On June 25, 2015 the United States Supreme Court announced its much anticipated decision to uphold the legality of health insurance subsidies for individuals participating in both federal and state-run insurance exchanges.
Reported by Mondaq 20 hours ago.
United States: Summary Of The Supreme Court Ruling On The Affordable Care Act - Stites & Harbison PLLC
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Last week was one of the most momentous of Obama's presidency ...
At the start of last week, the futures of the cornerstones of President Barack Obama's foreign-policy and domestic agendas were in doubt.By the end of the week, both — the Affordable Care Act and Obama's brewing Pacific trade deal — were more secure than ever before.
To boot, Obama became the president under whom gay marriage became legal throughout the United States. And to cap the week off, he delivered a moving eulogy at the funeral of the reverend who was one of nine people killed in last week's church shooting in Charleston, South Carolina.
It was one of the most momentous weeks of Obama's presidency — a defining one for his administration's legacy.
"I do think it's been a significant morning, it's been a significant couple of days, and it's certainly been a significant month for not only the President and the administration, but for the country," Eric Schultz, the principal deputy White House press secretary, told reporters on Friday.
"And if you take a moment to step back, I think the developments we've all experienced over the past few days speak to not only the modern American presidency, but also speak to the reason this president ran for office."
Two milestones over the past three days will help shape the Obama legacy long after he leaves office:
· After a brutal fight in Congress that he — and, curiously enough, Republican leaders — ended up winning, Obama is set to sign a bill that will give him so-called "fast-track" negotiating power on trade deals. His administration is in the process of negotiating the Trans-Pacific Partnership, a cornerstone of his "pivot" to Asia.
· The Supreme Court ruled in favor of the Obama administration and upheld a key provision of the Affordable Care Act that allows the federal government to provide subsidies for health insurance to millions of low-income Americans. A ruling against the administration could have thrown the future of the law as Obama envisioned it into doubt.
And on Friday, the Supreme Court ruled that same-sex couples have a constitutional right to marriage, putting a feather in the cap of the first president who formally endorsed gay marriage smack dab in the middle of his re-election fight in 2012.
*The 'most important' piece for Obama's Asia pivot*
Ian Bremmer, the president of Eurasia Group, told Business Insider that the Trans-Pacific Partnership is the "most important piece" of Obama's foreign-policy legacy.
"It's strengthening trade ties for 40% of the world's GDP; it's making good on US commitments to allies that are most interested in improving their relations with America; it's a net economic benefit for the US long term, and, by far most importantly, it's strategically important in countering China's efforts to build trade and financial architecture that completes with US-led global standards," Bremmer said.
"A failure on this front would have been a huge blow to the US in the most important part of the world for long-term American national interests."
Two weeks ago, it was basically left for dead. Obama endured a brutal fight with members of his own party on trade. He was rebuffed by House Minority Leader Nancy Pelosi (D-California) on a companion bill that needed to be paired with the fast-track authority for Obama to sign it.
Ultimately, House and Senate leaders worked around legislative setbacks and forced congressional Democrats into a corner. The fast-track authority passed the Senate Wednesday and headed to Obama's desk for his signature.
"This week's votes represent a much-needed win for hardworking American families," Obama said Thursday.
*'Instrumental to the future of Obamacare'*
The Supreme Court ruling on the Affordable Care Act could well end up being the most important event of the past week, as it entrenches Obamacare onto firm legal footing.
As Obama said in a victory-lap statement in the Rose Garden following the ruling, the law is "here to stay." And he nodded to the historic nature of the Affordable Care Act — the biggest federal healthcare overhaul in half a century.
"Three generations ago, we chose to end an era when seniors were left to languish in poverty," he said. "We passed Social Security, and slowly it was woven into the fabric of America and made a difference in the lives of millions of people. Two generations ago, we chose to end an age when Americans in their golden years didn’t have the guarantee of health care. Medicare was passed, and it helped millions of people.
"This generation of Americans chose to finish the job."
The challenge, King v. Burwell, would have had the potential to cripple the law and throw its future into highly uncertain territory in the nearly three dozen states in which the federal government provides subsidies for low-income people to buy health insurance. Challengers argued that only states should have been able to hand out subsidies, pointing to four words in the law that say exchanges are to be "established by the state."
But the majority of Supreme Court justices — including conservative-leaning Chief Justice John Roberts — didn't buy the challengers' underlying theory. And in leaving no ambiguity in its decision, the high court prevented a future theoretical Republican administration from undoing the law executively. It'll take an act of Congress to weaken, much less repeal, the Affordable Care Act.
"The decision leaves no wiggle room for a future Administration that might have wanted to end the ACA’s subsidies," said Larry Levitt, senior vice president at the Kaiser Family Foundation.
*Justice 'arrives like a thunderbolt'*
Not 24 hours later, Obama was back in the Rose Garden, delivering a statement on the Supreme Court's historic decision to legalize same-sex marriage nationwide. Justice, he said, had arrived "like a thunderbolt" and cemented a swift decade-plus of extraordinary shift on the issue from a gradually accepting American public.
He reflected on the often anonymous work of the people who "stood up," who came out, who "talked to parents," who endured bullying, who came to believe in themselves, and who "slowly made an entire country realize that love is love."
"What an extraordinary achievement," Obama said. "What a vindication of the belief that ordinary people can do extraordinary things. What a reminder of what Bobby Kennedy once said about how small actions can be like pebbles being thrown into a still lake, and ripples of hope cascade outwards and change the world."
Five hours and an Air Force One ride later, Obama delivered the eulogy for Clementa Pinckney, the reverend killed in last week's shooting in Charleston. He talked about some of the things — gun violence, racial relations, and more — that he thought ordinary people could change.
Then, he led members in a rendition of "Amazing Grace."
Join the conversation about this story »
NOW WATCH: Here are all the best moments from Donald Trump's presidential announcement Reported by Business Insider 20 hours ago.
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Let's Focus on Fixing - not Nixing - Obamacare
The Supreme Court has sloughed off another major challenge to Obamacare, forcing Republicans to devise a better strategy than their promise to repeal the health care law.
Congressional repeal of the Affordable Care Act is an appealing option, and would serve as an easy litmus test for the far right. But just because something is simple and grabs headlines (and votes), does not mean it is rational, good for the country or even realistic.
The Congressional Budget Office estimates that repealing Obamacare would increase the deficit by $137 billion over ten years. Even if this nonpartisan estimate is exaggerated, the barriers to repealing Obamacare are legal, practical and political. Simply put, Congress can't easily change direction on a policy affecting eight percent of GDP. Politically, Republicans do not have the Senate votes necessary to repeal. And many Americans support parts of Obamacare, including the requirement that insurance companies accept applicants with pre-existing conditions.
Yet, even the administration admits that parts of Obamacare are not working. A recent report from the Office of the National Coordinator for Health Information Technology found that fewer than three in 10 health care providers are able to share electronic health records (EHRs) with outside providers-despite $28 billion in incentives to transition to EHRs.
Also, the American Medical Association - the only large group of doctors to support Obamacare - says doctors complain looking at screens rather than at patients, and seeing fewer patients because of how time consuming linear EHR systems are. The current system is cumbersome. Because health records between different specialties do not easily link with each other, many doctors say it's easier to get and share information via printed paper reports. There is a bipartisan desire to fix these problems, as they are hurting both doctors and patients.
Another failure of the current law is the broken promise that patients can continue to see their own doctors. Horror stories abound of patients who can't match up surgeons and hospitals under their current health care plans, or are forced to stop complex multi-provider treatments because geographic boundaries were not set in the laws. This, too, is fixable.
Another failure is the law's mandate that employers insure all employees, including those working 30 hours a week and interns working more than a few months. Changing the "full-time" definition to 40 hours and requiring interns to work one full year before receiving health insurance would go a long way toward reducing employer angst. At our association, we face a tough decision: cutting back on the number of interns we hire or coughing up $90,000 to obtain health insurance for all of our interns.
Now that the Supreme Court has weighed in on Obamacare - again - and the law still stands, let's focus on revising and improving the current system rather than digging in our heels against it. Fixing a broken health care system offers an opportunity for some easy-but-substantial cost savings in health care policy that would save taxpayers billions annually.
Here are a few simple fixes:
1. *Allow Americans to buy their prescription drugs from Canada or other developed countries*. Americans pay billions more for drugs simply because the pharmaceutical industry has used political campaign contributions to bar competition and lower prices. This is absurd.
4. *Bar drug companies from giving secret rebates to doctors.* If a doctor is paid to prescribe or use a drug, the doctor should reveal that to patients. A Senate Committee on Aging hearing on this practice revealed bipartisan disgust but no action.
7. *Reimburse doctors injecting drugs for each treatment, rather than as a percentage of the cost of the drug.* Incentivizing doctors to use more expensive medications is a drain on our entitlement spending. For example, most doctors would use the50 Avastin rather than the2,000 Lucentis to treat macular degeneration, saving over1 billion a year for Medicare if they were paid equal amounts per injection and secret drug company payments were barred.
10. *Allow insurance companies to compete across state lines. America was built and thrives on competition.* It lowers prices. It results in better service. But under the current system, individuals must purchase insurance in their home states. We can choose to shop for just about any product we want, anywhere we want - why can't the same be true of our health insurance?
Thursday's Supreme Court decision gives Congress the opportunity to take the high ground, fix what's broken and reject crony capitalism. Let's hope they use this opportunity to dramatically improve our health - both that of the American people and the wellbeing of our federal bank account.Gary Shapiro is president and CEO of the Consumer Electronics Association (CEA)®, the U.S. trade association representing more than 2,000 consumer electronics companies, and author of the New York Times best-selling books, Ninja Innovation: The Ten Killer Strategies of the World's Most Successful Businesses and The Comeback: How Innovation Will Restore the American Dream. His views are his own. Connect with him on Twitter: @GaryShapiro
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 19 hours ago.
Congressional repeal of the Affordable Care Act is an appealing option, and would serve as an easy litmus test for the far right. But just because something is simple and grabs headlines (and votes), does not mean it is rational, good for the country or even realistic.
The Congressional Budget Office estimates that repealing Obamacare would increase the deficit by $137 billion over ten years. Even if this nonpartisan estimate is exaggerated, the barriers to repealing Obamacare are legal, practical and political. Simply put, Congress can't easily change direction on a policy affecting eight percent of GDP. Politically, Republicans do not have the Senate votes necessary to repeal. And many Americans support parts of Obamacare, including the requirement that insurance companies accept applicants with pre-existing conditions.
Yet, even the administration admits that parts of Obamacare are not working. A recent report from the Office of the National Coordinator for Health Information Technology found that fewer than three in 10 health care providers are able to share electronic health records (EHRs) with outside providers-despite $28 billion in incentives to transition to EHRs.
Also, the American Medical Association - the only large group of doctors to support Obamacare - says doctors complain looking at screens rather than at patients, and seeing fewer patients because of how time consuming linear EHR systems are. The current system is cumbersome. Because health records between different specialties do not easily link with each other, many doctors say it's easier to get and share information via printed paper reports. There is a bipartisan desire to fix these problems, as they are hurting both doctors and patients.
Another failure of the current law is the broken promise that patients can continue to see their own doctors. Horror stories abound of patients who can't match up surgeons and hospitals under their current health care plans, or are forced to stop complex multi-provider treatments because geographic boundaries were not set in the laws. This, too, is fixable.
Another failure is the law's mandate that employers insure all employees, including those working 30 hours a week and interns working more than a few months. Changing the "full-time" definition to 40 hours and requiring interns to work one full year before receiving health insurance would go a long way toward reducing employer angst. At our association, we face a tough decision: cutting back on the number of interns we hire or coughing up $90,000 to obtain health insurance for all of our interns.
Now that the Supreme Court has weighed in on Obamacare - again - and the law still stands, let's focus on revising and improving the current system rather than digging in our heels against it. Fixing a broken health care system offers an opportunity for some easy-but-substantial cost savings in health care policy that would save taxpayers billions annually.
Here are a few simple fixes:
1. *Allow Americans to buy their prescription drugs from Canada or other developed countries*. Americans pay billions more for drugs simply because the pharmaceutical industry has used political campaign contributions to bar competition and lower prices. This is absurd.
