Health insurance confusion likely for many filing taxes

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Reported by DallasNews 2 hours ago.

Affordable Care Act faces Supreme Court again

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The Supreme Court has agreed to hear a case Monday concerning the Affordable Care Act. The case challenges the government subsidies that help millions of low- and middle-income people afford their health insurance premiums. (Feb. 23)

 
 
 
 
 
 
 
  Reported by USATODAY.com 1 day ago.

Nurse indicted on charges of health care fraud, identity theft

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A federal grand jury has indicted a Stone Mountain wellness nurse on charges of health care fraud and identity theft. Prosecutors say that between May 2013 and September 2014 Daphne Patterson billed five health insurance companies, including UnitedHealthcare and Aetna, for more than $2.2 million in services she never performed, reports WABE. The indictment says Patterson used the money to buy jewelry and luxury watches. Click here to read more and to access a link to view the indictment. Reported by bizjournals 21 hours ago.

13 Million Illinois Citizens Named Bruce

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The billionaire Republican Governor of Illinois, Bruce Rauner, injected himself into ceremonies in Chicago last week presided over by the city’s Democratic mayor and the nation’s Democratic president.

Rauner insisted on attending because he wrongheadedly thought the Democrats were honoring his idol, kingpin George Pullman, the guy who invented the luxury railroad sleeper car, oppressed his workers and suppressed their union.

Rauner, and other kowtow-to-the-rich Republican governors, adhere to the Pullman philosophy that rich people are better than everyone else and that gives them the right to control the lives of everyone else. They don’t comprehend the dreams and desires of the middle class and working poor. So Rauner couldn’t conceive that the ceremony in Chicago’s South Side neighborhood named Pullman by Pullman for his personal self-aggrandizement was not about placing the mogul on a pedestal but really about recognizing the people who ultimately prevailed despite his exploitation.

*This 1943 image taken at Union Station in Chicago, Ill., by photographer Jack Delano of a sleeping car porter employed by the Pullman Company is from the U.S. Library of Congress. *

At ceremonies designating the Pullman Historic District as a national monument, President Obama’s speech served as both a rebuke and history lesson for Rauner. The president told the tale of Pullman from the workers’ point of view.

Pullman constructed his first sleeper car three years after the Civil War ended and nine years later employed his first black porters for an expanded service. These black men and women were hired at low wages to work long hours to wait on wealthy white customers hand and foot. This was a Southern plantation travelling America on rails.

Porters, who had to pay for their own uniforms and equipment such as shoe shine boxes, depended on tips for much of their income. As a result, most kept silent as white passengers referred to them all by Pullman’s first name, “George.” This demeaning treatment inspired the 2002 Robert Townsend film 10,000 Black Men Named George.

The community Pullman built around his factory was a company town in all the worst ways. Pullman owned everything, the homes, the hospital, the shops, the hotel named for his daughter Florence, and, of course, the source of all income – the jobs.

Pullman believed he should decide what was best for all the residents. The town contained no taverns because he felt residents were better off without alcohol. He refused to allow workers to own their homes because he feared “the risk of seeing families settle who are not sufficiently accustomed to the habits I wish to develop in the inhabitants of Pullman City."

During the recession of 1893 and 1894, Pullman slashed wages for workers, but not his own pay. He refused to ease rents and grocery costs, which would have reduced his profits, even as his workers and their children suffered. His row house inhabitants, barely surviving on soup kitchen handouts from Chicago charities, sent a delegation to negotiate with him. He wouldn’t relent, contending, as if he were a benevolent parent and not a insensitive tyrant, that they were “all his children.” 

Not willing to subsist as helpless inhabitants of a rich man’s dollhouse, the community’s workers, who believed in America’s promise of self-determination, organized a strike. It eventually spread across the country as the porters joined in. Pullman got the President to send in federal troops who fixed bayonets on the populace and killed more than 30 workers.

The workers returned to their jobs, but they’d experienced the power of collective action. And that couldn’t be repressed. The workers cheered in 1898 when the state Supreme Court ordered the company town sold. It would take decades longer, but the workers eventually secured their goal of collective action on the job.

In 1925, the porters established a labor union, the Brotherhood of Sleeping Car Porters, and chose civil rights activist A. Philip Randolph to lead it. At that meeting, Randolph explained why workers’ concerted action was essential: “What this is about is making you master of your economic fate.” 

Pullman refused to recognize the union and tried to squelch it, firing as many members of the brotherhood as his spies could find. It took the workers 12 years, but finally after passage of the National Labor Relations Act, which provided a clear legal path to unionization, Pullman was forced to acknowledge and negotiate with the brotherhood.

Standing in the Pullman Historic District Thursday, President Obama said, “So this site is at the heart of what would become America’s labor movement — and as a consequence, at the heart of what would become America’s middle class.”

"As Americans we believe workers' rights are civil rights. That dignity and opportunity aren’t just gifts to be handed down by a generous government or by a generous employer; they are rights given by God, as undeniable and worth protecting as the Grand Canyon or the Great Smoky Mountains.” President Obama said.

That, however, is not what Republicans like Bruce Rauner believe. They think, just as Pullman did, that workers’ rights should be circumvented, slighted and squashed for the benefit of the rich. 

And they’re striving to accomplish that. In one of his first acts as governor of Wisconsin, Scott Walker slashed the rights, pay and benefits of public sector union members. Republicans in Indiana and Michigan passed laws to ensure their citizens could work for less than what a labor union could bargain for them, and several other Republican-dominated states including Wisconsin, Nevada and West Virginia are considering measures to constrain the ability of workers to collectively seek better wages and working conditions.

The Republican governor of Ohio tried to restrict the rights of public sector workers to collectively bargain, but citizens overwhelmingly reversed him in a referendum.

In the weeks before the ceremony in Chicago, Rauner attempted by executive fiat to financially hobble labor unions representing state workers and urged the state’s cities and counties to ignore state and federal labor laws by creating zones where employees would have the right to work for less than the amount labor unions could negotiate for them. 

Similarly, he proposed in the budget he offered last week that the middle class and working poor take all of the hits to mend the state’s finances. He plans, for example, to cut Medicaid for the poor and elderly, health insurance and pensions for government workers, mass transit used by the working poor to get to jobs, and services to vulnerable former foster kids.

In the meantime, he had the state hire a $100,000-a-year assistant for his wife and plans to renovate the governor’s Civil War-era mansion.

Like Pullman, “Daddy” Rauner is intent on controlling Illinois’ “children.”  He said as he issued his budget, “Instilling discipline is not easy, saying ‘no’ is not popular.” That is a budget requiring no discipline for billionaire private equity CEOs like Rauner. His aides said he never even considered new taxes on his country club buddies. Only workers are to endure austerity in Rauner’s Illinois.

Rauner is making a bid for a new film set in Chicago. This one will be called 13 Million Illinois Citizens Named Bruce. Already it’s a flop with the populace.   Reported by Huffington Post 17 hours ago.

ConSova Corporation Selected as the Preferred Dependent Eligibility Verification Partner by Equity Healthcare, LLC

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ConSova Corporation has been named the Equity Healthcare Preferred Partner for dependent eligibility services. The 3-year agreement makes ConSova’s health care cost containment services available to the 40+ members and affiliates served by Equity Healthcare.

LAKEWOOD, CO (PRWEB) February 23, 2015

ConSova Corporation, one of the nation’s leading health care cost containment companies, today announced that Equity Healthcare, LLC has selected it as the preferred dependent eligibility partner for its 40+ affiliated companies.

