The two strangest parts of the Hobby Lobby decision

by Rob Cullen on July 17, 2014 - 9:42 AM

Reading the Supreme Court’s decision in the Hobby Lobby case, you can tell that the majority justices see it as a win-win: religious employers don’t have to pay for something that conflicts with their religious beliefs, while their female employees can still get contraceptive coverage. All the government has to do is extend the accommodation it already made for religious nonprofits (basically they fill out a form, a third party administrator provides the coverage, and the government will pick up the tab) to these for-profits as well. Or as Slate’s Emily Bazelon summed up their thinking: “No sincere belief harm, no IUD foul.”

So why then, does it seem to so many people like a particularly bad decision?   [click to continue reading...]

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Explainer on the Supreme Court’s contraceptive decision

by Rob Cullen on July 3, 2014 - 2:08 PM

In what’s becoming an annual June tradition, the Supreme Court issued another landmark healthcare ruling this week. In a 5 to 4 decision, the Court ruled that certain corporations don’t have to cover birth control in the insurance plans they provide their employees. The decision doesn’t eliminate Obamacare’s “contraception mandate,” but it does narrow it, and millions of women could be affected.

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kynect enrollment steve beshear

Kentucky is turning out to be a good example of how the politics of Obamacare have changed now that the law is actually in place. Its senators– Mitch McConnell and Rand Paul– have been two of Congress’s most vocal opponents of the new law, consistently calling for the repeal of “all of Obamacare.” They still do, but now that the law has been implemented, they’ve been getting a follow-up question: What should happen to the over 400,000 Kentuckians who got health insurance through the health care exchange created by Obamacare? And that’s a question that neither will answer.   [click to continue reading...]


EPA administrator Gina McCarthy signing new regulations on carbon pollution.

EPA administrator Gina McCarthy signing new regulations on carbon pollution.

Given all the health problems that climate change is already causing (and the even worse problems it’s expected to cause), it’s pretty important that the world’s second largest polluter of CO2 does something to significantly cut its emissions. Originally the Obama administration was pushing for a system of cap-and-trade, but when that bill died in Congress, the White House moved on to Plan B: regulating carbon through the EPA.

So far the EPA has already put forth strict new fuel-economy standards on cars and light trucks and regulations that would limit carbon pollution from new power plants. The final piece of the agenda, which the White House announced earlier this month, is both the trickiest and most important: reducing emissions from existing power plants. Here’s how the EPA plans to do it, and what it means for our health.   [click to continue reading...]

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Why climate change is a health issue

by Rob Cullen on June 11, 2014 - 4:20 PM

Patients being treated during the 2003 French heat wave.

Patients being treated during the 2003 heat wave in France.

Every major issue in the news has its own stock image: for the VA scandal it was an injured veteran, for the obesity crisis it’s a bulging gut with the head just out of frame, and during the financial crisis, a cratering economy meant a great year for whoever sells photos of sad stockbrokers. For climate change news, the go-to picture has long been the polar-bear stuck on a piece of ice. It’s indicative of how we’ve tended to think of climate change as something far away, both in time and space– one day all that melting ice would be a problem, but for now at least, only animals in the Arctic have to worry.

But in recent years, we’ve been seeing more and more evidence that climate change is causing trouble today. So when the EPA announced its plan to regulate carbon pollution from existing power plants for the first time ever, the news stories didn’t come with photos of polar bears– instead the photos were of smokestacks spewing nasty gases into the atmosphere. And for an even more accurate picture of climate change, we should also see kids with asthma inhalers, ticks and mosquitos carrying diseases, and ER rooms packed with people suffering from heat stroke. Because more than anything else, climate change is a healthcare problem.

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Disabled veteran

Yesterday we talked about the doctors waitlist scandal engulfing the VA. The Obama administration definitely deserves the heat they’re taking on this– it was a major management failure, with VA officials setting unrealistic goals to reduce wait times and then looking the other way as VA employees juked the stats to meet them.

The scandal comes in the wake of complaints about another problem with long waits involving the VA: a massive backlog of disability claims. About 300,000 claims are in the backlog and some veterans have waited years for a final decision. On the surface, those numbers sound pretty bad, but dig a little deeper and it’s a completely different story. If the waitlist scandal shows the consequences of officials juking the stats, the disability backlog story shows the consequences when they don’t.

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What’s going on with the VA? Part 1: The waitlist scandal

by Rob Cullen on May 30, 2014 - 7:01 PM

VA Secretary Shinseki

If you follow the news at all, by now you’re probably at least aware that there are some big problems with wait times at the Department of Veterans Affairs (VA). What’s confusing (especially if you haven’t been following closely) is that there are two separate issues:

  • Wait times for doctors appointments: In Phoenix, 1700 patients were kept off the official system for scheduling doctor visits and instead placed on a secret waiting list. This made it look like the hospital was meeting the VA’s goal of scheduling appointments within 14 to 30 days, when in fact the average wait time for a primary care visit was 115 days. And Phoenix isn’t the only VA hospital system where administrators manipulated patient wait lists to hide treatment delays. On Wednesday, the VA’s Office of Inspector General wrote released a report saying that its reviews of a “growing number” of VA medical facilities have “confirmed that inappropriate scheduling practices are systematic throughout” the veterans health system. Forty-two centers are now under investigation.
  • Wait times for disability claims: For months now there have been complaints about the massive backlog of disability claims. Currently, about 300,000 cases are stuck in processing for more than 125 days (down from a peak of 611,000 last year), and some veterans have been waiting for years for a decision.