4. *Bar drug companies from giving secret rebates to doctors.* If a doctor is paid to prescribe or use a drug, the doctor should reveal that to patients. A Senate Committee on Aging hearing on this practice revealed bipartisan disgust but no action.
7. *Reimburse doctors injecting drugs for each treatment, rather than as a percentage of the cost of the drug.* Incentivizing doctors to use more expensive medications is a drain on our entitlement spending. For example, most doctors would use the50 Avastin rather than the2,000 Lucentis to treat macular degeneration, saving over1 billion a year for Medicare if they were paid equal amounts per injection and secret drug company payments were barred.
10. *Allow insurance companies to compete across state lines. America was built and thrives on competition.* It lowers prices. It results in better service. But under the current system, individuals must purchase insurance in their home states. We can choose to shop for just about any product we want, anywhere we want - why can't the same be true of our health insurance?
Thursday's Supreme Court decision gives Congress the opportunity to take the high ground, fix what's broken and reject crony capitalism. Let's hope they use this opportunity to dramatically improve our health - both that of the American people and the wellbeing of our federal bank account.Gary Shapiro is president and CEO of the Consumer Electronics Association (CEA)®, the U.S. trade association representing more than 2,000 consumer electronics companies, and author of the New York Times best-selling books, Ninja Innovation: The Ten Killer Strategies of the World's Most Successful Businesses and The Comeback: How Innovation Will Restore the American Dream. His views are his own. Connect with him on Twitter: @GaryShapiro
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 19 hours ago.
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Let's Focus on Fixing -- Not Nixing -- Obamacare
The Supreme Court has sloughed off another major challenge to Obamacare, forcing Republicans to devise a better strategy than their promise to repeal the healthcare law.
Congressional repeal of the Affordable Care Act is an appealing option and would serve as an easy litmus test for the far right. But just because something is simple and grabs headlines (and votes) does not mean it is rational, good for the country or even realistic.
The Congressional Budget Office estimates that repealing Obamacare would increase the deficit by $137 billion over 10 years. Even if this nonpartisan estimate is exaggerated, the barriers to repealing Obamacare are legal, practical and political. Simply put, Congress can't easily change direction on a policy affecting 8 percent of GDP. Politically, Republicans do not have the Senate votes necessary to repeal. And many Americans support parts of Obamacare, including the requirement that insurance companies accept applicants with preexisting conditions.
Yet even the administration admits that parts of Obamacare are not working. A recent report from the Office of the National Coordinator for Health Information Technology found that fewer than three in 10 healthcare providers are able to share electronic health records (EHRs) with outside providers -- despite $28 billion in incentives to transition to EHRs.
Also, the American Medical Association -- the only large group of doctors to support Obamacare -- says doctors complain about looking at screens rather than at patients, and seeing fewer patients because of how time-consuming linear EHR systems are. The current system is cumbersome. Because health records between different specialties do not easily link with each other, many doctors say it's easier to get and share information via printed paper reports. There is a bipartisan desire to fix these problems, as they are hurting both doctors and patients.
Another failure of the current law is the broken promise that patients can continue to see their own doctors. Horror stories abound of patients who can't match up surgeons and hospitals under their current healthcare plans or are forced to stop complex multi-provider treatments because geographic boundaries were not set in the laws. This, too, is fixable.
Another failure is the law's mandate that employers insure all employees, including those working 30 hours a week and interns working more than a few months. Changing the "full-time" definition to 40 hours and requiring interns to work one full year before receiving health insurance would go a long way toward reducing employer angst. At our association, we face a tough decision: cutting back on the number of interns we hire or coughing up $90,000 to obtain health insurance for all our interns.
Now that the Supreme Court has weighed in on Obamacare -- again -- and the law still stands, let's focus on revising and improving the current system rather than digging in our heels against it. Fixing a broken healthcare system offers an opportunity for some easy-but-substantial cost savings in healthcare policy that would save taxpayers billions annually.
Here are a few simple fixes:
1. *Allow Americans to buy their prescription drugs from Canada or other developed countries.* Americans pay billions more for drugs simply because the pharmaceutical industry has used political campaign contributions to bar competition and lower prices. This is absurd.
4. *Bar drug companies from giving secret rebates to doctors.* If a doctor is paid to prescribe or use a drug, the doctor should reveal that to patients. A Senate Committee on Aging hearing on this practice revealed bipartisan disgust but no action.
7. *Reimburse doctors injecting drugs for each treatment rather than as a percentage of the cost of the drug.* Incentivizing doctors to use more expensive medications is a drain on our entitlement spending. For example, most doctors would use the $50 Avastin rather than the $2,000 Lucentis to treat macular degeneration, saving over $1 billion a year for Medicare if they were paid equal amounts per injection and secret drug company payments were barred.
10. *Allow insurance companies to compete across state lines.* America was built and thrives on competition. It lowers prices. It results in better service. But under the current system, individuals must purchase insurance in their home states. We can choose to shop for just about any product we want, anywhere we want; why can't the same be true of our health insurance?
Thursday's Supreme Court decision gives Congress the opportunity to take the high ground, fix what's broken and reject crony capitalism. Let's hope they use this opportunity to dramatically improve our health -- both that of the American people and the well-being of our federal bank account.
Gary Shapiro is the president and CEO of the Consumer Electronics Association (CEA)®, the U.S. trade association representing more than 2,000 consumer electronics companies, and the author of the New York Times bestselling books Ninja Innovation: The Ten Killer Strategies of the World's Most Successful Businesses and The Comeback: How Innovation Will Restore the American Dream. His views are his own. Connect with him on Twitter @GaryShapiro.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 17 hours ago.
Congressional repeal of the Affordable Care Act is an appealing option and would serve as an easy litmus test for the far right. But just because something is simple and grabs headlines (and votes) does not mean it is rational, good for the country or even realistic.
The Congressional Budget Office estimates that repealing Obamacare would increase the deficit by $137 billion over 10 years. Even if this nonpartisan estimate is exaggerated, the barriers to repealing Obamacare are legal, practical and political. Simply put, Congress can't easily change direction on a policy affecting 8 percent of GDP. Politically, Republicans do not have the Senate votes necessary to repeal. And many Americans support parts of Obamacare, including the requirement that insurance companies accept applicants with preexisting conditions.
Yet even the administration admits that parts of Obamacare are not working. A recent report from the Office of the National Coordinator for Health Information Technology found that fewer than three in 10 healthcare providers are able to share electronic health records (EHRs) with outside providers -- despite $28 billion in incentives to transition to EHRs.
Also, the American Medical Association -- the only large group of doctors to support Obamacare -- says doctors complain about looking at screens rather than at patients, and seeing fewer patients because of how time-consuming linear EHR systems are. The current system is cumbersome. Because health records between different specialties do not easily link with each other, many doctors say it's easier to get and share information via printed paper reports. There is a bipartisan desire to fix these problems, as they are hurting both doctors and patients.
Another failure of the current law is the broken promise that patients can continue to see their own doctors. Horror stories abound of patients who can't match up surgeons and hospitals under their current healthcare plans or are forced to stop complex multi-provider treatments because geographic boundaries were not set in the laws. This, too, is fixable.
Another failure is the law's mandate that employers insure all employees, including those working 30 hours a week and interns working more than a few months. Changing the "full-time" definition to 40 hours and requiring interns to work one full year before receiving health insurance would go a long way toward reducing employer angst. At our association, we face a tough decision: cutting back on the number of interns we hire or coughing up $90,000 to obtain health insurance for all our interns.
Now that the Supreme Court has weighed in on Obamacare -- again -- and the law still stands, let's focus on revising and improving the current system rather than digging in our heels against it. Fixing a broken healthcare system offers an opportunity for some easy-but-substantial cost savings in healthcare policy that would save taxpayers billions annually.
Here are a few simple fixes:
1. *Allow Americans to buy their prescription drugs from Canada or other developed countries.* Americans pay billions more for drugs simply because the pharmaceutical industry has used political campaign contributions to bar competition and lower prices. This is absurd.
4. *Bar drug companies from giving secret rebates to doctors.* If a doctor is paid to prescribe or use a drug, the doctor should reveal that to patients. A Senate Committee on Aging hearing on this practice revealed bipartisan disgust but no action.
7. *Reimburse doctors injecting drugs for each treatment rather than as a percentage of the cost of the drug.* Incentivizing doctors to use more expensive medications is a drain on our entitlement spending. For example, most doctors would use the $50 Avastin rather than the $2,000 Lucentis to treat macular degeneration, saving over $1 billion a year for Medicare if they were paid equal amounts per injection and secret drug company payments were barred.
10. *Allow insurance companies to compete across state lines.* America was built and thrives on competition. It lowers prices. It results in better service. But under the current system, individuals must purchase insurance in their home states. We can choose to shop for just about any product we want, anywhere we want; why can't the same be true of our health insurance?
Thursday's Supreme Court decision gives Congress the opportunity to take the high ground, fix what's broken and reject crony capitalism. Let's hope they use this opportunity to dramatically improve our health -- both that of the American people and the well-being of our federal bank account.
Gary Shapiro is the president and CEO of the Consumer Electronics Association (CEA)®, the U.S. trade association representing more than 2,000 consumer electronics companies, and the author of the New York Times bestselling books Ninja Innovation: The Ten Killer Strategies of the World's Most Successful Businesses and The Comeback: How Innovation Will Restore the American Dream. His views are his own. Connect with him on Twitter @GaryShapiro.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 17 hours ago.
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Do Health Insurance Mergers Really Need to Sweat DOJ Reviews?
Reported by 24/7 Wall St. 17 hours ago.
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Blue Cross and Blue Shield of Minnesota announces two new leadership appointments within its Commercial Markets division
Mary Ellen Anderson leading affiliate TPA business; Sandy Hill named vice president of division’s sales operations and shared services
Eagan, Minnesota (PRWEB) June 29, 2015
Blue Cross and Blue Shield of Minnesota (Blue Cross) today announced the promotion of two leaders with the Commercial Markets division, which includes the company’s commercial health plan portfolio of products and services for individuals, small and large employers, and Minnesota-headquartered companies with regional, national and international reach. Mary Ellen Anderson now holds the title of vice president, president of Comprehensive Care Services, Inc. (CCStpa). Sandy Hill had been named as vice president, commercial markets, sales operations and shared services.
About Mary Ellen Anderson
In her role, Anderson is responsible for providing strategic direction and overall management of CCStpa, a Blue Cross subsidiary and third party administrator (TPA) of health plans for Minnesota-based employers and groups. She oversees a team assigned to developing and distributing the CCStpa product portfolio for medical, dental, life and vision care plans. Anderson has been driving strategies as the CCStpa president since being named to the position in September 2014. She came to this role following more than 20 years of sales and account management experience at Blue Cross.
“Mary Ellen is the right person to drive the continued growth of CCStpa,” said David Corkum, senior vice president of commercial markets at Blue Cross. “CCStpa is the largest third-party administrator in Minnesota, with a diverse range of customers that have very unique benefit design and administrative requirements. Mary Ellen is singularly focused on the overall satisfaction of those businesses and organizations.”
Anderson joined Blue Cross in 1993 and served in various management and leadership roles in which she fostered key external relationships with employers, benefit consulting and broker firms, agents, and key industry groups and coalitions. Prior to Blue Cross, Anderson worked as a registered nurse. She holds a nursing degree from Lake Superior College. She is currently completing her B.S.in Health Care Management from the University of St. Catherine.
About Sandy Hill
In her new role as a vice president of commercial markets, Hill leads a team responsible for compliance enablement, commission management and analytics, customer relationship management (CRM) strategy, commercial market-focused communications and marketplace platform assessment, design and strategy.
“Sandy has been an influential leader and marker of change within the Commercial Markets division since joining Blue Cross more than two decades ago,” said Corkum. “She has consistently demonstrated exceptional value and commitment to the team, making her a natural fit for this position.”