Through this agreement, ConSova joins forces with Equity Healthcare to offer a full range of health care cost containment solutions to the companies within the Blackstone Group’s global asset management portfolio as well as other affiliated private equity firms. Equity Healthcare’s companies will gain access to best-of-breed solutions for Dependent Eligibility Verification, Working Spouse Provision Audits and Ongoing Verification Services.

Equity Healthcare, a wholly owned subsidiary of The Blackstone Group, leverages the scale of the combined purchasing power of its portfolio companies to contract for services aimed at delivering better quality health care, while driving down costs. By collaborating with ConSova, Equity Healthcare is able to help its members strengthen their commitment to running benefit plans in a fiscally responsible manner and gain control over a major cost factor.

“We ran a rigorous RFP process which evaluated the best firms in this space. Because of their commitment to service and innovative approach, ConSova separated themselves from the field and was the clear choice for us,” said Dr. Robert Galvin, Chief Executive Officer of Equity Healthcare.

The health care cost containment solutions offered by ConSova afford Equity Healthcare members the opportunity to meaningfully reduce their annual health care spend. These savings are achieved through the identification of ineligible dependents (5-8 percent of covered dependents on average) currently covered on the plan and through the implementation of Other Coverage Verification for those organizations with working spouse rules.

Pressed between rising health care costs and mandatory health insurance rules, an increasing number of employers are looking to working spouse provisions to help contain costs. The adoption of spousal surcharges and exclusion rules (also known as carve-out rules) has created the need for verification of other coverage available at a spouse’s employer. ConSova has pioneered a Working Spouse Provision Audit that enables health plans to achieve 30 percent participation rates in these programs, well above the 8.3 percent average participation experienced by employers without proper verification mechanisms in place.

“Our ability to quickly deliver bottom line results will be a great fit for Equity Healthcare’s portfolio companies and is well aligned with their mission,” said John Cratin, SVP, ConSova Corporation. “We embrace the opportunity to work with the private equity community and share in their commitment to strengthen member health plans through greater cost containment and risk avoidance.”

About ConSova Corporation

Founded in 2003, ConSova is one of the first companies on the market to provide eligibility verification and health care cost-containment innovation for self-insured organizations. Leveraging unparalleled expertise in human resources, benefits and health care planning, the company has delivered over $1 Billion in savings on work with over 500 clients nationwide. For more information, visit http://www.consova.com.

About Equity Healthcare, LLC

Equity Healthcare was formed in 2008 by the Blackstone Group and works with private equity firms and their portfolio companies to bring innovative solutions to manage healthcare costs. Unlike traditional group purchasing organizations, EH focuses on the health of employees and their families and the quality of care they receive. EH has a several year track record of controlling healthcare costs while improving population health and has grown to 300,000 members. Currently, 7 private equity firms and 44 portfolio companies participate, with annual health expenditures exceeding $1.5B making it one of the largest private sector purchasers of healthcare services in the US. For more information, visit https://www.equityhealthcare.com/ Reported by PRWeb 18 hours ago.

This Is How Normal People Feel About the Death Penalty

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Utah recently approved "death by firing squad" as a capital punishment option, replacing the former procedure -- death by stabbing... which is still more humane than, say, being forced to watch the NBA All-Star Game or eat Totino's Pizza Rolls.

If I was on death row -- or, as it's sometimes called, "the Khloe Kardashion of the prison system" -- I think I'd prefer a round of bullets over lethal injection. Needles make me queasy.

I'd also be okay with the electric chair, as long as it has an outlet to recharge my cell phone. Hey, if you only have twenty minutes to live, that still gives you twenty minutes to text. If there's one last thing I need to do in the seconds left before I die, it's to invite all my Facebook friends to play Candy Crush.

The guillotine seems pretty quick and painless. Perhaps we, as a compassionate society, should bring back the guillotine. Though I'm not sure where you can still purchase a guillotine. I think they used to sell them at Radio Shack.

But here's the thing with the death penalty. (Though if it's "capital" punishment, it should probably be THE DEATH PENALTY. Lower case punishment is for misdemeanors. And our most vicious criminals deserve a comic sans font.) Americans have trouble separating the philosophy of the death penalty with the reality of our legal system.

Philosophically, I support capital punishment. Society does not need selfie sticks, non-alcoholic beer, and brutal murderers who are still breathing. The life of a serial killer is not precious. In theory, the government has the moral authority to enact the ultimate punishment. (Well, the "ultimate punishment" is an all-day 2 Broke Girls marathon. But the death penalty is probably in the top five.)

Some people argue that the state does not have an inherent right to kill people. That might be true. On the other hand, I'm not sure if the state has an inherent right to imprison people and keep them confined in a tiny cell, either. But, heck, we need to do something with these assholes. By living here, you agree to the rules and you recognize the legal authority to enact and enforce those rules. If you prefer to reside in a chaotic wasteland where anyone can do anything they want without consequence... well, then welcome to Canada.

One criticism of capital punishment is the possibility of putting to death an innocent person. And "life in prison without parole" is a fairer option. Yes, but life in prison brings with it the possibility of putting an innocent person in prison for life. And that ain't so great, either. Let's agree that innocent people should not be convicted of crimes. Yes, our court system is a mess. Fix it! But we can't base our system of punishment on the assumption that the perpetrator might be innocent. If that's the case, then prison should be nicer. Maybe paint the cell walls a fashionable lime green.

Spending years in jail is probably a harsher penalty than death. Dead people aren't consumed with the fear of getting pummeled in the prison shower by a gang of skinheads. Heck, I'm consumed by that fear... and I'm not even in prison. Death is kind of an easy way out. That's why murderers often kill themselves before they can be arrested. Death is more lenient than prison. I bet if you put a cyanide pill in front of every inmate in America, a large percentage of people would swallow it. Sort of like if you put cyanide in front of every person watching The Talk on CBS.

As justification for the death penalty, some people quote from the Bible: "an eye for an eye." Or maybe that's from Dr. Seuss. Either way, it doesn't really make a lot of sense. If a person kills and so their punishment is to be killed, then, logically, the punishment for drunk driving should be drunk driving. But I'm not sure how that would work.

In fact, there are many logical inconsistencies that surround capital punishment. Most states still offer death row inmates a "last-meal" request. Sure, you brutally tortured and murdered seven people and we're stripping you of your freedom and your possessions and your dignity and we're going to strap you into a death gurney and inject lethal poison into your veins... but, just to show there are no hard feelings, do you like French fries?

Trivia: In 2011, Texas abolished special last-meal requests after a prisoner on death row ordered a ludicrously complex meal (but didn't eat it). Wow. I think it's unfair to deny all evil monsters a special treat just because of one bad apple.

Thirty-two American states have the death penalty. Eighteen states do not. In Virginia, you can be executed for murder. But not in West Virginia. So my advice to psychopaths who are about to kill someone while standing on the Virginia/West Virginia border and who don't want to be electrocuted is to drag your victim a few feet east.

And here's another piece of advice for murderers...

Be rich.

It's good advice. The vast majority of inmates on death row are poor. Especially once their National Football League contracts are up.

In support of our current system, one could say, "Well, poor people are the ones committing the murders." Perhaps. And it's irrational to excuse any murder. I mean, if you're poor, you can steal a loaf of bread without killing the cashier. But I'm interested in why it's mostly the poor who are doing these horrible things. Are poor people just morally "worse?" And how would that explain Ryan Seacrest's enormous bank account?