Many people have combined the two issues into one big “the VA is a mess and Obama has failed to fix it” storyline, but that’s misleading for a couple reasons.

For one, the VA continues to be one of the best healthcare systems in the country– in fact, that’s one reason why it has longer wait times. As one expert put it, “Veterans are piling up at the door because they’ve heard from other veterans that the VA is a great place to get care.” Also, while both wait time issues are problems (and have been since long before President Obama took office), there’s been a huge difference in how each was dealt with. Obama’s VA has made major strides in slashing the backlog of disability claims, but its efforts to reduce wait times for doctors appointments have been a disaster.

And so to avoid confusion, we’ll tackle each issue in a separate post. First up, the disaster: secret waitlists for VA doctors appointments.   [click to continue reading...]


massachusetts health reform sign

Yesterday we looked at a recent study showing that after Massachusetts passed a health reform law expanding insurance coverage, the mortality rate dropped. The authors estimate that for every 830 people who got coverage there, one death was avoided. If that same rate holds for the 20 million uninsured who are expected to get coverage under Obamacare, it will save 24,000 lives every year. So of course, conservative critics of Obamacare disagree with the results of the study. But the authors of the Massachusetts study were very, very thorough. As Adrianna McIntyre, a health policy expert and blogger puts it, “The findings aren’t bulletproof, but they’re close.”   [click to continue reading...]


Mitt Romney signing Massachusetts' health reform bill in 2006.

Mitt Romney signing Massachusetts’ health reform bill in 2006.

One of the many, many, many points of disagreement between Obamacare supporters and critics is over whether the new law will save lives. Supporters say that of course it will, pointing to stories about how people who got insurance stopped putting off surgery or skipping needed medicine. Opponents claim that the uninsured can get life-saving treatment in emergency rooms, and if they have worse health outcomes it’s for other reasons.

As for actual data, estimates for the effect of insurance on mortality have been all over the place. At the high end, a study done by researchers at Harvard medical school found that 45,000 people die each year because they lack insurance. On the other end of the spectrum, a study by Richard Konick at UCSD found no different risk of dying between the uninsured and those with employer-sponsored health insurance. That study is an outlier though– the overwhelming majority of studies have shown at least some connection between having insurance and better health.

However, none of those studies was a randomized controlled trial (RCT). In an RCT, they would take a bunch of uninsured people, randomly give some of them health coverage, and then see if there was any difference in the mortality rate between the two groups over time. It’s really the only way to prove that health insurance is the cause of improved health, and not something else that those without insurance tend to have in common. (The uninsured are more likely to be low-income, black or latino, and/or unemployed– all things that are also associated with worse health.)

So why hasn’t there been a study like that? The challenge, as Harold Pollack, a professor of social service administration at the University of Chicago, points out, is that deaths among the non-elderly are rare. For adults between the ages of 25 and 64 in the U.S. (the group most likely to be uninsured) the mortality rate is less than 0.4 percent. To detect a change in such a small figure would require a massive study with hundreds of thousands of participants across the country over many years. Such an experiment would be too expensive and impractical, but researchers may have found the next best thing in Massachusetts.

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smokestack pollution

When Americans think about what keeps us healthy, we tend to focus on doctors, hospitals, and medicine, food, and exercise– the air we breathe is often overlooked. But dirty air is a widespread public health problem: according to a recent report from the American Lung Association, nearly half of all Americans live in places with unsafe air pollution. The website Vox has more:

Depending on the type of pollution, that can create a variety of problems. Short-term spikes in particulates (say, from a sudden surge in wood-burning during winter) can increase the risk of strokes or heart attacks. Long-term exposure to particulates (say, from living near a busy highway) can damage lung function or lead to asthma. And ozone (aka smog) can cause shortness of breath and increase the risk of lung infections.

Luckily, there was some good news for those of us who breathe: by a 6-to-2 decision, the Supreme Court upheld an Environmental Protection Agency rule regulating air pollution that drifts across state lines. This rule is expected to prevent up to 36,000 premature deaths, 23,000 nonfatal heart attacks, and 240,000 cases of asthma every year.

Also, this is just one of a bunch of clean air rules that have been proposed by the Obama administration’s EPA. Altogether, these rules could do as much to improve Americans’ health as Obamacare, but they have to make it through delays, court challenges, and opposition from powerful lobbyists (and sometimes the White House itself). We’ve been tracking these rules for a while now, and figured we’re overdue for an update on how things are going. [click to continue reading...]

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