Hill joined Blue Cross in 1990 and has held leadership positions in a variety of areas throughout the organization, with an emphasis on sales, operations and strategic initiatives. Most recently, Hill was senior director of the company’s health reform and exchange office. In this capacity, she was responsible for the development and implementation of Blue Cross’ integration with Minnesota’s state health insurance exchange. Additionally, Hill drove the overall management and execution of exchange-related functions at Blue Cross, including governance, infrastructure, resource management and financial management, and planning and organization readiness.
Hill holds a bachelor’s degree in education from Winona State University.
Blue Cross and Blue Shield of Minnesota (bluecrossmn.com), with headquarters in the St. Paul suburb of Eagan, was chartered in 1933 as Minnesota’s first health plan and continues to carry out its charter mission today as a health company: to promote a wider, more economical and timely availability of health services for the people of Minnesota. Blue Cross is a not-for-profit, taxable organization. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association, headquartered in Chicago.
— 30 — Reported by PRWeb 17 hours ago.
Eagan, Minnesota (PRWEB) June 29, 2015
Blue Cross and Blue Shield of Minnesota (Blue Cross) today announced the promotion of two leaders with the Commercial Markets division, which includes the company’s commercial health plan portfolio of products and services for individuals, small and large employers, and Minnesota-headquartered companies with regional, national and international reach. Mary Ellen Anderson now holds the title of vice president, president of Comprehensive Care Services, Inc. (CCStpa). Sandy Hill had been named as vice president, commercial markets, sales operations and shared services.
About Mary Ellen Anderson
In her role, Anderson is responsible for providing strategic direction and overall management of CCStpa, a Blue Cross subsidiary and third party administrator (TPA) of health plans for Minnesota-based employers and groups. She oversees a team assigned to developing and distributing the CCStpa product portfolio for medical, dental, life and vision care plans. Anderson has been driving strategies as the CCStpa president since being named to the position in September 2014. She came to this role following more than 20 years of sales and account management experience at Blue Cross.
“Mary Ellen is the right person to drive the continued growth of CCStpa,” said David Corkum, senior vice president of commercial markets at Blue Cross. “CCStpa is the largest third-party administrator in Minnesota, with a diverse range of customers that have very unique benefit design and administrative requirements. Mary Ellen is singularly focused on the overall satisfaction of those businesses and organizations.”
Anderson joined Blue Cross in 1993 and served in various management and leadership roles in which she fostered key external relationships with employers, benefit consulting and broker firms, agents, and key industry groups and coalitions. Prior to Blue Cross, Anderson worked as a registered nurse. She holds a nursing degree from Lake Superior College. She is currently completing her B.S.in Health Care Management from the University of St. Catherine.
About Sandy Hill
In her new role as a vice president of commercial markets, Hill leads a team responsible for compliance enablement, commission management and analytics, customer relationship management (CRM) strategy, commercial market-focused communications and marketplace platform assessment, design and strategy.
“Sandy has been an influential leader and marker of change within the Commercial Markets division since joining Blue Cross more than two decades ago,” said Corkum. “She has consistently demonstrated exceptional value and commitment to the team, making her a natural fit for this position.”
Hill joined Blue Cross in 1990 and has held leadership positions in a variety of areas throughout the organization, with an emphasis on sales, operations and strategic initiatives. Most recently, Hill was senior director of the company’s health reform and exchange office. In this capacity, she was responsible for the development and implementation of Blue Cross’ integration with Minnesota’s state health insurance exchange. Additionally, Hill drove the overall management and execution of exchange-related functions at Blue Cross, including governance, infrastructure, resource management and financial management, and planning and organization readiness.
Hill holds a bachelor’s degree in education from Winona State University.
Blue Cross and Blue Shield of Minnesota (bluecrossmn.com), with headquarters in the St. Paul suburb of Eagan, was chartered in 1933 as Minnesota’s first health plan and continues to carry out its charter mission today as a health company: to promote a wider, more economical and timely availability of health services for the people of Minnesota. Blue Cross is a not-for-profit, taxable organization. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association, headquartered in Chicago.
— 30 — Reported by PRWeb 17 hours ago.
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Replacing doctor's visits with apps could save us $104 billion a year
Going to the doctor's office is expensive.Not only is there the cost of co-pays, but the cost of traveling to the office and the time taken out of the day to do so can add up.
In a lot of cases checking in on minor issues, like a rash or nausea, doesn't even require the doctor to look at the symptom and listen to the patient.
What if you could cut out the office visit?
According to research done by Goldman Sachs, moving those minor doctor visits from the brick and mortar offices to video conference platforms, similar to Skype or FaceTime, would reduce healthcare costs by around $104 billion per year.
According to a 2010 National Ambulatory Medicare Survey, the average American visits the doctor 3.32 times each year. Factoring in the healthcare system's increasing size due to the Affordable Care Act, Goldman Sachs analysts David Roman and Kyle Conlee estimated that this number has increased to approximately 4.0 since then. That's a total 1.3 billion doctor visits every year.
"Going to the doctor is both expensive and inconvenient. Further, of the over 1.3 billion physician office visits annually, our industry diligence suggests that close to half of them do not require doctor/patient contact," wrote Roman and Conlee.
This is where computers come in. Services such as Doctor on Demand and American Well allow patients to use their phones or computers to video chat with doctors face-to-face without going to the office. This saves a lot of money, a Doctor on Demand call costs $40 all told, while traditional visits average $200 total, meaning it could cut costs by 75%.
The platform is also gaining widespread acceptance. On April 30, United Healthcare, the largest health insurance provider in the country, announced that it had partnered with the three largest healthcare video conferencing companies and has begun to cover the costs of the video visits.
Roman and Conlee do accept that this technology is not a substitute for many doctor visits and patients trusting digital platforms could be a hurdle.
The quicker the adoption, the quicker the savings for the healthcare industry and consumers will add up. With intense focus on cutting healthcare costs, videoconferencing with a doctor is a multibillion dollar solution already available on the AppStore.
Join the conversation about this story »
NOW WATCH: 6 scientifically proven features men find attractive in women Reported by Business Insider 17 hours ago.
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United States: Proposed Managed Care Rules Leave State Obligations For CHIP Largely Unchanged - Sheppard Mullin Richter & Hampton
The CMS's proposed rule that updates Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems, leaves state obligations largely unchanged for the Children's Health Insurance Program.
Reported by Mondaq 17 hours ago.
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What Grade Does the Supreme Court Earn on Its Affordable Care Act Decision?
On June 25, 2015, the Supreme Court again upheld the ACA against a challenge, this time to federal subsidies. Was this a good or bad decision? What grade should we give the court, and for that matter congress as well?
Because the court held that the congressional intent was to provide insurance for more people, the decision was good. It preserves affordable insurance for financially challenged individuals, and many of my patients have insurance today but were uninsured before the ACA. Fewer people are uninsured now, thanks to the ACA. Who could possibly be against getting more patients health insurance, someway, somehow?
However, the costs of this insurance to those without subsidies have escalated, sometimes un-affordably and sometimes resulting in job loss rather than job creation. But it now remains for congress and states to continue to develop improved methods paying for health care, including less expensive health care delivery systems and more optimal utilization of resources so that premiums can be reduced. Such value-based programs are being developed by organized medicine (Choosing Wisely) and by the administration as well (Accountable Care Organization expansion, and the Oncology Care Model of Medicare).
Had the court decided to strictly interpret the language of the act and prohibited subsidies for those individuals on the federal exchange, many patients nationally would no longer have been able to afford insurance, and their care would have been threatened or interrupted. Many of my cancer patients would have had to discontinue life saving therapy. If this had happened to any of your relatives or friends, you would have been outraged.
So it is report card time, and here are my grades.
For the Supreme Court:
Access to health care: A, since one third of previously uninsured Americans are now insured according to the president and the Department of Health and Human Services, and will continue to be so.
Sustainability of health care: B, since the insurance market is stable, but costs are continuing to rise and for many people their premiums are too expensive and their higher deductibles reduce their desire to get treatments.
Sustainability of laws: D, since the Supreme Court has now taken the view that they can correctly interpret the intent of any law and change the language written by Congress, thus leading to a lack of confidence that any law will continue to work like Congress said it would.
Overall: the Supremes get a B
What about Congress:
The grade for drafting clear legislation: D, since there was ambiguity between intent and language.
Grade for health care reform: C, since access is better but costs are higher than anticipated, and implementation has been inefficient and across the states inconsistent
Grade for finishing health care reform: Incomplete, since programs to increase outcomes and reduce costs (a net increase in Value) are just now being more widely implemented.
Overall Congress earns a C- and a note from the "professors" (the public) to work harder and do better. I know they can.
Health care reform is not yet finished, and it will not be in our lifetimes. In my estimation, every health care system throughout the world has problems. Today, we are living in America where the reforms in health care delivery and scientific advances continue to give more of us confidence in long lives and happiness with control and prevention of illness. For tips on how to navigate the reforms in health care, see my book Surviving American Medicine. And be sure to discuss the impact of theses reforms on your own doctor's practice at your next visit.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 15 hours ago.
Because the court held that the congressional intent was to provide insurance for more people, the decision was good. It preserves affordable insurance for financially challenged individuals, and many of my patients have insurance today but were uninsured before the ACA. Fewer people are uninsured now, thanks to the ACA. Who could possibly be against getting more patients health insurance, someway, somehow?
However, the costs of this insurance to those without subsidies have escalated, sometimes un-affordably and sometimes resulting in job loss rather than job creation. But it now remains for congress and states to continue to develop improved methods paying for health care, including less expensive health care delivery systems and more optimal utilization of resources so that premiums can be reduced. Such value-based programs are being developed by organized medicine (Choosing Wisely) and by the administration as well (Accountable Care Organization expansion, and the Oncology Care Model of Medicare).
Had the court decided to strictly interpret the language of the act and prohibited subsidies for those individuals on the federal exchange, many patients nationally would no longer have been able to afford insurance, and their care would have been threatened or interrupted. Many of my cancer patients would have had to discontinue life saving therapy. If this had happened to any of your relatives or friends, you would have been outraged.
So it is report card time, and here are my grades.
For the Supreme Court:
Access to health care: A, since one third of previously uninsured Americans are now insured according to the president and the Department of Health and Human Services, and will continue to be so.
Sustainability of health care: B, since the insurance market is stable, but costs are continuing to rise and for many people their premiums are too expensive and their higher deductibles reduce their desire to get treatments.
Sustainability of laws: D, since the Supreme Court has now taken the view that they can correctly interpret the intent of any law and change the language written by Congress, thus leading to a lack of confidence that any law will continue to work like Congress said it would.
Overall: the Supremes get a B
What about Congress:
The grade for drafting clear legislation: D, since there was ambiguity between intent and language.
Grade for health care reform: C, since access is better but costs are higher than anticipated, and implementation has been inefficient and across the states inconsistent
Grade for finishing health care reform: Incomplete, since programs to increase outcomes and reduce costs (a net increase in Value) are just now being more widely implemented.
Overall Congress earns a C- and a note from the "professors" (the public) to work harder and do better. I know they can.
Health care reform is not yet finished, and it will not be in our lifetimes. In my estimation, every health care system throughout the world has problems. Today, we are living in America where the reforms in health care delivery and scientific advances continue to give more of us confidence in long lives and happiness with control and prevention of illness. For tips on how to navigate the reforms in health care, see my book Surviving American Medicine. And be sure to discuss the impact of theses reforms on your own doctor's practice at your next visit.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 15 hours ago.
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Paychex Earnings Preview: Revenue Timing, Health Insurance Demand To Drive Top Line
Paychex is set to release its fourth quarter fiscal 2015 earnings on Wednesday, July 1, before the market opens. For the fourth quarter, we expect to see growth in Payroll revenues as a result of a shift in revenue timing. However, growth could be tempered due to some weakness in small business employment. Purchases of solutions for compliance with the Patient Protection and Affordable Care Act should also have helped increase Paychex's revenues.
Reported by Forbes.com 14 hours ago.
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Your Hospital Could Be Marking Up Costs 1,000 Percent
A recent study found that 50 hospitals are marking up prices by 10 times the actual cost. How much does health insurance matter, and should you care?
Reported by Forbes.com 14 hours ago.