Philosophically, I'm okay with the death penalty for murderers. But the problem is that society socially constructs the idea of "murder" in a way that puts poor people, once again, at a disadvantage.

When poor people kill someone, it's murder. When wealthy people kill someone, it's called economic freedom or it's the reality of war or it's a competitive health industry. Nobody on food stamps has ever been in charge of corporate environmental destruction. People in line at the food bank aren't the CEOs of companies caught knowingly selling dangerous and faulty products. Impoverished people don't deny health insurance claims. Profit-motivated military excursions are not the brainchild of the homeless.

There will never be an episode of CSI in which the villain runs a corporation that is- sort of legally- slowly releasing poisonous toxins into the air and in our food and water that make us sicker and sicker, subtly and over so many years that nobody really notices. But that guy is causing a lot more death than the brilliant-but-deranged janitor kidnapping college kids and surgically replacing their faces with pig snouts.

Despite what common sense might tell us, in the history of the United States, wealthy and socially powerful people have killed a hundred times, a thousand times, ten-thousand times as many people as have poor people. But powerful people don't get in trouble for their actions. And they certainly don't receive the death penalty.

People ask, in defense of capital punishment, "What if someone in your family was murdered? Would you want the perpetrator to die?" Hell, yeah! I'd want to kill him myself. On the other hand, I also support lethal injection for the bastard who cut me off in traffic yesterday. So I'm not sure I'm the best person to ask.

Luckily, most people don't have a close family member who was murdered. But I bet most people have a loved one who died before their time- from a disease or an accident or something other than old age. What if this person didn't have to die? What if, indirectly, this person's death was the result of unnatural forces, of the practices of powerful individuals? What would you like to see happen to the individuals whose greed caused your loved one to die?

In theory, the death penalty is a practical way to deal with social evil. And it also supplies food for our nation's cannibals. Unfortunately, we don't live in a theoretical society. We live in a world where people are not blind to race and economics, and where legal reality is controlled by those with power, in a way that benefits themselves.

Really, the biggest problem is not who receives the death penalty. It's who doesn't receive it. In a fair and just society, we're going to have to start executing a hell of a lot more people. Rest up, firing squads. You have a lot of work to do. Or we could just eliminate capital punishment. Whatever works best. Reported by Huffington Post 16 hours ago.

Parent of Columbia St. Mary's, Ministry expands in health insurance

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The parent company of Columbia St. Mary's and Ministry Health Care is expanding in the health insurance business with plans to acquire U.S. Health and Life Insurance Co., which sells insurance in the Wisconsin market. A Michigan subsidiary of St. Louis-based Ascension Health plans to buy U.S. Health and Life Insurance Co. for $50 million, according to Crain's Detroit Business. The proposed acquisition will be through a new Ascension subsidiary called Ascension Care Management LLC. The subsidiary's… Reported by bizjournals 14 hours ago.

Brits Think We're Nuts for Believing Our Health System is Better than Theirs

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America is the home of the brave, they say, but a lot of us brave folks are terrified of the way the British do health care.

We're even afraid of other Americans who aren't afraid of it, like Dr. Donald Berwick. President Obama nominated Berwick to lead the Centers for Medicare and Medicaid Services a few years back, but Senate Republicans were so united in their opposition to Berwick that Obama had to wait until Congress was in recess to appoint him. Berwick struck fear in the hearts of the senators when a few years earlier he said a few positive things about Britain's National Health Service.

The truth is that those most frightened by the National Health Service--then and now--are insurance industry executives. My former colleagues have been unceasing in their depiction of the NHS as "socialized medicine." How could anything in the world possibly be worse than a single-payer system in which insurance companies would be unnecessary?

When I was an industry PR guy, I was part of a never-ending effort to defame the NHS, usually by citing a few anecdotes about Brits who claimed to endure long waits for needed care.

The industry's propaganda got little resistance from the media or the American public. Few folks on this side of the Atlantic bothered to ask the Brits why they would put up with such an obviously inferior system and why they weren't clamoring for American-style health care.

To make amends for the years I worked to mislead folks about the NHS, I'd like to recommend a couple of recent articles about Brits who have received care in both the U.S. and the U.K.

The headline of the January 12 story in The Guardian is about all you need to read, quite frankly. "Too many choices, high costs and bureaucracy: British expats grade American healthcare system 'a pain in the arse.' "

The subhead was even more of an indictment of the way we do things here: "Moving to the U.S. for work has advantages for British citizens. The healthcare system is not one of them. It's so bad that some expats fly home for treatment."

The article begins by relating the experience of Scottish-born David Gray, now living in Brooklyn, who was recently given the unfortunate news that his doctor was no longer in his insurance company's network of providers. He was turned away.

"Gray is far from alone," the article noted. "The American 'health insurance' system comes as a nasty shock to many British expatriates working and living in the United States."

What also comes as a shock is the fact that "many Americans stay in a job they hate for 20 or 30 years mainly because it provides health insurance for them and their families.

"That strikes Brits as a kind of serfdom in The Land of The Free."

The article quotes Helen Colquhoun, who moved from the U.K. to Boston 12 years ago, as being baffled "why so many Americans are opposed to the idea of what they call 'socialized medicine' and why health insurance has anything to do with employment."

"Why it is tied to employment is beyond me," she says. "It is a massive burden on business like another tax."

The other piece I recommend was written for Business Insider by Jim Edwards, a businessman with dual citizenship.

In the January 29 article, Edwards recounts his experiences getting care in both countries for a recent inner ear problem. He wrote about how long it took him to get an appointment with a doctor in the U.S. and then the long wait to be treated after he arrived at the doctor's office. "I have read many a back issue of Newsweek in my primary care doctor's office" he wrote.

In the UK, by contrast, "I showed up at 9 a.m. and was seen instantly."

"For an American, this was bizarre: My butt barely touched the seat in the waiting room before my name was called. Turns out my doc and her staff are serious about patient scheduling."

Both The Guardian and Business Insider articles noted how Americans are often buried in paperwork after getting medical care.

"If you ever had any health issue that required more than a simple doctor visit, you will know that it precipitates a seemingly never-ending series of forms, bills and letters," Edwards wrote. "You will be paying bills months, years, later. And it's almost impossible to correct a billing error. It's stressful. I developed an intense hatred for health insurance companies in the U.S. because of this."

In the NHS, he wrote, "there was close to zero paperwork."

Neither article paints the NHS as nirvana. But none of the Brits would trade the NHS for American-style health care.

"Americans think they have the best health care in the world," Edward wrote. "Take it from me, a fellow American: They don't." Reported by Huffington Post 13 hours ago.

Brits Think We're Nuts for Believing Our Health System Is Better Than Theirs

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America is the home of the brave, they say, but a lot of us brave folks are terrified of the way the British do health care.

We're even afraid of other Americans who aren't afraid of it, like Dr. Donald Berwick. President Obama nominated Berwick to lead the Centers for Medicare and Medicaid Services a few years back, but Senate Republicans were so united in their opposition to Berwick that Obama had to wait until Congress was in recess to appoint him. Berwick struck fear in the hearts of the senators when a few years earlier he said a few positive things about Britain's National Health Service.

The truth is that those most frightened by the National Health Service -- then and now -- are insurance industry executives. My former colleagues have been unceasing in their depiction of the NHS as "socialized medicine." How could anything in the world possibly be worse than a single-payer system in which insurance companies would be unnecessary?

When I was an industry PR guy, I was part of a never-ending effort to defame the NHS, usually by citing a few anecdotes about Brits who claimed to endure long waits for needed care.

