Showing posts with label Obama. Show all posts
Showing posts with label Obama. Show all posts

Tuesday, March 23, 2010

Health Reform Makes History - What Does it Mean?

The House voted late Sunday March 21, 2010 (219-212 vote) in favor of sending the Health Reform Bill to President Obama. In addition, the House Democrats made some changes to the Senate's health reform bill (220-211 vote) which now goes back to the Senate. They must pass word-for-word reconciliation. As I post this blog entry, Obama is signing this long-awaited bill for the health of our nation.

32 million uninsured will now have health insurance. Excluded in this number are: illegal immigrants (who are also banned from purchasing in the health insurance exchanges), those eligible for Medicaid who won't enroll until they seek care, and those choosing to pay the fine instead of purchasing health insurance.

Here is a breakdown of (some of) what is included in this historical piece of health legislation.

Effective Immediately up to 6 Months From Now:
1) Insurers can't deny coverage to sick children (due to preexisting health conditions)
2) Free preventive care--screenings and preventive care must be excluded from annual deductibles on any new plans (all other plans affected in 2018)
3) No caps on lifetime benefits and restrictions on annual limits on coverage
4) Young adults allowed to stay on parent's insurance until the age 0f 26
5) Medicare Advantage (Medicare benefits delivered by private firms) gets cuts in spending in 2011
6) Children on Medicaid or state CHIP can't be dropped from now until 2019
7) Excise tax on tanning beds (10%)--"sin" tax
8) Individuals without coverage because of preexisting conditions can purchase it from high-risk pools (to be combined into exchanges in 2014)
9) Rebate of $250 for Medicare seniors in the "donut hole" for prescription drug benefits. First of incremental steps to close the hole (half-closed next year)

Effective in (or just prior to) 2014:
1) Individual Mandate--Everyone must purchase health insurance or pay annual fine of $95 (rises to $695 in 2016) unless they can prove financial hardship.
2) State health insurance exchanges--marketplace of insurance plans--goes into effect
3) Insurers can't deny coverage to adults with preexisting health conditions
4) Insurers required to cover maternity care same as medical procedures
5) Tax credits will start helping pay premiums for working families with incomes up to $88,000 per year
6) Medicaid expanded to cover more low-income people, up to 133% of federal poverty level
7) Medicare payroll tax increase of 1% for individuals making >$200k and couples making >$250k
8) New Medicare tax on unearned income of 3.8% (in 2013)
9) "Donut Hole" closing--Medicare Part D prescription drug coverage gap to be fully closed by 2020

Other items:
In 2018, "Cadillac health plans" are taxed 40% of value of the plan above thresholds (of $10,200 per individual or $27,500 per family)
The bill maintains longstanding federal funding restrictions (known as Hyde Amendment) on abortions. The exception would be in cases of rape or incest, or when the life of the woman would be endangered.

It is estimated by the nonpartisan Congressional Budget Office to cut federal deficits by $143 billion over the next decade. This bill is a landmark piece of legislation to improve the health of our nation's people. In my eyes, this is an incremental step (and focused on health insurance reform), but an amazing step nonetheless.

What are your thoughts about this this historical event, the passing of health reform?

Monday, May 4, 2009

Obama "Nudges" Regulatory Czar

Cass Sunstein, the most cited law professor in the US (some say world) was "nudged" by Obama on April 20, 2009 to be the new "regulatory czar," formally, the Administrator of the Office of Information and Regulatory Affairs (OIRA), Office of Management and Budget.

There are a few hot topics of critique about Sunstein's appointment.  One includes his backing of a "senior health discount," an economic method of valuing younger lives more than the elderly.  Secondly, he questions the constitutionality of workplace safety laws and the Clean Air Act.  Third, some consumer groups are afraid he is going to push his animal-rights ideas in the White House (re: Sunstein's 2004 book, "Animal Rights: Current Debates and New Directions").  His appointment is pending Senate approval.

Sunstein is the author of over 400 publications, his most recent book titled, "Nudge:  Improving Decisions About Health, Wealth, and Happiness," coauthored with Richard Thaler.  The book expands Econ 101's notion of individuals making rational choices and taps into the true psyche of humans and how we can design environments to help people make better decisions--behavioral economics.  The authors use examples of things like 401(k) plans, marriage, and organ donations to explain their view of libertarian paternalism (not bigger government, but better governance).  I have yet to read this book, but it is definitely on my to-read list.

More of Sunstein's books include:  "After the Rights Revolution" (1990), "Risk and Reason" (2002), and "Laws of Fear: Beyond the Precautionary Principle" (2005).  He taught for 27 years at University of Chicago Law School, until last year, when he left to become the Felix Frankfurter Professor of Law at Harvard.  He is also the Samuel Rubin Visiting Professor of Law at Columbia.  His expertise lies in constitutional law, administrative law, and risk policies.

Friday, November 21, 2008

Obama & Health Care: Most Likely Outcomes

Obama has some hefty challenges awaiting him in the White House for sure.  The rough economy and war overseas will have to be immediate priorities in January.  Health care reform is also in that list of top priorities.  Last week, Johns Hopkins School of Public Health (JHSPH) held their 4th event in the Universal Healthcare Series, "Moving Toward Universal Healthcare:  Alternative approaches to reform in the US."  Harvard's Dr. David Himmelstein was among the speakers, whom pointedly noted that we've had plenty of opportunities for reform, which have failed (think Clinton's 1992 effort and many multiple state attempts).  He pointed out that now is our opportunity for reform.  

In today's issue of The Lancet, Nellie Bristol discusses Obama's plans for our country and the world's health (Obama's plans for US and global health care).   Many project the following are most probable and feasible Obama's immediate administration:  reversal of Bush's ban on stem cell research, expansion of State Children's Health Insurance Program (SCHIP), reversal in "Mexico City policy" (aka global gag rule), and the establishment of a comparative effectiveness group (similar to UK's National Institute for Health & Clinical Excellence).  

To expand on probable immediate actions, Obama is likely to remove some of the restrictions Bush placed on stem cell research (to only use existing stem-cell lines).  Secondly, SCHIP was vetoed by Bush last year after approval from both houses of Congress.  Most likely coverage will be expanded by $35 billion to $60 billion (paid by cigarette taxes).  Children make up 20% of the US uninsured population (Kaiser Foundation).  Expansion of SCHIP appears likely.  Next, the Mexico City policy (global gag policy) requires NGOs to agree to neither "perform nor actively promote abortion as a method of family planning in other nations."  It was enacted by Reagan in 1984, overturned by Clinton, and put back into place by Bush.   Finally, the comparative effectiveness group would look at evidence-based medicine and the Medicare system for physician reimbursements to give guidelines for clinical practice.  

What will be the long-term results though?  Will we move away from employer-based health insurance?  Will we cover all Americans?  Will we have better preventive care and can we improve health outcomes with new policy reform?  How much will we spend on global health, when the US needs the health improvement also?  

It's certainly an interesting time to be near Washington DC and in the field of Health Policy & Management.  Be sure to advocate and put full pressure on local representatives to push for health care reform (there is also currently a $1m media campaign targeted at newly elected officials to "keep their promises" for health care reform).  

If we don't reform US health care now, (when) will we?