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5 Inexpensive Benefits Millennials Value More Than Health Insurance
Younger workers, unsurprisingly, are less likely to demand health insurance than older workers but don't overlook their birthdays.
Reported by FOXNews.com 13 hours ago.
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Coverage and Financial Security Preserved for Millions of Americans in the Supreme Court Ruling for the Government
*Co-authored by Sara Collins*
The Supreme Court decided last week in favor of the government in the King v. Burwell case. The case had contested the legality of the Affordable Care Act’s premium subsidies in the 34 states that have federally facilitated marketplaces.^1 The decision means that the estimated 6.4 million Americans who are currently receiving subsidies in these states will continue to benefit from affordable health insurance.
A new survey from The Commonwealth Fund shows what a difference this new marketplace insurance and new Medicaid coverage have made in millions of people’s lives across the country. In the survey, more than half of working-age adults who currently have coverage either through marketplace plans or Medicaid were uninsured prior to gaining this coverage; of those more than six of 10 had been without insurance for a year or longer.According to the survey, this new health insurance has improved people’s ability to get the health care that they need. Among adults with new coverage who have used it to go to the doctor or a hospital, or to fill a prescription, more than six of 10 reported that they would not have been able to access or afford this care before. While people who were uninsured previously were more likely to say they could not have gotten this care before, nearly half of those who had health insurance when they enrolled said the same.But as critical as the ruling is, significant challenges remain to realize the potential of the law’s sweeping insurance reforms and expansions. This next set of challenges includes continuing to increase the number of Americans who have health insurance, keeping premiums affordable, and protecting people from high out-of-pocket costs.The Commonwealth Fund survey finds that as many as 25 million adults remain uninsured. Nearly six of 10 remaining uninsured adults are living in the 22 states that have yet to expand eligibility for their Medicaid programs, as allowed under the Supreme Court’s 2012 Affordable Care Act decision. People in these states with incomes under 100 percent of poverty are in a coverage gap: they are ineligible for premium subsidies through the marketplaces because Congress assumed every state would expand Medicaid. Uninsured rates among people in this income group in nonexpansion states have barely budged from 2014, while uninsured rates have fallen significantly for poor adults in states that have expanded their programs.But the Medicaid expansion is not the only reason why people who are eligible for the law’s coverage options are not yet enrolled. The survey finds that many uninsured adults are either unaware of the coverage options available to them or have reasons for not exploring their insurance options, including uncertainty about whether they can afford coverage. Future gains in coverage will be dependent on states finding ways to expand eligibility for Medicaid and the pursuit by federal and state policymakers of targeted outreach and education efforts to help those eligible enroll.Keeping premiums and deductibles affordable for consumers will be an ongoing challenge for federal and state governments, and health industry stakeholders. A Commonwealth Fund report found that a majority of people with marketplace plans found their premiums very or somewhat easy to afford. But they were less likely than people with employer coverage to view their premiums as affordable. While marketplace premiums did not change on average in 2015, there was significant variability across states.Similarly, while the law’s cost-sharing subsidies have been effective in reducing deductibles and copayments for people in marketplace plans with lower incomes, many who are above the subsidy thresholds are left with high deductibles. But the use of high deductibles in marketplace plans reflects broader trends in the U.S. health insurance industry. Another recent Commonwealth Fund report found that the share of Americans in employer-based plans with deductibles that are high relative to their incomes has climbed steadily over the past decade. According to the report, an estimated 31 million insured U.S. adults have such high out-of-pocket costs relative to their incomes that they are effectively “underinsured.” While this estimate has held steady since 2010, if insurers and employers continue to use deductibles to contain their own health care costs, underinsurance is certain to begin to climb again.No policy, whether at the federal or state level, is static. Both Medicare and Medicaid have evolved over time to adjust to changes in health care and the needs of beneficiaries. The same is true of the Affordable Care Act. States that have used the resources and tools provided to them by the law have created different approaches to implementation that reflect the unique characteristics of their residents and political cultures. In 2017, every state can apply for the law’s so-called 1,332 waivers to further meld the law to fit their own vision of a health care system that insures nearly everyone in a way that guarantees access to timely care. With King v. Burwell resolved, policymakers, insurers, and providers can now focus their attention on continuous improvement of Americans’ insurance coverage and access to health care.
--------------------
Notes
^1Delaware and Pennsylvania, which have federally facilitated marketplaces, recently received conditional approval from the U.S. Department of Health and Human Services to operate their own marketplaces and enroll people through the federal website, HealthCare.gov. Three other states—Nevada, New Mexico, and Oregon—currently use this model.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 14 hours ago.
The Supreme Court decided last week in favor of the government in the King v. Burwell case. The case had contested the legality of the Affordable Care Act’s premium subsidies in the 34 states that have federally facilitated marketplaces.^1 The decision means that the estimated 6.4 million Americans who are currently receiving subsidies in these states will continue to benefit from affordable health insurance.
A new survey from The Commonwealth Fund shows what a difference this new marketplace insurance and new Medicaid coverage have made in millions of people’s lives across the country. In the survey, more than half of working-age adults who currently have coverage either through marketplace plans or Medicaid were uninsured prior to gaining this coverage; of those more than six of 10 had been without insurance for a year or longer.According to the survey, this new health insurance has improved people’s ability to get the health care that they need. Among adults with new coverage who have used it to go to the doctor or a hospital, or to fill a prescription, more than six of 10 reported that they would not have been able to access or afford this care before. While people who were uninsured previously were more likely to say they could not have gotten this care before, nearly half of those who had health insurance when they enrolled said the same.But as critical as the ruling is, significant challenges remain to realize the potential of the law’s sweeping insurance reforms and expansions. This next set of challenges includes continuing to increase the number of Americans who have health insurance, keeping premiums affordable, and protecting people from high out-of-pocket costs.The Commonwealth Fund survey finds that as many as 25 million adults remain uninsured. Nearly six of 10 remaining uninsured adults are living in the 22 states that have yet to expand eligibility for their Medicaid programs, as allowed under the Supreme Court’s 2012 Affordable Care Act decision. People in these states with incomes under 100 percent of poverty are in a coverage gap: they are ineligible for premium subsidies through the marketplaces because Congress assumed every state would expand Medicaid. Uninsured rates among people in this income group in nonexpansion states have barely budged from 2014, while uninsured rates have fallen significantly for poor adults in states that have expanded their programs.But the Medicaid expansion is not the only reason why people who are eligible for the law’s coverage options are not yet enrolled. The survey finds that many uninsured adults are either unaware of the coverage options available to them or have reasons for not exploring their insurance options, including uncertainty about whether they can afford coverage. Future gains in coverage will be dependent on states finding ways to expand eligibility for Medicaid and the pursuit by federal and state policymakers of targeted outreach and education efforts to help those eligible enroll.Keeping premiums and deductibles affordable for consumers will be an ongoing challenge for federal and state governments, and health industry stakeholders. A Commonwealth Fund report found that a majority of people with marketplace plans found their premiums very or somewhat easy to afford. But they were less likely than people with employer coverage to view their premiums as affordable. While marketplace premiums did not change on average in 2015, there was significant variability across states.Similarly, while the law’s cost-sharing subsidies have been effective in reducing deductibles and copayments for people in marketplace plans with lower incomes, many who are above the subsidy thresholds are left with high deductibles. But the use of high deductibles in marketplace plans reflects broader trends in the U.S. health insurance industry. Another recent Commonwealth Fund report found that the share of Americans in employer-based plans with deductibles that are high relative to their incomes has climbed steadily over the past decade. According to the report, an estimated 31 million insured U.S. adults have such high out-of-pocket costs relative to their incomes that they are effectively “underinsured.” While this estimate has held steady since 2010, if insurers and employers continue to use deductibles to contain their own health care costs, underinsurance is certain to begin to climb again.No policy, whether at the federal or state level, is static. Both Medicare and Medicaid have evolved over time to adjust to changes in health care and the needs of beneficiaries. The same is true of the Affordable Care Act. States that have used the resources and tools provided to them by the law have created different approaches to implementation that reflect the unique characteristics of their residents and political cultures. In 2017, every state can apply for the law’s so-called 1,332 waivers to further meld the law to fit their own vision of a health care system that insures nearly everyone in a way that guarantees access to timely care. With King v. Burwell resolved, policymakers, insurers, and providers can now focus their attention on continuous improvement of Americans’ insurance coverage and access to health care.
--------------------
Notes
^1Delaware and Pennsylvania, which have federally facilitated marketplaces, recently received conditional approval from the U.S. Department of Health and Human Services to operate their own marketplaces and enroll people through the federal website, HealthCare.gov. Three other states—Nevada, New Mexico, and Oregon—currently use this model.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 14 hours ago.
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GASB Publishes New Standards for Reporting Health Insurance and Other Retiree Benefits
NORWALK, Conn.--(BUSINESS WIRE)--The Governmental Accounting Standards Board (GASB) today published two Statements that intend to improve the accounting and financial reporting by state and local governments for postemployment benefits other than pensions (OPEB), primarily retiree health insurance. The GASB also issued a third Statement establishing accounting and financial reporting requirements for pensions and pension plans that were outside the scope of the pension standards the GASB releas
Reported by Business Wire 13 hours ago.
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On King v. Burwell: What Is a Natural Reading?
In King v. Burwell, decided last Thursday, the Supreme Court has once again (no doubt inadvertently) given us a lesson in the philosophy of language. Let me explain by way of an example.
Some years ago as I was driving my father back to his apartment in Florida we approached an intersection where the light had turned red. He said, "Go through the light." What did he mean? He could have meant, "Don't stop even if the light is red"; or he could have meant, "When you get to the intersection go straight, don't turn either left or right." Which was it, and how could I figure it out?
Well, it would depend on what I assumed his intention was. Did he doubt that his son, a college professor and therefore someone ill-equipped to negotiate the everyday world, was capable of remembering the way to the apartment, although he had been there many times? Or had he suddenly recalled an appointment he was late for, saw there was no one around, and decided that a little minor law-breaking would do no harm and save him a minute or two? Or was he experiencing some physical discomfort and needed to get home as soon as possible?
In order to settle on any of these meanings (and there are more that could have been listed), I might have had to ask him some questions. Or perhaps I wouldn't have had to ask questions because I knew him so well that I could pretty much be certain what he might be saying in a situation like this one. In either case -- if I were relying on my deep knowledge of him or if I were puzzled by his imperative and sought clarity -- what I would be after is his intention, a sense of what he had in mind, and it is in the light of that intention that the meaning of his words would stabilize. And if I neither asked questions nor were confident in my understanding of his character -- of why he, being who he was, might say such a thing -- his utterance would continue to be unstable with respect to its meaning; it would continue to be a series of recognizable, even ordinary, English monosyllables whose significance was multiple and unclear.
The moral (or at least the one I draw) is that words, no matter how simple or carefully crafted, do not declare their own meaning, and they are readable -- that is, construed as having a determinate sense -- only when the intention informing them is either presupposed or established by inquiring into it.
The additional moral is that the traditional distinction between what is said and what is meant doesn't hold up. That distinction assumes that there is a level of language, sometimes called literal, that is self-sufficient in its capacity to convey a message and doesn't require any external information about the speaker's intention (or about anything else) to piece it out. In this view of the matter, intention is either built into the language or is something in a speaker's head that might or might not match up with what is spoken. (Thus the possibility of the disjunction between what was said and what was meant.) But what my example shows is that there is no such literal level -- there is no literal meaning of "go through the light," only the various meanings that seem obvious and inescapable (and, yes, literal) once an intention is specified -- and that without either the assumption or the positing of intention, a string of words doesn't have a meaning at all, but is, rather, a collection of semantic possibilities waiting for something to narrow it down. While in that condition -- existing in an abstract space and tied to nothing -- words are irremediably ambiguous -- all of them.
I put it that way because of something Justice Antonin Scalia says in his dissent. The dispute in the case is over the meaning of the phrase "exchange established by the state." Chief Justice John Roberts, writing for the majority, argues that the phrase can and should be read to include an exchange established by the federal government. He explains that "exchange established by the state" is ambiguous because when read in context (as he proceeds to do) it means something different than it does when read in isolation. Scalia retorts that by the logic of such a reading, "everything is ambiguous."