The industry's propaganda got little resistance from the media or the American public. Few folks on this side of the Atlantic bothered to ask the Brits why they would put up with such an obviously inferior system and why they weren't clamoring for American-style health care.

To make amends for the years I worked to mislead folks about the NHS, I'd like to recommend a couple of recent articles about Brits who have received care in both the U.S. and the U.K.

The headline of the January 12 story in the Guardian is about all you need to read, quite frankly. "Too many choices, high costs and bureaucracy: British expats grade American healthcare system 'a pain in the arse.' "

The subhead was even more of an indictment of the way we do things here: "Moving to the U.S. for work has advantages for British citizens. The healthcare system is not one of them. It's so bad that some expats fly home for treatment."

The article begins by relating the experience of Scottish-born David Gray, now living in Brooklyn, who was recently given the unfortunate news that his doctor was no longer in his insurance company's network of providers. He was turned away.

"Gray is far from alone," the article noted. "The American 'health insurance' system comes as a nasty shock to many British expatriates working and living in the United States."

What also comes as a shock is the fact that "many Americans stay in a job they hate for 20 or 30 years mainly because it provides health insurance for them and their families.

"That strikes Brits as a kind of serfdom in The Land of The Free."

The article quotes Helen Colquhoun, who moved from the U.K. to Boston 12 years ago, as being baffled "why so many Americans are opposed to the idea of what they call 'socialized medicine' and why health insurance has anything to do with employment."

"Why it is tied to employment is beyond me," she says. "It is a massive burden on business like another tax."

The other piece I recommend was written for Business Insider by Jim Edwards, a businessman with dual citizenship.

In the January 29 article, Edwards recounts his experiences getting care in both countries for a recent inner ear problem. He wrote about how long it took him to get an appointment with a doctor in the U.S. and then the long wait to be treated after he arrived at the doctor's office. "I have read many a back issue of Newsweek in my primary care doctor's office" he wrote.

In the UK, by contrast, "I showed up at 9 a.m. and was seen instantly."

"For an American, this was bizarre: My butt barely touched the seat in the waiting room before my name was called. Turns out my doc and her staff are serious about patient scheduling."

Both the Guardian and Business Insider articles noted how Americans are often buried in paperwork after getting medical care.

"If you ever had any health issue that required more than a simple doctor visit, you will know that it precipitates a seemingly never-ending series of forms, bills and letters," Edwards wrote. "You will be paying bills months, years, later. And it's almost impossible to correct a billing error. It's stressful. I developed an intense hatred for health insurance companies in the U.S. because of this."

In the NHS, he wrote, "there was close to zero paperwork."

Neither article paints the NHS as nirvana. But none of the Brits would trade the NHS for American-style health care.

"Americans think they have the best health care in the world," Edward wrote. "Take it from me, a fellow American: They don't." Reported by Huffington Post 13 hours ago.

The Straightforward Explanation for "Established by the State" in the Affordable Care Act

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In the coming weeks much will be written about King v. Burwell, the latest attack on the Affordable Care Act before the Supreme Court. The law's opponents argue the statute authorizes tax credits only in the states that operate their own health insurance marketplaces (also known as exchanges). If this were correct -- and subsidies weren't available to Americans living in states where the federal government operates the exchanges -- as many as 11 million Americans could lose health coverage and insurance markets in 34 states could be upended.The lynchpin of their argument is a mistaken interpretation of a single phrase -- "an Exchange established by the State" -- in the definition of "Premium Assistance Amount" in one sentence of a long and complicated law. They say these few words can refer only to the exchanges run by the states, not the 34 exchanges operated by the federal government for states that elected not to run their own.But the explanation for these words is actually not complicated. The concept of 50 state-specific exchanges is essential to the law. Regardless of whether a state operates its own exchange or the federal government does it for the state, each state will have its own distinct roster of insurance companies and rate options. The identifier "an Exchange established by the State" is a clarifying reference to a particular state-specific exchange, as opposed to the exchanges operating in other states (this is what's referred to as a "term of art"). When the IRS determines the appropriate tax credit, distinguishing between state-specific exchanges matters: Texans are supposed to get tax credits based on the cost of health insurance in the Texas exchange, not New York's or North Dakota's.In the broader context, it's even clearer: one section of the law directs the IRS to take into account the rates charged in "an Exchange established by the State" in setting premium assistance, while another provides that federally run exchanges are "such Exchange within the State," and are to be treated as exchanges established by the states. It's just an attempt at statutory clarity. And it amounts to nothing more than that, no matter how creatively the law's opponents try to interpret those words.Of course, the lawyers challenging the Affordable Care Act (ACA) haven't only invented a new interpretation, but they have concocted an entire theory that Congress and the President intended this result. This is preposterous and defies the statutory language, the context and design of the law, and the legislative history.The ACA was built on three interlocking principles: prohibiting insurance companies from discriminating against individuals with pre-existing conditions, requiring everyone to have insurance to prevent adverse selection from undermining the market, and providing tax credits to help everyone afford coverage. Although the ACA obviously has attracted implacable opponents, it's silly even for them to argue that a single, unremarkable phrase could be interpreted in a way that upends the law's fundamental architecture.It's even more ridiculous to pretend the ACA was intended to operate in the dysfunctional and self-defeating way its legal opponents insist it should. As President Obama's Director of Legislative Affairs when the ACA was enacted, I know (because I was part of them) that the President was briefed in memos and in meetings on every imaginable issue as the legislation worked its way through Congress. The notion that the law would base tax credits on whether states set up their own exchanges -- and deny subsidies to American families as a result -- never came up. When Democratic leaders huddled in the White House in January 2010 to resolve differences between the Senate and House bills, this issue never came up. When the Congressional Budget Office and even the Heritage Foundation analyzed the ACA, this issue never came up. When the law was debated in the Senate for 25 days--in the second longest continuous Senate floor debate in history -- this issue never came up. And when the President met all day with Republicans and Democrats in February 2010 on national television--in a final attempt to find common ground -- this issue never came up.It never came up because everyone had a common understanding. No one working for or against the bill interpreted the language to discriminate between Americans depending on whether their states set up an exchange. That's because the law states that a credit "shall be allowed" to every "applicable taxpayer." And no Democratic representative or senator from a state with a Republican governor would ever have voted for the ACA if it meant their constituents might run the risk of being denied tax credits simply because a governor might refuse to set up an exchange.
King v. Burwell can't be taken lightly because the Supreme Court decided to hear the case. But the plain language, the context, and the intent all couldn't be clearer. Reported by Huffington Post 13 hours ago.

Ropes & Gray Bolsters Health Care Privacy and Data Security Capabilities on the West Coast with Addition of Counsel Ira Parghi

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SAN FRANCISCO, Feb. 23, 2015 /PRNewswire/ -- Ropes & Gray announced today that Ira Parghi has joined the firm's health care practice group as counsel in the San Francisco office. Ms. Parghi has extensive knowledge of patient privacy issues and compliance with the Health Insurance... Reported by PR Newswire 12 hours ago.

Disruptors Paul Zane Pilzer and Rick Lindquist Featured on Bloomberg BNA

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Bloomberg BNA features an excerpt from Paul Zane Pilzer and Rick Lindquist’s book “The End of Employer Provided Health Insurance.”

Salt Lake City, Utah (PRWEB) February 23, 2015

Bloomberg BNA, the leading source of legal, tax, regulatory and business information, has featured an excerpt from Paul Zane Pilzer and Rick Lindquist’s new book “The End of Employer-Provided Health Insurance” on their Pension & Benefits Daily publication.