That's both right and not right: everything is ambiguous, if by everything is meant words considered apart from any intention informing them; but if an intention is either taken for granted or put in place, the potential ambiguities -- produced when language is imagined as being in an unanchored state -- will have pretty much disappeared. Once I have determined to my own satisfaction what purpose prompted my father to say "go through the light," his words are no longer ambiguous, but clear as a bell. Of course I might turn out to be wrong, in which case my initial determination would be succeeded by another, and his words would still be clear as a bell, but the clarity would be different.
So it is just as cogent to say "nothing is ambiguous" (unless of course an ambiguity is intended, in which case the ambiguity is straightforward) as it is to say that "everything is ambiguous." What you can't say is that either ambiguity or clarity follows from the language of an utterance considered in and of itself; they both follow from the fact of intention or its absence. Words always mean what their speakers intend, and they fail or multiply in their meaning if no intention is attached to them. (There is no such thing as either clear or ambiguous language, although there are certainly clear or ambiguous utterances.)
Chief Justice Roberts is no less confused about this than Scalia. He thinks that in order to make his case about the interpretation of "exchange established by the state" he has to depart from what both he and Scalia call the "natural" reading or sense of the phrase: "The context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase." By "natural reading" or "natural sense," Roberts could mean one of two things:
(1): a sense that belongs to the words by right; the words have an essential, not a merely conventional, relationship to the things they name; the words capture the nature of the things;
(2) a sense that corresponds to standard usage at the time of the text's production; the statistically, not naturally, normative sense.
Nobody (with the possible exception of George Orwell in his very bad and silly essay "Politics and the English Language") believes in (1), for that would be to believe that all language was, at least ideally, onomatopoeic -- every word would work as "bow-wow" and "meow" do.
Therefore (2) is obviously what the two justices subscribe to. But that amounts to saying no more than that, all things being equal, words and phrases should be interpreted in accord with the meaning most usually associated with them; that is, in accord with the intention most speakers have in mind when they utter them.
But when all things are not equal, when there is good reason to think that another, not statistically predominant, intentional context is presiding over the scene of communication, you affirm the reading that context generates, which then becomes the "natural" reading. The natural reading is not a reading arrived at apart from context, but the reading that seems most natural to you given the context you are reading or hearing within. Roberts is not departing from anything; he is just going with the reading that now seems inescapable to him in light of his determination of what the authors of the affordable care act had in mind -- of what they were up to.
He says as much, quoting an earlier case: "...the words of a statute must be read in their context and with a view to their place in the overall regulatory scheme." And, again: "We cannot interpret federal statutes to negate their own stated purposes." In this case, the stated purpose, he tells us, was to "improve health insurance markets and not to destroy them," and therefore "we must interpret the Act in a way that is consistent with the former and avoids the latter."
This is not to subvert the natural reading, but to insist on it. The unnatural reading is the one that regards the phrase "exchange established by the state" as if it floated in space untethered to the constraint of any actual communicative project and bore a timeless meaning that was somehow its property. The unnatural reading is Scalia's. As Justice Elena Kagan said in the oral arguments, "We don't look at four [or five] words. We look at the whole, the particular context, the more general context, try to make everything harmonious with everything else." And when we do this, she might have added, we are not engaging in a special or aberrant mode of interpretation; we're just doing interpretation in the way that it is always, and necessarily, done.
Roberts does not know how strong his position is, and he is kept from that knowledge by his signing on to the existence of a "natural" reading in the stronger (and impossible) sense of a reading the words naturally have. This mistake opens the door for Scalia's chest-thumping and table-pounding fulminations and for his accusation that the majority is rewriting, not interpreting, the Act: "'Exchange established by the state' means what it looks like it means.""Words no longer have meaning if an Exchange that is not established by the state is 'established by the state.'"
Had Roberts deconstructed (God forbid!) the idea of a naturally "natural" reading, he would not have been so vulnerable to Scalia's scathing rhetoric on this point (although he would have then been vulnerable on other grounds).
But perhaps this is too harsh a judgment. As the justices themselves often say, they are lawyers, not philosophers, and they are bound not by theses in the philosophy of language but by the practices and vocabulary of their profession. Splitting utterances into two kinds -- the ambiguous and the unambiguous -- is, I think, all wrong, but the accepted canons of legal interpretation require it (this is the famous Chevron rule), and a justice must fall in with that requirement even if it commits him to positing entities (like an objectively natural reading or a-contextual meanings) that do not exist, and commits him also to the task of finding his way out of the dilemmas that believing in those entities creates.
But, after all, Roberts manages to do it.
_____________
Stanley Fish is the Davidson-Kahn Distinguished University Professor and Professor of Law at Florida International University, and the Floersheimer Distinguished Visiting Professor of Law at Cardozo Law School.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 12 hours ago.
Some years ago as I was driving my father back to his apartment in Florida we approached an intersection where the light had turned red. He said, "Go through the light." What did he mean? He could have meant, "Don't stop even if the light is red"; or he could have meant, "When you get to the intersection go straight, don't turn either left or right." Which was it, and how could I figure it out?
Well, it would depend on what I assumed his intention was. Did he doubt that his son, a college professor and therefore someone ill-equipped to negotiate the everyday world, was capable of remembering the way to the apartment, although he had been there many times? Or had he suddenly recalled an appointment he was late for, saw there was no one around, and decided that a little minor law-breaking would do no harm and save him a minute or two? Or was he experiencing some physical discomfort and needed to get home as soon as possible?
In order to settle on any of these meanings (and there are more that could have been listed), I might have had to ask him some questions. Or perhaps I wouldn't have had to ask questions because I knew him so well that I could pretty much be certain what he might be saying in a situation like this one. In either case -- if I were relying on my deep knowledge of him or if I were puzzled by his imperative and sought clarity -- what I would be after is his intention, a sense of what he had in mind, and it is in the light of that intention that the meaning of his words would stabilize. And if I neither asked questions nor were confident in my understanding of his character -- of why he, being who he was, might say such a thing -- his utterance would continue to be unstable with respect to its meaning; it would continue to be a series of recognizable, even ordinary, English monosyllables whose significance was multiple and unclear.
The moral (or at least the one I draw) is that words, no matter how simple or carefully crafted, do not declare their own meaning, and they are readable -- that is, construed as having a determinate sense -- only when the intention informing them is either presupposed or established by inquiring into it.
The additional moral is that the traditional distinction between what is said and what is meant doesn't hold up. That distinction assumes that there is a level of language, sometimes called literal, that is self-sufficient in its capacity to convey a message and doesn't require any external information about the speaker's intention (or about anything else) to piece it out. In this view of the matter, intention is either built into the language or is something in a speaker's head that might or might not match up with what is spoken. (Thus the possibility of the disjunction between what was said and what was meant.) But what my example shows is that there is no such literal level -- there is no literal meaning of "go through the light," only the various meanings that seem obvious and inescapable (and, yes, literal) once an intention is specified -- and that without either the assumption or the positing of intention, a string of words doesn't have a meaning at all, but is, rather, a collection of semantic possibilities waiting for something to narrow it down. While in that condition -- existing in an abstract space and tied to nothing -- words are irremediably ambiguous -- all of them.
I put it that way because of something Justice Antonin Scalia says in his dissent. The dispute in the case is over the meaning of the phrase "exchange established by the state." Chief Justice John Roberts, writing for the majority, argues that the phrase can and should be read to include an exchange established by the federal government. He explains that "exchange established by the state" is ambiguous because when read in context (as he proceeds to do) it means something different than it does when read in isolation. Scalia retorts that by the logic of such a reading, "everything is ambiguous."
That's both right and not right: everything is ambiguous, if by everything is meant words considered apart from any intention informing them; but if an intention is either taken for granted or put in place, the potential ambiguities -- produced when language is imagined as being in an unanchored state -- will have pretty much disappeared. Once I have determined to my own satisfaction what purpose prompted my father to say "go through the light," his words are no longer ambiguous, but clear as a bell. Of course I might turn out to be wrong, in which case my initial determination would be succeeded by another, and his words would still be clear as a bell, but the clarity would be different.
So it is just as cogent to say "nothing is ambiguous" (unless of course an ambiguity is intended, in which case the ambiguity is straightforward) as it is to say that "everything is ambiguous." What you can't say is that either ambiguity or clarity follows from the language of an utterance considered in and of itself; they both follow from the fact of intention or its absence. Words always mean what their speakers intend, and they fail or multiply in their meaning if no intention is attached to them. (There is no such thing as either clear or ambiguous language, although there are certainly clear or ambiguous utterances.)
Chief Justice Roberts is no less confused about this than Scalia. He thinks that in order to make his case about the interpretation of "exchange established by the state" he has to depart from what both he and Scalia call the "natural" reading or sense of the phrase: "The context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase." By "natural reading" or "natural sense," Roberts could mean one of two things:
(1): a sense that belongs to the words by right; the words have an essential, not a merely conventional, relationship to the things they name; the words capture the nature of the things;
(2) a sense that corresponds to standard usage at the time of the text's production; the statistically, not naturally, normative sense.
Nobody (with the possible exception of George Orwell in his very bad and silly essay "Politics and the English Language") believes in (1), for that would be to believe that all language was, at least ideally, onomatopoeic -- every word would work as "bow-wow" and "meow" do.
Therefore (2) is obviously what the two justices subscribe to. But that amounts to saying no more than that, all things being equal, words and phrases should be interpreted in accord with the meaning most usually associated with them; that is, in accord with the intention most speakers have in mind when they utter them.
But when all things are not equal, when there is good reason to think that another, not statistically predominant, intentional context is presiding over the scene of communication, you affirm the reading that context generates, which then becomes the "natural" reading. The natural reading is not a reading arrived at apart from context, but the reading that seems most natural to you given the context you are reading or hearing within. Roberts is not departing from anything; he is just going with the reading that now seems inescapable to him in light of his determination of what the authors of the affordable care act had in mind -- of what they were up to.
He says as much, quoting an earlier case: "...the words of a statute must be read in their context and with a view to their place in the overall regulatory scheme." And, again: "We cannot interpret federal statutes to negate their own stated purposes." In this case, the stated purpose, he tells us, was to "improve health insurance markets and not to destroy them," and therefore "we must interpret the Act in a way that is consistent with the former and avoids the latter."
This is not to subvert the natural reading, but to insist on it. The unnatural reading is the one that regards the phrase "exchange established by the state" as if it floated in space untethered to the constraint of any actual communicative project and bore a timeless meaning that was somehow its property. The unnatural reading is Scalia's. As Justice Elena Kagan said in the oral arguments, "We don't look at four [or five] words. We look at the whole, the particular context, the more general context, try to make everything harmonious with everything else." And when we do this, she might have added, we are not engaging in a special or aberrant mode of interpretation; we're just doing interpretation in the way that it is always, and necessarily, done.
Roberts does not know how strong his position is, and he is kept from that knowledge by his signing on to the existence of a "natural" reading in the stronger (and impossible) sense of a reading the words naturally have. This mistake opens the door for Scalia's chest-thumping and table-pounding fulminations and for his accusation that the majority is rewriting, not interpreting, the Act: "'Exchange established by the state' means what it looks like it means.""Words no longer have meaning if an Exchange that is not established by the state is 'established by the state.'"
Had Roberts deconstructed (God forbid!) the idea of a naturally "natural" reading, he would not have been so vulnerable to Scalia's scathing rhetoric on this point (although he would have then been vulnerable on other grounds).
But perhaps this is too harsh a judgment. As the justices themselves often say, they are lawyers, not philosophers, and they are bound not by theses in the philosophy of language but by the practices and vocabulary of their profession. Splitting utterances into two kinds -- the ambiguous and the unambiguous -- is, I think, all wrong, but the accepted canons of legal interpretation require it (this is the famous Chevron rule), and a justice must fall in with that requirement even if it commits him to positing entities (like an objectively natural reading or a-contextual meanings) that do not exist, and commits him also to the task of finding his way out of the dilemmas that believing in those entities creates.
But, after all, Roberts manages to do it.
_____________
Stanley Fish is the Davidson-Kahn Distinguished University Professor and Professor of Law at Florida International University, and the Floersheimer Distinguished Visiting Professor of Law at Cardozo Law School.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 12 hours ago.
↧
A Big Week for the Supremes
This has been a busy week for the Supreme Court, which came down with three much-anticipated decisions.
The first was the decision on same-sex marriage (Obergefell v. Hodges ). As a libertarian, I have absolutely no problem with gay couples enjoying the same legal rights as heterosexual ones. I also see no reason why they should be spared the ravages of our divorce system just because they are gay. In fact, I look forward to the day when the anti-male bias of the divorce courts in most countries is tempered by precedents coming from gay divorces, where the enemy is much harder to identify.
As someone who suffers from a quaint and decidedly unfashionable belief that words should actually mean something, I have a bit of a problem with calling it same-sex "marriage," since this word has meant, from time immemorial, something involving a man and woman. However, I can easily get over this.
What I do have a problem with, however, is how this decision is being discussed by commentators on both sides. The continuous discussions about whether this or that justice, usually referring to Roberts or Kennedy, has gone over to the liberal or conservative side. Or the invocation of opinion polls or the spirit of the times. All of these things speak to a fundamental misunderstanding of the role of the Supreme Court, which is the most disconcerting part of the reaction.
Discussion about the decision on Obamacare (King v. Burwell ) shows a similar partisan inability to distinguish between the political and the legal issues at hand. Right or left applaud or decry the decision based on whether it is a win or loss for their "side." For my part, although politically I am not thrilled by the decision, my non-lawyer mind always thought that the legal case was weak.
I have spent most of my business career surrounded by laws from multiple jurisdictions. I can tell you that nearly all of them are drafted badly. If judges started invalidating the clear intent of laws on the basis of poor drafting, then we would quickly be back to "Thou shalt not kill" and little else. Like it or not, Congress fully intended that subsidies be available to anyone buying health insurance over any state or federal exchange. To expect the Supreme Court to overrule this political decision due to the slip of a pen was always a reach.
Lastly, we have the most disappointing decision of all, as least from my perspective. This is the decision in Texas Department of Housing and Community Affairs v. The Inclusive Communities Project, Inc., which relates to the doctrine of "disparate impact," as I have discussed earlier . Here the court has ruled in favour of the doctrine as it relates to the Fair Housing Act. Although the decision could be, and hopefully will be, read as narrowly applying only to this Act, it represents yet another nose under the tent for this pernicious theory. And it is being celebrated as such by liberal commentators, including the reliably left-leaning Noah Feldman from BloomberView, who is teaching the next generation of social-engineers at Harvard Law School.
I will quote at length from his recent blog on this decision (with italics added for emphasis):
What's important about the decision isn't the rationale but the real-world effects. Housing discrimination is a significant legacy of the broader history of racial discrimination throughout the U.S., in North and South alike. Proving intentional discrimination, however, is difficult to do - especially when a faceless institution is involved....It's entirely possible that no one in the Texas office was consciously or knowingly engaged in racial discrimination. Yet the effects on housing markets, and by extension on racial equality, could be real, regardless of intent.
When the law is interpreted to allow disparate impact claims, it permits statistically based challenges to the reality of discrimination. It draws attention away from the fantasy that behind every discriminatory act lies some identifiable racial animus.
This kind of pragmatic approach is particularly desirable in this historical moment, when police discrimination has been so much a matter of public attention. Frequently, police officers have no conscious intent to treat blacks differently from whites. That's one reason discrimination can happen even when officers are black - and even when a department is led by a black chief. Yet discriminatory effects can nevertheless be felt by blacks even if no one knowingly means to discriminate....
Discrimination is still with us even as conscious, knowing racism declines. Disparate impact remains a crucial tool for producing more equal outcomes in a more equal America.
There you have it: the liberal view of the rule of law. Legal rationale isn't important, just a "pragmatic" approach to "real world effects" in which we can have crimes without criminals. Or even crimes without crimes, so long as the damage is "felt." And all of this guided and justified by the overriding goal of "producing more equal outcomes in a more equal America," in which "disparate impact" will become indistinguishable - if it ever has been - from "disparate outcome," and where the latter standard will be applied to more and more categories of disparity. And since discrimination seems to exist in some kind of aether, outside of the realms of "conscious" or "knowing," then the likes of Feldman will only be able to pronounce its eradication when we have achieved statistic perfection.
Gay marriage and the Obamacare victory will get all the coverage, but I predict that Texas Department of Housing is the ruling that America will most come to regret.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 11 hours ago.
The first was the decision on same-sex marriage (Obergefell v. Hodges ). As a libertarian, I have absolutely no problem with gay couples enjoying the same legal rights as heterosexual ones. I also see no reason why they should be spared the ravages of our divorce system just because they are gay. In fact, I look forward to the day when the anti-male bias of the divorce courts in most countries is tempered by precedents coming from gay divorces, where the enemy is much harder to identify.
As someone who suffers from a quaint and decidedly unfashionable belief that words should actually mean something, I have a bit of a problem with calling it same-sex "marriage," since this word has meant, from time immemorial, something involving a man and woman. However, I can easily get over this.
What I do have a problem with, however, is how this decision is being discussed by commentators on both sides. The continuous discussions about whether this or that justice, usually referring to Roberts or Kennedy, has gone over to the liberal or conservative side. Or the invocation of opinion polls or the spirit of the times. All of these things speak to a fundamental misunderstanding of the role of the Supreme Court, which is the most disconcerting part of the reaction.
Discussion about the decision on Obamacare (King v. Burwell ) shows a similar partisan inability to distinguish between the political and the legal issues at hand. Right or left applaud or decry the decision based on whether it is a win or loss for their "side." For my part, although politically I am not thrilled by the decision, my non-lawyer mind always thought that the legal case was weak.
I have spent most of my business career surrounded by laws from multiple jurisdictions. I can tell you that nearly all of them are drafted badly. If judges started invalidating the clear intent of laws on the basis of poor drafting, then we would quickly be back to "Thou shalt not kill" and little else. Like it or not, Congress fully intended that subsidies be available to anyone buying health insurance over any state or federal exchange. To expect the Supreme Court to overrule this political decision due to the slip of a pen was always a reach.
Lastly, we have the most disappointing decision of all, as least from my perspective. This is the decision in Texas Department of Housing and Community Affairs v. The Inclusive Communities Project, Inc., which relates to the doctrine of "disparate impact," as I have discussed earlier . Here the court has ruled in favour of the doctrine as it relates to the Fair Housing Act. Although the decision could be, and hopefully will be, read as narrowly applying only to this Act, it represents yet another nose under the tent for this pernicious theory. And it is being celebrated as such by liberal commentators, including the reliably left-leaning Noah Feldman from BloomberView, who is teaching the next generation of social-engineers at Harvard Law School.
I will quote at length from his recent blog on this decision (with italics added for emphasis):
What's important about the decision isn't the rationale but the real-world effects. Housing discrimination is a significant legacy of the broader history of racial discrimination throughout the U.S., in North and South alike. Proving intentional discrimination, however, is difficult to do - especially when a faceless institution is involved....It's entirely possible that no one in the Texas office was consciously or knowingly engaged in racial discrimination. Yet the effects on housing markets, and by extension on racial equality, could be real, regardless of intent.
When the law is interpreted to allow disparate impact claims, it permits statistically based challenges to the reality of discrimination. It draws attention away from the fantasy that behind every discriminatory act lies some identifiable racial animus.
This kind of pragmatic approach is particularly desirable in this historical moment, when police discrimination has been so much a matter of public attention. Frequently, police officers have no conscious intent to treat blacks differently from whites. That's one reason discrimination can happen even when officers are black - and even when a department is led by a black chief. Yet discriminatory effects can nevertheless be felt by blacks even if no one knowingly means to discriminate....
Discrimination is still with us even as conscious, knowing racism declines. Disparate impact remains a crucial tool for producing more equal outcomes in a more equal America.
There you have it: the liberal view of the rule of law. Legal rationale isn't important, just a "pragmatic" approach to "real world effects" in which we can have crimes without criminals. Or even crimes without crimes, so long as the damage is "felt." And all of this guided and justified by the overriding goal of "producing more equal outcomes in a more equal America," in which "disparate impact" will become indistinguishable - if it ever has been - from "disparate outcome," and where the latter standard will be applied to more and more categories of disparity. And since discrimination seems to exist in some kind of aether, outside of the realms of "conscious" or "knowing," then the likes of Feldman will only be able to pronounce its eradication when we have achieved statistic perfection.
Gay marriage and the Obamacare victory will get all the coverage, but I predict that Texas Department of Housing is the ruling that America will most come to regret.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 11 hours ago.
↧
Who is the Patient: The Insurance Industry or Real People?
by John Geyman, M.D.
http://www.johngeymanmd.org
The long-awaited ruling by the U. S. Supreme Court (SCOTUS) supporting subsidies/tax credits for the Affordable Care Act (ACA) has been hailed by the mainstream media (even including MSNBC) as a landmark event showing the success of health care reform. Granted, the ACA after five years has brought new coverage to 16 million people through the exchanges and expanded Medicaid, and has established some limited insurance reforms, such as banning insurers from denying coverage based on pre-existing conditions. But as the media celebrate and hype this event, we need to ask some hard questions about where we now find ourselves in reforming our dysfunctional system.
First, as to numbers, there were 50 million uninsured Americans in 2010, when the ACA was enacted; that number today is still 35 million. (1) Tens of millions more are underinsured, and we will never achieve universal coverage under the ACA. Even with insurance, one in three Americans cannot afford necessary health care, with many foregoing care and being forced into debt or bankruptcy. The ACA does not address underlying causes of medical debt, including high cost-sharing in many plans, little or no coverage for out-of-network care, and limits on essential health benefits. (2) Despite the original intent of the ACA to provide new insurance protections, insurers can still discriminate against the sick through inadequate provider networks, high deductibles, restrictive drug formularies, deceptive marketing practices, and other means. (3)
Uncontrolled inflation of health care costs continues unimpeded as insurers, hospitals, drug companies, and others in the medical-industrial complex embrace expanded and subsidized new markets with minimal oversight. This problem is growing worse as insurers and hospitals consolidate, gain near-monopoly market shares, and raise their prices to what the traffic will bear. Meanwhile, the bureaucracy and cost of the ACA's infrastructure continues to grow.
This SCOTUS decision is yet another bailout of a dying private health insurance industry that would be gone without federal subsidies--from us, the taxpayers. In describing the rationale for the Court's ruling, Chief Justice John Roberts said: "Congress passed the Act to improve health insurance markets, not to destroy them." America's Health Insurance Plans (AHIP), the industry's trade group, had previously filed an amicus brief with the court in King v. Burwell that described a calamitous outcome for the industry unless subsidies were continued. (4)
This makes me ask: who was the patient that SCOTUS was trying to help--the insurance industry or everyday American real patients? This latest ruling props up a dying industry for another period of time. Despite the ACA's successes to date, we are still left with uncontrolled inflation of health care costs that are unaffordable for much of the shrinking middle class, continued erosion of employer-sponsored insurance (ESI) as many employers shift employees to the exchanges or defined benefit plans, and increasing cost-shifting to patients.
We need to recognize the failures of the insurance industry even as they receive their second bailout from SCOTUS. These examples illustrate how inadequate the industry is in handling health care financing in this country:
· Almost one-half of physician networks for plans sold on the exchanges include less than 25 percent of physicians in their region; patients receiving out-of-network care are subject to high costs without coverage. (5)· There are inadequate price controls in the ACA, thereby giving insurers, hospitals, pharmaceutical companies, and other corporate stakeholders in the medical-industrial complex expanded subsidized markets with minimal oversight.· More than 20 states rejected Medicaid expansion under the ACA leaving about 8 million people uninsured; as a result of their foregoing necessary care, it is estimated that the number of deaths in opt-out states will range between 7,115 and 17,104. (6)· There are still about 18 million Americans who are eligible for coverage under the ACA but have not purchased coverage, in many cases because of its high costs. (7)· According to the Centers for Medicare and Medicaid Services (CMS), the expanding bureaucracy under the ACA will take up one quarter of federal spending and add almost274 billion in new administrative costs heading into 2022. (8)
We can expect this next stage of the ongoing debate over health care reform to be heated as both political parties adapt their messages to this latest development in the 2016 election cycle. But we need to keep in mind who the patient is as the debate goes forward--it should be real patients, not the self-interest of giant corporate stakeholders in our medical-industrial complex.