According to Bloomberg’s website, Pension & Benefits Daily covers all major legislative, regulatory, legal, and industry developments in the area of employee benefits every business day, focusing on actions by Congress, the Department of Labor/Employee Benefits Security Administration, the Internal Revenue Service, and the Pension Benefit Guaranty Corporation.

According to the book’s Amazon page, “The End of Employer-Provided Health Insurance” authors predict a shift from an employer-driven defined benefit model to an individual-driven defined contribution model. Lindquist says, “More than 100 million Americans will move from employer-provided to individually purchased health insurance over the next 10 years. The book focuses on this shift, which Pilzer and Lindquist believe will be led by small businesses.

For more information visit:ZaneBenefits.com and BNA.com

EDITORS NOTE: Rick Lindquist is available for questions from the media through Zane Benefits. Contact Leah Bergersen at 435-659-2921 or leah.bergersen(at)zanebenefits(dot)com

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About the Authors:

Paul Zane Pilzer is The New York Times best-selling author of 11 books, a former professor at NYU, and has served as an economist in two White House administrations. He is also the founder of six companies including the two largest U.S. suppliers of personalized employee health benefits, Extend Health (1999) and Zane Benefits (2006).

Rick Lindquist is CEO and President of Zane Benefits, Inc., the U.S. leader in individual health insurance reimbursement for small businesses. Zane Benefits’ software has been featured on the front page of The Wall Street Journal, USA Today, and The New York Times. He is a regular contributor to leading health benefits publications, including ClarifyingHealth.com.

About the Book:
The #1 Amazon best-selling The End of Employer-Provided Health Insurance is a comprehensive guide to utilizing new individual health plans to save 20 to 60 percent on health insurance. Over the next 10 years, 100 million Americans will move from employer-provided to individually purchased health insurance. Written by a world-renowned economist and New York Times best-selling author, this insightful guide explains how individual health insurance offers more to employees than employer-provided plans.

The End of Employer-Provided Health Insurance: Why It’s Good for You, Your Family, and Your Company (Wiley, 2014, ISBN: 978-1-119-01211-5, $25.00) is available at bookstores nationwide, from major online booksellers, and direct from the publisher by calling 800-225-5945. In Canada, call 800-567-4797. For more information, please visit the book’s page on http://www.wiley.com.

About Zane Benefits:

Zane Benefits is the leader in individual health insurance reimbursement for small businesses. Since 2006, Zane Benefits has been on a mission to bring the benefits of individual health insurance to business owners and their employees.

Zane Benefits' software helps businesses reimburse employees for individual health insurance plans for annual savings of 20 to 60 percent compared with traditional employer-provided health insurance. Today, over 20,000 customers use Zane Benefits' software, services, and support to reimburse individual health insurance plans purchased independent of employment. For more information visit ZaneBenefits.com. Reported by PRWeb 12 hours ago.

Meaning of 4 words at center of high court health law fight

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The lawsuit focuses on the health insurance marketplaces, or exchanges, that have been set up to allow people to find coverage if they don't get insurance through their jobs or the government. Insurers can't deny coverage because of "pre-existing" health conditions; almost everyone must be insured, in order to get enough healthy people into the system; and consumers who otherwise would spend too much of their paycheck on their premiums get financial help in the form of tax credits. Several portions of the law indicate that consumers can claim tax credits no matter where they live, and that a central purpose of the law was to make health care affordable to all Americans. No member of Congress indicated that subsidies would be limited, and several states argue in a separate brief to the court that they had no inkling they had to set up their own exchange for their residents to get tax credits. A. That should produce a win for the administration because Supreme Court precedent holds that federal agencies get the benefit of the doubt when the meaning of a law, or part of it, can't be definitively determined from the text. A. Independent studies by the Urban Institute and the Rand Corporation estimate that 8 million people would lose insurance if the court rules for the challengers. Subsidies appear to be safe for people living in the 13 states and the District of Columbia with their own markets — California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont and Washington — and perhaps in three others — Nevada, New Mexico and Oregon — that set up their own exchanges, but rely on the federal government for eligibility determinations. Of the six appellate judges who have ruled, four who were appointed by Democrats upheld the provision at issue and two Republican appointees voted to strike it down. Reported by SeattlePI.com 11 hours ago.

Zane Benefits Says IRS Delayed Penalties Help Small Businesses

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Zane Benefits CEO, Rick Lindquist says IRS Notice 2015-17 delays are good for small businesses, but more action is needed.

Salt Lake City, Utah (PRWEB) February 23, 2015

On February 18th, 2015 the Internal Revenue Service released Notice 2015-17 outlining that penalties levied on small businesses with under 50 employees taking part in an Employer Payment Plan will be delayed until June 30, 2015.

According to Zane Benefits CEO Rick Lindquist, “Notice 2015-17 is great news for small businesses nationwide struggling to offer affordable health benefits to their employees while remaining compliant with the Affordable Care Act.”

Lindquist added, “This is a temporary solution. Small businesses may see further relief with the reintroduction of the Small Business Healthcare Relief Act, previously introduced in 2014 by Reps. Mike Thompson (D-CA) and Charles Boustany (R-LA).

In the meantime, businesses should replace noncompliant health reimbursement arrangements and employer payment plans with compliant solutions. Our ZaneHealth solution is a compliant alternative to HRAs and employer payment plans.”

According to the bill, the Small Business Healthcare Relief Act will ensure small businesses are allowed to use pre-tax dollars to give employees a defined contribution via a health reimbursement arrangement, or HRA.

For more information visit:ZaneBenefits.com

EDITORS NOTE: Rick Lindquist is available for questions from the media through Zane Benefits. Contact Leah Bergersen at 435-659-2921 or leah(dot)bergersen(at)zanebenefits(dot)com

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About Zane Benefits:
Zane Benefits is the leader in individual health insurance reimbursement for small businesses. Since 2006, Zane Benefits has been on a mission to bring the benefits of individual health insurance to business owners and their employees.

Zane Benefits' software helps businesses reimburse employees for individual health insurance plans for annual savings of 20 to 60 percent compared with traditional employer-provided health insurance. Today, over 20,000 customers use Zane Benefits' software, services, and support to reimburse individual health insurance plans purchased independent of employment. For more information visit ZaneBenefits.com. Reported by PRWeb 11 hours ago.

40 Essential Tips for Cubicle Dwellers

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We cubicle dwellers have our own subculture. We are among the working class who don't get to go outside and blow stuff up. We don't save lives or use a paint brush or have an office with a door that you can close.

We can identify each other by the hollow looks in our eyes and the standard defeated shoulder slump.

I am here to help you, my cubicle dwelling brothers and sisters.

Okay, this post is grouped into two sets of 20 tips. The first set of tips are excuses for not going to work. The best tip I can give you as a cubicle dweller: spend as little time as possible in your cube.

Use every allotted sick day. Don't waste one. "Sick" is so vague. After all, what's the real definition of "sick"? Don't pull out your fancy dictionaries or anything. I say it's up to the individual to define "sick". Also, if you are one of those people who just can't seem to find the time to use ALL your vacation days, then I think there might be no hope for you.

I never have a problem using all my vacation days.
-20 reasons to completely avoid going into work for the day:-
1. Don't turn down any offered surgeries. We don't need all of our organs. If an organ acts up, then get rid of it. Sure, it's painful, but being home on painkillers is better than being in your cubicle with your unnecessary organs.

2. If you're female and you have a male boss, call in and toss around the words ovaries and fallopian tubes. They'll beg you to stay home.