SCOTUS has bailed out the private insurance market once again, as it previously did in 2012. The government continues to subsidize a bloated and failing market. We can expect to see increasing premiums and less value of coverage in the next few years as insurers maximize profits over service. What will we do about the next dire call by the health insurance industry about the "death spiral? We have already tolerated too many years of its false arguments for its central role in health care financing. We can no longer afford its inefficiencies, profiteering, and disingenuous statements of its necessity. It is time to move on to real health care reform, with single-payer, not-for-profit financing of the U. S. health care system.
*References: *
1. Radofsky, L. Meet the health-law holdouts. Wall Street Journal, June 25, 2015.
2. Pollitz, K, Cox, c, Lucia, K et al. Medical debt among people with health insurance. Kaiser Family Foundation, January 2014.
3. Patient advocacy groups. Letter to Sylvia Burwell, Secretary of Health and Human Services, July 28, 2014.
4. Potter, W. Insurers' arguments key to Supreme Court decision. Commentary: upholding Obamacare only way to avoid 'death spiral'. Center for Public Integrity, June 25, 2015.
5. Andrews, M. Study finds almost half of health law plans offer very limited physician networks. Kaiser Health News, June 26, 2015.
6. Dickman, S, Himmelstein, DU, McCormick, D et al. Opting out of Medicaid expansion: The health and financial impacts. Health Affairs Blog, January 30, 2014.
7. Rau, J. Having survived Court ruling, insurance markets still face economic threats. Kaiser Health News, June 25, 2015.
8. Himmelstein, DU. Woolhandler, S. The post-launch problem: the Affordable Care Act's persistently high administrative costs. Health Affairs Blog, May 27, 2015.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 11 hours ago.
http://www.johngeymanmd.org
The long-awaited ruling by the U. S. Supreme Court (SCOTUS) supporting subsidies/tax credits for the Affordable Care Act (ACA) has been hailed by the mainstream media (even including MSNBC) as a landmark event showing the success of health care reform. Granted, the ACA after five years has brought new coverage to 16 million people through the exchanges and expanded Medicaid, and has established some limited insurance reforms, such as banning insurers from denying coverage based on pre-existing conditions. But as the media celebrate and hype this event, we need to ask some hard questions about where we now find ourselves in reforming our dysfunctional system.
First, as to numbers, there were 50 million uninsured Americans in 2010, when the ACA was enacted; that number today is still 35 million. (1) Tens of millions more are underinsured, and we will never achieve universal coverage under the ACA. Even with insurance, one in three Americans cannot afford necessary health care, with many foregoing care and being forced into debt or bankruptcy. The ACA does not address underlying causes of medical debt, including high cost-sharing in many plans, little or no coverage for out-of-network care, and limits on essential health benefits. (2) Despite the original intent of the ACA to provide new insurance protections, insurers can still discriminate against the sick through inadequate provider networks, high deductibles, restrictive drug formularies, deceptive marketing practices, and other means. (3)
Uncontrolled inflation of health care costs continues unimpeded as insurers, hospitals, drug companies, and others in the medical-industrial complex embrace expanded and subsidized new markets with minimal oversight. This problem is growing worse as insurers and hospitals consolidate, gain near-monopoly market shares, and raise their prices to what the traffic will bear. Meanwhile, the bureaucracy and cost of the ACA's infrastructure continues to grow.
This SCOTUS decision is yet another bailout of a dying private health insurance industry that would be gone without federal subsidies--from us, the taxpayers. In describing the rationale for the Court's ruling, Chief Justice John Roberts said: "Congress passed the Act to improve health insurance markets, not to destroy them." America's Health Insurance Plans (AHIP), the industry's trade group, had previously filed an amicus brief with the court in King v. Burwell that described a calamitous outcome for the industry unless subsidies were continued. (4)
This makes me ask: who was the patient that SCOTUS was trying to help--the insurance industry or everyday American real patients? This latest ruling props up a dying industry for another period of time. Despite the ACA's successes to date, we are still left with uncontrolled inflation of health care costs that are unaffordable for much of the shrinking middle class, continued erosion of employer-sponsored insurance (ESI) as many employers shift employees to the exchanges or defined benefit plans, and increasing cost-shifting to patients.
We need to recognize the failures of the insurance industry even as they receive their second bailout from SCOTUS. These examples illustrate how inadequate the industry is in handling health care financing in this country:
· Almost one-half of physician networks for plans sold on the exchanges include less than 25 percent of physicians in their region; patients receiving out-of-network care are subject to high costs without coverage. (5)· There are inadequate price controls in the ACA, thereby giving insurers, hospitals, pharmaceutical companies, and other corporate stakeholders in the medical-industrial complex expanded subsidized markets with minimal oversight.· More than 20 states rejected Medicaid expansion under the ACA leaving about 8 million people uninsured; as a result of their foregoing necessary care, it is estimated that the number of deaths in opt-out states will range between 7,115 and 17,104. (6)· There are still about 18 million Americans who are eligible for coverage under the ACA but have not purchased coverage, in many cases because of its high costs. (7)· According to the Centers for Medicare and Medicaid Services (CMS), the expanding bureaucracy under the ACA will take up one quarter of federal spending and add almost274 billion in new administrative costs heading into 2022. (8)
We can expect this next stage of the ongoing debate over health care reform to be heated as both political parties adapt their messages to this latest development in the 2016 election cycle. But we need to keep in mind who the patient is as the debate goes forward--it should be real patients, not the self-interest of giant corporate stakeholders in our medical-industrial complex.
SCOTUS has bailed out the private insurance market once again, as it previously did in 2012. The government continues to subsidize a bloated and failing market. We can expect to see increasing premiums and less value of coverage in the next few years as insurers maximize profits over service. What will we do about the next dire call by the health insurance industry about the "death spiral? We have already tolerated too many years of its false arguments for its central role in health care financing. We can no longer afford its inefficiencies, profiteering, and disingenuous statements of its necessity. It is time to move on to real health care reform, with single-payer, not-for-profit financing of the U. S. health care system.
*References: *
1. Radofsky, L. Meet the health-law holdouts. Wall Street Journal, June 25, 2015.
2. Pollitz, K, Cox, c, Lucia, K et al. Medical debt among people with health insurance. Kaiser Family Foundation, January 2014.
3. Patient advocacy groups. Letter to Sylvia Burwell, Secretary of Health and Human Services, July 28, 2014.
4. Potter, W. Insurers' arguments key to Supreme Court decision. Commentary: upholding Obamacare only way to avoid 'death spiral'. Center for Public Integrity, June 25, 2015.
5. Andrews, M. Study finds almost half of health law plans offer very limited physician networks. Kaiser Health News, June 26, 2015.
6. Dickman, S, Himmelstein, DU, McCormick, D et al. Opting out of Medicaid expansion: The health and financial impacts. Health Affairs Blog, January 30, 2014.
7. Rau, J. Having survived Court ruling, insurance markets still face economic threats. Kaiser Health News, June 25, 2015.
8. Himmelstein, DU. Woolhandler, S. The post-launch problem: the Affordable Care Act's persistently high administrative costs. Health Affairs Blog, May 27, 2015.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 11 hours ago.
↧
↧
Who Is the Patient: The Insurance Industry or Real People?
The long-awaited ruling by the U. S. Supreme Court (SCOTUS) supporting subsidies/tax credits for the Affordable Care Act (ACA) has been hailed by the mainstream media (even including MSNBC) as a landmark event showing the success of health care reform. Granted, the ACA after five years has brought new coverage to 16 million people through the exchanges and expanded Medicaid, and has established some limited insurance reforms, such as banning insurers from denying coverage based on pre-existing conditions. But as the media celebrate and hype this event, we need to ask some hard questions about where we now find ourselves in reforming our dysfunctional system.
First, as to numbers, there were 50 million uninsured Americans in 2010, when the ACA was enacted; that number today is still 35 million. (1) Tens of millions more are underinsured, and we will never achieve universal coverage under the ACA. Even with insurance, one in three Americans cannot afford necessary health care, with many foregoing care and being forced into debt or bankruptcy. The ACA does not address underlying causes of medical debt, including high cost-sharing in many plans, little or no coverage for out-of-network care, and limits on essential health benefits. (2) Despite the original intent of the ACA to provide new insurance protections, insurers can still discriminate against the sick through inadequate provider networks, high deductibles, restrictive drug formularies, deceptive marketing practices, and other means. (3)
Uncontrolled inflation of health care costs continues unimpeded as insurers, hospitals, drug companies, and others in the medical-industrial complex embrace expanded and subsidized new markets with minimal oversight. This problem is growing worse as insurers and hospitals consolidate, gain near-monopoly market shares, and raise their prices to what the traffic will bear. Meanwhile, the bureaucracy and cost of the ACA's infrastructure continues to grow.
This SCOTUS decision is yet another bailout of a dying private health insurance industry that would be gone without federal subsidies--from us, the taxpayers. In describing the rationale for the Court's ruling, Chief Justice John Roberts said: "Congress passed the Act to improve health insurance markets, not to destroy them." America's Health Insurance Plans (AHIP), the industry's trade group, had previously filed an amicus brief with the court in King v. Burwell that described a calamitous outcome for the industry unless subsidies were continued. (4)
This makes me ask: who was the patient that SCOTUS was trying to help -- the insurance industry or everyday American real patients? This latest ruling props up a dying industry for another period of time. Despite the ACA's successes to date, we are still left with uncontrolled inflation of health care costs that are unaffordable for much of the shrinking middle class, continued erosion of employer-sponsored insurance (ESI) as many employers shift employees to the exchanges or defined benefit plans, and increasing cost-shifting to patients.
We need to recognize the failures of the insurance industry even as they receive their second bailout from SCOTUS. These examples illustrate how inadequate the industry is in handling health care financing in this country:
· Almost one-half of physician networks for plans sold on the exchanges include less than 25 percent of physicians in their region; patients receiving out-of-network care are subject to high costs without coverage. (5)· There are inadequate price controls in the ACA, thereby giving insurers, hospitals, pharmaceutical companies, and other corporate stakeholders in the medical-industrial complex expanded subsidized markets with minimal oversight.· More than 20 states rejected Medicaid expansion under the ACA leaving about 8 million people uninsured; as a result of their foregoing necessary care, it is estimated that the number of deaths in opt-out states will range between 7,115 and 17,104. (6)· There are still about 18 million Americans who are eligible for coverage under the ACA but have not purchased coverage, in many cases because of its high costs. (7)· According to the Centers for Medicare and Medicaid Services (CMS), the expanding bureaucracy under the ACA will take up one quarter of federal spending and add almost274 billion in new administrative costs heading into 2022. (8)
We can expect this next stage of the ongoing debate over health care reform to be heated as both political parties adapt their messages to this latest development in the 2016 election cycle. But we need to keep in mind who the patient is as the debate goes forward--it should be real patients, not the self-interest of giant corporate stakeholders in our medical-industrial complex.
SCOTUS has bailed out the private insurance market once again, as it previously did in 2012. The government continues to subsidize a bloated and failing market. We can expect to see increasing premiums and less value of coverage in the next few years as insurers maximize profits over service. What will we do about the next dire call by the health insurance industry about the "death spiral? We have already tolerated too many years of its false arguments for its central role in health care financing. We can no longer afford its inefficiencies, profiteering, and disingenuous statements of its necessity. It is time to move on to real health care reform, with single-payer, not-for-profit financing of the U. S. health care system.
*References: *
1. Radofsky, L. Meet the health-law holdouts. Wall Street Journal, June 25, 2015.
2. Pollitz, K, Cox, c, Lucia, K et al. Medical debt among people with health insurance. Kaiser Family Foundation, January 2014.