3. Opening day for hay fever. No way can you work on opening day for hay fever. This day can be of your choosing. There is no way to determine what day the pollen will get you. Probably shouldn't try this in the Winter months, though.

4. No clean underwear. You can't go in without clean underwear. What if you get in a car wreck? You should disguise this reason as 'migraine'.

5. You can't be expected to work when your baseboards are so filthy. Also, my baseboards are filthy, so when you're done with yours....

6. You have to take your cat to the vet. Don't have a cat? Borrow a neighbors. Or find a feral one in your neighborhood. Bonus if that feral cat scratches you up, because....

7. Can't come in because a feral cat scratched you up.

8. Join all the religions and observe their holidays. You might want to consider making up your own religion so you can create new holidays.

9. Car makes a funny sound, so you can't risk driving in. The funny sound can be your favorite comedian playing on your car stereo.

10. It's Robert Downey Jr's birthday. You keep that day sacred.

11. Had a self-pedicure disaster and have to see a professional.

12. You need a day to categorize all the ways you feel you've failed as a parent.

13. You need a day to recover from the overwhelming guilt you feel after categorizing all the ways you feel you have failed as a parent.

14. Your mother called first thing in the morning. Those phone calls take a while.

15. You realize you're the only person on the planet who hasn't watched Breaking Bad and you have to start your Breaking Bad marathon on a Monday, because all new habits have to start on a Monday. That's like a rule.

16. Your neighbors are drunk and fighting outside at 7:00 am. No way you are missing that.

17. You are drunk and fighting outside with your husband at 7:00 am.

18. The 'no bourbon on Sunday' rule got broken.

19. You can't live another day without matching up all the socks. There are three different baskets of them for fuck's sake.

20. You know the guy in the next cube is going to start the day by saying 'Top o the morning, to you' in a fake Irish brogue. You can't hear that again or you might commit murder.

Actually, I would use boss/employee shorthand and just call most of these "migraine".

If you ignore the first rule of cubicle club, which is "don't fucking go to work", then you're going to need reasons to avoid doing actual work while you are there.
-Here are 20 tips for avoiding actual work while you are at work:-
1. Judy in accounting asks for a June revenue spreadsheet. After you do the spreadsheet, she says she really needed May. You can't deal with this crap. Spend a while indignantly wandering the halls and tell every person in the building about dumb ass Judy.

2. Twitter. What better way to avoid work than Twitter?

3. Hang out in stall # 4 and play Scramble on your phone. Make vague excuses about bad Mexican food as your reason for being in the bathroom for half the morning.

4. Argue with someone over the "right" way to do a project, even if their idea is sound.

5. Stand in front of the communal fridge. Move things around while muttering about how no one ever cleans their shit out of the fridge.

6. Volunteer for committee meetings, then go get coffee instead of attending the meetings. Claim you were too busy to attend.

7. Ask the boss about his golf game. Sure, you will have to watch his stupid lips flapping, but at least you aren't working.

8. Go in search of just the right pain reliever after listening the office drama queen overhead page someone for the 100th time in one day.

9. Make multiple trips to the supply room because you never know when you might find a box of tissues in a pink box. You like the pink box. Also, check to see if they restocked the batteries. Batteries are expensive, except for when they are free.

10. Make a vague comment about hearing that they aren't giving any raises. Again. This is known as "rattling cages". The natives will be loud and angry for at least an hour after that.

11. Go to HR and ask for a detailed explanation of the health insurance benefits. Ask a lot of pointless questions.

12. Write a diatribe about the abysmal choices in the vending machines.

13. Walk briskly throughout the building carrying a report and talking to yourself. This is a good way to get exercise and get paid for it.

14. Write a blog post.

15. Make a friend at work so that you have someone to instant message with all day. Bonus, your clicking keyboard will sound like you are hard at work.

16. Go online and research buying your own island.

17. Spend an hour cleaning and dusting your messy cubicle. Then do mine. Mine is just embarrassing.

18. Think of ways to maim the douche twizzle in accounting who not only asks for you to work on projects for him, but finds ways to insult you in the process.

19. Practice your "do not talk to me" face in the bathroom mirror.

20. Google the distance between your cubicle and the beach. All the beaches. In the whole world.

Now, give me some new ways to waste time. I'm running out and I have to do this for the rest of my life. Reported by Huffington Post 10 hours ago.

King v. Burwell: Public Health's 21st Century Call to Action

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In the 1960s, health reformers mobilized to advocate for medical coverage for senior citizens. Physician advocates and public health groups among others came together to make Medicare part of the Social Security Act. In 1965, Medicare was signed into law, representing a huge victory for reformers and grassroots movements in healthcare reform.

Almost 20 years later, during the AIDS crisis in the 1980s, patients and the healthcare community created a powerful advocacy movement to demand equitable primary care services for persons living with HIV and AIDS. Spurred on by their belief that no individual should be denied access to life-saving care, activists eventually achieved a significant victory with the passage of the Ryan White Care Act in 1990.

Both movements share a valuable narrative: the power in grassroots activism to inspire critical change in our healthcare system, and for those activists to come from the medical and public health community. These movements defined a space outside hospitals, clinics and research facilities for health professionals to advocate for their patients. Moreover, it reinforced the exceptional trust we place in the medical profession to provide congruent care beyond hospital and exam room walls.

This is the beautiful, matchless quality that characterizes our healthcare community. Providers and advocates care for people and work to preserve health because it is a passion and not just a profession. Today, the King v. Burwell Supreme Court case is another pivotal moment that not only threatens to unravel our healthcare system, but also threatens life-saving care for millions of patients. It is the reason why healthcare professionals and advocates are called to action again, much like in the Medicare and AIDS stories, to elevate their voice and continue protecting their patients.

The King v. Burwell case is that opportunity to advocate for the accessible, affordable and quality healthcare that everyone deserves. On March 4, 2015, the Supreme Court will hear oral arguments in a case that attempts to strip premium tax credits that make healthcare affordable in 34 federal health exchange marketplaces--that is up to 9 million individuals who would lose health insurance, and more than 9,800 preventable deaths per year. As a public health student, training to promote and preserve the health of our nation, I am acutely aware of how affordable health insurance enables so many individuals to receive necessary preventive care and timely treatment they would otherwise not have. Coverage is good medicine. The healthcare community knows this better than anyone and it is a necessary responsibility to advocate for patients when health and wellbeing is threatened.

Working toward a more equitable, just society takes time and is challenging, but some of the most unprecedented progress has been made in grassroots movements. The action that brought about Medicare and the Ryan White Act were powered by empathy and catalyzed by a vision that every individual should be able to reach their fullest potential. The healthcare community has immeasurable power to organize for the sake of millions of patients who stand to lose from a ruling for the plaintiff in King v. Burwell.

This is an optimal advocacy moment--to speak up for those individuals, for whom affordable health insurance is making all the difference. As physicians, public health professionals and caregivers, our motive to care must extend beyond clinics and into boardrooms, senate offices and even the steps of the United States Supreme Court. This is where I will be on March 4, 2015, alongside hundreds of healthcare professionals who believe so strongly that coverage is good medicine. Reported by Huffington Post 9 hours ago.

Connie Casad, MD To Provide Online Patient Forms

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Dr. Casad will make online patient forms available beginning in April.

Dallas, TX (PRWEB) February 23, 2015

Connie Casad, MD, a well-known and respected gynecologist, bioidentical hormone specialist and functional medicine advocate with 30 years of practice experience in Dallas, Texas, recently announced that she will be adding another level of service for her patients with the availability of online patient forms starting in April.

When asked to explain her interest in providing this service, Dr. Casad said, “Providing secure online forms where patients can enter their insurance data and health history prior to the appointment saves them time, increases the accuracy of the information obtained, improves the overall quality of care and provides our medical staff more time to evaluate the patient’s health history prior to their appointment-- an important factor in providing their treatment.”

She continued, “My medical practice goal is to develop the best professional medical relationship possible with our patients. Just like we provide the latest advancements in medical care, we want to provide the best office experience we can to enhance their comfort and satisfaction before and while they are in our office. We are always exploring ways to be more responsive to our patient’s needs. This service will offer the ease of providing their information using their own time frame prior to the appointment and sending it to us in advance without the worry of leaving it at home or having to try to do it in our office on the day of their appointment.”

In accordance with the security requirements of The Health Insurance Portability and Accountability Act (HIPAA) and for the privacy of patients who use the online forms to submit their personal information and health history, all data provided will be secure, utilizing the highest level of encryption possible. Dr. Casad’s staff and office procedures ensure that all sensitive information remains private.

About the practice:
Dr. Connie Casad is the medical director of a restorative wellness practice based in Dallas, TX, offering personalized attention and care that patients will not always find at other medical practices. Dr. Casad focuses on improving the health and wellness of women using Bioidentical Hormone Replacement Therapy (BHRT). She specializes in creating integrated, comprehensive and individualized programs for her patients to resolve age-related diseases in addition to stress and weight management issues. Focusing on prevention, Dr. Casad encourages her patients to preserve and promote long-term wellness by taking proactive measures towards achieving health and beauty from the inside out. For more information, visit http://www.bio-identicaldoctors.com/. Reported by PRWeb 7 hours ago.

GOP Senator Insists Case For Obamacare Lawsuit Is 'Clear,' Then Shows Why It Isn't

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WASHINGTON -- Sen. Orrin Hatch (R-Utah) on Monday tried to argue that something he wrote in 2010 does not undercut the premise of the anti-Obamacare lawsuit that the Supreme Court will hear next week.

It was not a particularly convincing effort.

Yes, we’re back to talking about King v. Burwell -- the case, scheduled for oral argument on March 4, about how and where the federal government may help people buy health insurance. The Affordable Care Act calls upon states to create special insurance exchanges, through which people without access to job-based coverage can buy policies -- and, depending on their incomes, qualify for tax credits that discount the premiums by hundreds or thousands of dollars a year. If states fail to act, the law says, the federal government should step in and create the exchanges instead.

About these issues, there’s no real argument. The controversy is over whether those federally run exchanges should be functionally similar to the state-run versions. The answer, according to the lawsuit, is unambiguously “no.” Proponents of this view focus on a few passages in the law -- in particular, a key section authorizing the distribution of tax credits in exchanges “established by the State.” The section says nothing about federally run exchanges. This omission, the lawsuit claims, was intentional -- designed to compel states to act out of fear their citizens wouldn’t get the tax credits.

If this view prevails in the Supreme Court, the consequences may be chaos and increased misery. Officials in roughly two-thirds of the states, including Florida and Texas, have not built exchanges. Millions of people now getting subsidized coverage in those places would lose their tax credits and, in most cases, become uninsured. Entire state insurance markets would likely become unstable.

But that’s only if the case succeeds. There’s a powerful argument -- a very, very powerful argument -- that the lawsuit’s supporters are misreading both the law and its history. For one thing, other provisions suggest the tax credits should flow in all states, regardless of who runs the exchanges. In addition, virtually every elected and appointed official who worked directly on the law has stated publicly that he or she understood subsidies would be available in all states. (The most recent to make this argument was Phil Schiliro, who was the White House director of legislative affairs during Obamacare’s enactment.)

But some of the most powerful testimonials have come from the archives: mainly, quotes from Republican members of Congress from back in 2009 and 2010. And one of the more telling quotes came from Hatch.

Ever since the lawsuit that became King v. Burwell started getting attention, Hatch has been a staunch supporter of its arguments -- going so far as to join more than a dozen other Republicans on an amicus brief insisting that Congress intended to deny subsidies in states that didn’t create exchanges. In his statements about the case, he has said that the controversy over the law's meaning is not even a close call -- a sentiment he repeated during an appearance at the Heritage Foundation on Monday. “The incentive for states to act also could not be more clear,” Hatch said. “If a state fails to establish an exchange, its citizens lose out on millions -- perhaps even billions -- of dollars in subsidies.”

But things didn’t seem so clear to Hatch back in January 2010, when he co-authored an op-ed for The Wall Street Journal. In making an argument about health care reform’s constitutionality, Hatch explained how the law would work -- and proceeded to sketch out precisely the structure he now says Congress did not intend to create:
A third constitutional defect in this ObamaCare legislation is its command that states establish such things as benefit exchanges, which will require state legislation and regulations. This is not a condition for receiving federal funds, which would still leave some kind of choice to the states. No, this legislation requires states to establish these exchanges or says that the Secretary of Health and Human Services will step in and do it for them. It renders states little more than subdivisions of the federal government. [Emphasis added]
Near the end of Monday’s remarks, Hatch talked about that op-ed, which resurfaced a few weeks ago, and accused Obamacare defenders who have cited it of “twisting my words.” The subject of the op-ed, Hatch said, was not tax credits. “The op-ed is about the constitutionality -- or rather, the unconstitutionality -- of Obamacare, whereas King is about the meaning of a specific Obamacare provision,” Hatch said. “Different issues, different questions, different analysis.”

Hatch went on to say that, in the op-ed, he was actually making a much more nuanced argument -- touching, among other things, on parallels (or lack thereof) between Obamacare and the federal government’s push, in the 1970s, to make highway funding conditional upon states raising the drinking age.

Hatch’s full comments are available at his website. Readers can decide for themselves whether his explanation actually puts the excerpt of the op-ed into a different context -- or whether, by talking about constitutionality and court doctrine on federal-state relations, he was simply trying to kick up some rhetorical dust. But even with a generous interpretation, it is hard to see how he can square his present support for the lawsuit’s premise -- specifically, that establishing an exchange is a condition for the distribution of tax credits -- with his seemingly clear statement from 2010 -- namely, that building an exchange “is not a condition for receiving federal funds.”

Of course, getting clarity on precisely what Hatch was trying to say then or now is not such a simple matter. At one point Monday, he used an analogy about a child cleaning his room that, if anything, seemed to reinforce the government’s argument, not the plaintiffs’ -- although, presumably, that was not Hatch's intention. Befuddling quotes like this, alas, are pretty common -- unique neither to Republicans nor to discussions of the Affordable Care Act. Pinpointing what a member of Congress was actually thinking based on a past statement is frequently difficult, all the more so when the legislation is complex.

That’s one reason that the hunt for congressional intent is so fraught -- and that, in cases of ambiguity over what a law actually says, courts traditionally allow executive branch agencies to make any “permissible” reading. The problem for Hatch and his allies is that, in King v. Burwell, showing such deference to agencies would almost certainly mean heeding the Obama administration’s interpretation of the law -- so that Obamacare could continue working as it does today. Reported by Huffington Post 4 hours ago.

The IUD Is Getting More Popular In America. Here's Why

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A birth control method that works more than 99 percent of the time is making a comeback after all but disappearing from America in the 1980s and 1990s.