3. Patient advocacy groups. Letter to Sylvia Burwell, Secretary of Health and Human Services, July 28, 2014.
4. Potter, W. Insurers' arguments key to Supreme Court decision. Commentary: upholding Obamacare only way to avoid 'death spiral'. Center for Public Integrity, June 25, 2015.
5. Andrews, M. Study finds almost half of health law plans offer very limited physician networks. Kaiser Health News, June 26, 2015.
6. Dickman, S, Himmelstein, DU, McCormick, D et al. Opting out of Medicaid expansion: The health and financial impacts. Health Affairs Blog, January 30, 2014.
7. Rau, J. Having survived Court ruling, insurance markets still face economic threats. Kaiser Health News, June 25, 2015.
8. Himmelstein, DU. Woolhandler, S. The post-launch problem: the Affordable Care Act's persistently high administrative costs. Health Affairs Blog, May 27, 2015.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 10 hours ago.
First, as to numbers, there were 50 million uninsured Americans in 2010, when the ACA was enacted; that number today is still 35 million. (1) Tens of millions more are underinsured, and we will never achieve universal coverage under the ACA. Even with insurance, one in three Americans cannot afford necessary health care, with many foregoing care and being forced into debt or bankruptcy. The ACA does not address underlying causes of medical debt, including high cost-sharing in many plans, little or no coverage for out-of-network care, and limits on essential health benefits. (2) Despite the original intent of the ACA to provide new insurance protections, insurers can still discriminate against the sick through inadequate provider networks, high deductibles, restrictive drug formularies, deceptive marketing practices, and other means. (3)
Uncontrolled inflation of health care costs continues unimpeded as insurers, hospitals, drug companies, and others in the medical-industrial complex embrace expanded and subsidized new markets with minimal oversight. This problem is growing worse as insurers and hospitals consolidate, gain near-monopoly market shares, and raise their prices to what the traffic will bear. Meanwhile, the bureaucracy and cost of the ACA's infrastructure continues to grow.
This SCOTUS decision is yet another bailout of a dying private health insurance industry that would be gone without federal subsidies--from us, the taxpayers. In describing the rationale for the Court's ruling, Chief Justice John Roberts said: "Congress passed the Act to improve health insurance markets, not to destroy them." America's Health Insurance Plans (AHIP), the industry's trade group, had previously filed an amicus brief with the court in King v. Burwell that described a calamitous outcome for the industry unless subsidies were continued. (4)
This makes me ask: who was the patient that SCOTUS was trying to help -- the insurance industry or everyday American real patients? This latest ruling props up a dying industry for another period of time. Despite the ACA's successes to date, we are still left with uncontrolled inflation of health care costs that are unaffordable for much of the shrinking middle class, continued erosion of employer-sponsored insurance (ESI) as many employers shift employees to the exchanges or defined benefit plans, and increasing cost-shifting to patients.
We need to recognize the failures of the insurance industry even as they receive their second bailout from SCOTUS. These examples illustrate how inadequate the industry is in handling health care financing in this country:
· Almost one-half of physician networks for plans sold on the exchanges include less than 25 percent of physicians in their region; patients receiving out-of-network care are subject to high costs without coverage. (5)· There are inadequate price controls in the ACA, thereby giving insurers, hospitals, pharmaceutical companies, and other corporate stakeholders in the medical-industrial complex expanded subsidized markets with minimal oversight.· More than 20 states rejected Medicaid expansion under the ACA leaving about 8 million people uninsured; as a result of their foregoing necessary care, it is estimated that the number of deaths in opt-out states will range between 7,115 and 17,104. (6)· There are still about 18 million Americans who are eligible for coverage under the ACA but have not purchased coverage, in many cases because of its high costs. (7)· According to the Centers for Medicare and Medicaid Services (CMS), the expanding bureaucracy under the ACA will take up one quarter of federal spending and add almost274 billion in new administrative costs heading into 2022. (8)
We can expect this next stage of the ongoing debate over health care reform to be heated as both political parties adapt their messages to this latest development in the 2016 election cycle. But we need to keep in mind who the patient is as the debate goes forward--it should be real patients, not the self-interest of giant corporate stakeholders in our medical-industrial complex.
SCOTUS has bailed out the private insurance market once again, as it previously did in 2012. The government continues to subsidize a bloated and failing market. We can expect to see increasing premiums and less value of coverage in the next few years as insurers maximize profits over service. What will we do about the next dire call by the health insurance industry about the "death spiral? We have already tolerated too many years of its false arguments for its central role in health care financing. We can no longer afford its inefficiencies, profiteering, and disingenuous statements of its necessity. It is time to move on to real health care reform, with single-payer, not-for-profit financing of the U. S. health care system.
*References: *
1. Radofsky, L. Meet the health-law holdouts. Wall Street Journal, June 25, 2015.
2. Pollitz, K, Cox, c, Lucia, K et al. Medical debt among people with health insurance. Kaiser Family Foundation, January 2014.
3. Patient advocacy groups. Letter to Sylvia Burwell, Secretary of Health and Human Services, July 28, 2014.
4. Potter, W. Insurers' arguments key to Supreme Court decision. Commentary: upholding Obamacare only way to avoid 'death spiral'. Center for Public Integrity, June 25, 2015.
5. Andrews, M. Study finds almost half of health law plans offer very limited physician networks. Kaiser Health News, June 26, 2015.
6. Dickman, S, Himmelstein, DU, McCormick, D et al. Opting out of Medicaid expansion: The health and financial impacts. Health Affairs Blog, January 30, 2014.
7. Rau, J. Having survived Court ruling, insurance markets still face economic threats. Kaiser Health News, June 25, 2015.
8. Himmelstein, DU. Woolhandler, S. The post-launch problem: the Affordable Care Act's persistently high administrative costs. Health Affairs Blog, May 27, 2015.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 10 hours ago.
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Pressure to Cut Employee Benefits Threatens Labor Peace
Many big companies are pushing to cut spending on employee benefits—from pensions to health insurance—and could face labor strikes as a result.
Reported by Wall Street Journal 4 hours ago.
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A Hard Day's Work Deserves a Fair Day's Pay
It's been a good few days for America.
On Thursday, the Supreme Court reaffirmed the Affordable Care Act. It is here to stay.
And, Democrats and Republicans in Congress paved the way for the United States to rewrite the rules of global trade to benefit American workers and American businesses.
On Friday, the Court recognized the Constitutional guarantee of marriage equality. With that ruling, our union became a little more perfect -- a place where more people are treated equally, no matter who they are or who they love.
These steps build upon America's steady progress in recent years. Out of the depths of recession, we've emerged ready to write our own future. Our businesses have created 12.6 million new jobs over the past 63 months -- the longest streak on record. More than 16 million Americans have gained health insurance. More kids are graduating from high school and college than ever before.
But more work lies ahead, if we are to succeed in making sure this recovery reaches all hardworking Americans and their families.
We've got to keep expanding access to affordable health care. Right now, 22 states haven't expanded Medicaid -- even though, under the ACA, they can. We'll keep encouraging those governors to do the right thing for their constituents. And we're making sure people know all the ways that they can benefit from the ACA. Wednesday, I'll go to Tennessee to meet Americans whose lives have been changed by this law, and to talk about how, instead of refighting settled battles of the past, we can move forward together.
We've got to keep making sure hard work is rewarded. Right now, too many Americans are working long days for less pay than they deserve. That's partly because we've failed to update overtime regulations for years -- and an exemption meant for highly paid, white collar employees now leaves out workers making as little as $23,660 a year -- no matter how many hours they work.
This week, I'll head to Wisconsin to discuss my plan to extend overtime protections to nearly 5 million workers in 2016, covering all salaried workers making up to about $50,400 next year. That's good for workers who want fair pay, and it's good for business owners who are already paying their employees what they deserve -- since those who are doing right by their employees are undercut by competitors who aren't.
That's how America should do business. In this country, a hard day's work deserves a fair day's pay. That's at the heart of what it means to be middle class in America.
As president, my top priority is to strengthen the middle class, expand opportunity and grow the economy. That's why I believe in middle-class economics -- the idea that our country does best when everyone gets a fair shot, everyone does their fair share, and everyone plays by the same set of rules. It's driven me from day one. It's fueled our American comeback. And it's at the heart of the fundamental choice our country faces today.
Will we accept an economy where only a few of us do exceptionally well? Or will we push for an economy where every American who works hard can contribute to and benefit from our success?
Will we invest in programs that would help educate our children, maintain our roads and bridges, and train our workers for the high-paying jobs of the future? Or will we cut these programs, and decide to give more to the wealthiest Americans instead?
To me, the answer is clear. Let's invest in America's future. Let's commit to an economy that rewards hard work, generates rising incomes, and allows everyone to share in the prosperity of a growing America. Let's reverse harmful cuts to vital programs, and instead make the critical investments we need to grow our economy and strengthen the middle class.
That's what I'll be talking about this week -- this choice, and these priorities.
America is at its best when we look out for one another. We soar when we strive to do better for one another. That's what I'm focused on and that's what I'll fight for every day for the next 18 months.
Let's get to work.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 7 hours ago.
On Thursday, the Supreme Court reaffirmed the Affordable Care Act. It is here to stay.
And, Democrats and Republicans in Congress paved the way for the United States to rewrite the rules of global trade to benefit American workers and American businesses.
On Friday, the Court recognized the Constitutional guarantee of marriage equality. With that ruling, our union became a little more perfect -- a place where more people are treated equally, no matter who they are or who they love.
These steps build upon America's steady progress in recent years. Out of the depths of recession, we've emerged ready to write our own future. Our businesses have created 12.6 million new jobs over the past 63 months -- the longest streak on record. More than 16 million Americans have gained health insurance. More kids are graduating from high school and college than ever before.
But more work lies ahead, if we are to succeed in making sure this recovery reaches all hardworking Americans and their families.
We've got to keep expanding access to affordable health care. Right now, 22 states haven't expanded Medicaid -- even though, under the ACA, they can. We'll keep encouraging those governors to do the right thing for their constituents. And we're making sure people know all the ways that they can benefit from the ACA. Wednesday, I'll go to Tennessee to meet Americans whose lives have been changed by this law, and to talk about how, instead of refighting settled battles of the past, we can move forward together.
We've got to keep making sure hard work is rewarded. Right now, too many Americans are working long days for less pay than they deserve. That's partly because we've failed to update overtime regulations for years -- and an exemption meant for highly paid, white collar employees now leaves out workers making as little as $23,660 a year -- no matter how many hours they work.
This week, I'll head to Wisconsin to discuss my plan to extend overtime protections to nearly 5 million workers in 2016, covering all salaried workers making up to about $50,400 next year. That's good for workers who want fair pay, and it's good for business owners who are already paying their employees what they deserve -- since those who are doing right by their employees are undercut by competitors who aren't.
That's how America should do business. In this country, a hard day's work deserves a fair day's pay. That's at the heart of what it means to be middle class in America.
As president, my top priority is to strengthen the middle class, expand opportunity and grow the economy. That's why I believe in middle-class economics -- the idea that our country does best when everyone gets a fair shot, everyone does their fair share, and everyone plays by the same set of rules. It's driven me from day one. It's fueled our American comeback. And it's at the heart of the fundamental choice our country faces today.
Will we accept an economy where only a few of us do exceptionally well? Or will we push for an economy where every American who works hard can contribute to and benefit from our success?
Will we invest in programs that would help educate our children, maintain our roads and bridges, and train our workers for the high-paying jobs of the future? Or will we cut these programs, and decide to give more to the wealthiest Americans instead?
To me, the answer is clear. Let's invest in America's future. Let's commit to an economy that rewards hard work, generates rising incomes, and allows everyone to share in the prosperity of a growing America. Let's reverse harmful cuts to vital programs, and instead make the critical investments we need to grow our economy and strengthen the middle class.
That's what I'll be talking about this week -- this choice, and these priorities.
America is at its best when we look out for one another. We soar when we strive to do better for one another. That's what I'm focused on and that's what I'll fight for every day for the next 18 months.
Let's get to work.
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 7 hours ago.
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