The intrauterine device, or IUD, was the contraceptive of choice for 6.4 percent of American women aged 15-44 from 2011 to 2013, according to a report published Tuesday by the Centers for Disease Control and Prevention. Though the IUD, a small, T-shaped device implanted in the uterus, is far behind more popular methods of birth control like the pill or condoms, the share of women using one nearly doubled from 2006 to 2010, and is dramatically higher than the less than 1 percent of women who had IUDs in the mid-1990s.

The Guttmacher Institute reports that 51 percent of pregnancies are unplanned, and 95 percent of those result from not using or misusing birth control -- like forgetting to take the pill every day at the same time. Wider adoption of the IUD would lead to fewer unplanned pregnancies and abortions, according to the American College of Obstetricians and Gynecologists.

“The more you can take the user out of the equation -- if she so desires -- the more you’ll be able to prevent unintended pregnancy,” said Megan Kavanaugh, a senior research scientist and public health specialist at the Guttmacher Institute, which studies reproductive health. “More and more people are jumping on the IUD and implant bandwagon because it seems like they might be potentially appropriate to cover for these long periods of a woman’s life when she needs coverage.”

Decades have passed since the Dalkon Shield scandal of the 1970s, when an estimated 200,000 women were injured, many became infertile and about 20 died from infections related to that IUD. But new, safer products started coming onto the U.S. market from the late 1980s through the current decade. Medical societies have adopted policies in recent years recommending physicians consider IUDs and other long-acting contraceptives for more types of patients, including women who’ve never had a child and teenagers. And word-of-mouth combined with advertising and marketing by IUD manufacturers has increased consumer awareness.

The Affordable Care Act’s requirement that health insurance cover all types of birth control at no cost is expected to accelerate adoption of IUDs. The price for an IUD implantation is more than $1,000.

The IUD is almost as effective as sterilization, but it’s not permanent. After having the device implanted in a physician’s office, a woman doesn’t have to take any further actions to prevent pregnancy throughout the 3-to-10-year lifespan of the IUD. The device fails less than 1 percent of the time, compared to 9 percent for the pill, 18 percent for male condoms and 24 percent for the rhythm method, CDC data show.

Erin Stevens, 28, opted for an IUD in 2013 after a pregnancy scare. “I remember taking the test, and I literally just felt this dread,” she said. “I knew that was a sign to myself that I better do something different.” Stevens and her husband, Brad, who live near Louisville, Kentucky, in Jeffersonville, Indiana, aren’t planning to have children, she said.

Still, Stevens went off birth control pills, which she often forgot to take. Her sex drive spiked, which just upped the risk of going without contraception. “The pull-out method isn’t always the best method,” she said. (Withdrawal has a 22 percent failure rate, according to the CDC.) So far, she’s pleased with her IUD, a Mirena device made by Bayer that uses hormones. Her periods are virtually gone, as is the anxiety about remembering to take her pill -- and about getting pregnant, she said. “I know that we’re good for the next five years.”

*For more firsthand accounts from women like Erin Stevens, read "8 Women Share What It's Like Switching To An IUD."*

Mirena has been available in the United States since 2000 and is designed to work for five years. Bayer introduced a smaller IUD called Sklya in 2013, meant to be used for three years. Both use hormones, but Skyla, unlike Mirena, is approved by the Food and Drug Administration for women and girls who have never had a child. Another IUD without hormones, called ParaGard and made for 10 years of use by women who have or have not given birth, has been around since 1988 and is sold by Teva.

Long-acting reversible contraceptives have several obvious advantages over other forms of birth control, like the pill and condoms. An IUD or implant is always in place, and women don’t have to take extra steps or rely on their partners to avoid becoming pregnant. Some women experience lighter or no periods after their IUDs have been in place for several months.

There are drawbacks, of course. Some women experience discomfort and irregular bleeding during the first few months, or even longer. In rare cases, an IUD can become dislodged. The device doesn’t prevent sexually transmitted infections. A woman who decides she wants to become pregnant must have the device removed. And IUDs must be implanted inside the uterus, which requires a typically painful procedure that involves pushing the device past the cervix.

“The worst part was that I would literally feel her turning it to adjust it in my abdomen. Like, if you’ve seen the movie where the ugly alien shoots out of somebody’s stomach -- that’s it,” Stevens said. The five-minute procedure hurt worse than the six hours she spent getting a tattoo across her rib cage, she said. But, she added, it was worth it.

Women in Stevens’ age group are driving the resurgence of IUDs, as well as hormonal implants, a plastic device placed in the arm that delivers hormones to the body for up to three years. Together, these birth control methods are called long-acting reversible contraceptives, and more than 11 percent of women aged 25 to 34 are now using them, the CDC report says. Women with IUDs make up most of this group. IUD use among women who have never had a child rose almost tenfold between 2006-2010 and the most recent CDC survey in 2011-2013.

That’s a reflection of the changing attitudes among women and their doctors, Kavanaugh said. “We’ve definitely seen increased awareness and education among providers that these methods are appropriate for women at all stages of their reproductive career, not just women who are spacing or limiting their births, the women that were traditionally seen as appropriate candidates for the method,” she said.

This is more true of gynecologists and family planning specialists who are exposed to the latest research and more familiar with different kinds of birth control than it is with pediatricians and general practitioners, Kavanaugh said. “That is slowly changing. It just takes time,” she said.

In 2011, the American College of Obstetricians and Gynecologists adopted new guidelines encouraging physicians to discuss IUDs with patients. The American Academy of Pediatrics followed last year by endorsing IUDs as a first-line contraceptive option for teenage girls.

Physician organizations like these, and doctors themselves, are changing the way they think about long-acting reversible contraceptives because more studies have shown they are safe and effective for women at various ages, said Laura MacIsaac, associate professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai in New York.

MacIsaac said that in her experience, memories of the Dalkon Shield recall in 1974 and the FDA call for all women to stop using it in 1983 don’t influence patients’ decisions. But there are doctors who remain skeptical, she said.

“There was a backlash against all IUDs,” she said. “It still lingers, especially with older physicians.”

That’s gradually diminishing, especially as evidence emerges that IUDs are also helpful as a treatment for women with heavy and painful periods, she said.

As more physicians talk about these options and become adept at implanting IUDs and comfortable giving them to younger women, single women and women who haven’t had kids, the number of patients using them rises and word spreads, Kavanaugh said. “More women know that they’re available,” she said.

Bayer has targeted educational and training resources to gynecologists and family planning specialists, but not primary care doctors or pediatricians, said Paul Bedard, general manager of women’s health at the company. Bayer and Teva also heavily advertise their products.

“When we’ve done those activities, we’ve seen the awareness of a product like Mirena, now of Skyla, increase over time, and we think that contributes to having more discussions with their physicians,” Bedard said.

That was Stevens’ experience, she said. “When I first heard about it was on a Mirena commercial. And I remember thinking, ‘God, I would love to have that.’”

The Affordable Care Act rule that health plans cover contraceptives without any copayments has been in place since 2012 -- and benefited Stevens -- but it has not been in place long enough to have had an effect yet, MacIsaac said. “That will happen. I just think it hasn’t happened yet,” she said. Removing the cost barrier to long-acting reversible contraceptives is bound to increase their use, she said.

Within a decade, MacIsaac predicts as much as one-quarter of American women will use IUDs, akin to the rates in European countries, where the Dalkon Shield’s problems didn’t frighten women and doctors away, she said.

“That’s what I hope, because it helps women balance all their different goals and opportunities and responsibilities,” MacIsaac said. Reported by Huffington Post 1 hour ago.
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