What you should know about insurers’ proposed rates for next year

by Rob Cullen on August 12, 2014 - 8:08 AM

aca help desk

A reader in Louisiana writes us:

This was in the local paper.

Basically Blue Cross is saying that claims are up this year so they want to increase premiums on ACA policies. Have you been seeing this in other states? Is this increase in claims really unexpected?

Your insight appreciated as always!

They’re both good questions, and as insurers release their planned rates for 2015, we’re starting to get a sense of how Obamacare premiums will be changing across the country. Here’s what you should know.   [click to continue reading...]


jonathan gruber

In our last post, explaining the most recent Obamacare court battles, we pointed out that there was no evidence that Congress intended to withhold subsidies on the federal exchanges. Well, on Friday conservatives said they’d found proof– a January 2012 speech from Jonathan Gruber, an MIT health economics professor and former adviser to the White House, where he gave this response to a question from an audience member:

I think what’s important to remember politically about this, is if you’re a state and you don’t set up an Exchange, that means your citizens don’t get their tax credits. 

And later in the afternoon, video surfaced from the Q&A of another speaking engagement where he said basically the same thing.

These two comments have received a ton of attention– not because they prove anything about Congress’s intent regarding the subsidies (after all Gruber was just one of many, many advisers helping with the law). Instead they’re subject of intense focus because they’re literally the only evidence that opponents have to make their case. Yet these statements are contradicted by the facts at the time, Gruber’s own work on the bill, and the hundreds of other people involved in writing and reporting on Obamacare over the last few years.   [click to continue reading...]


What this week’s court rulings actually mean for Obamacare

by Rob Cullen on July 24, 2014 - 8:55 AM

Conservatives once said that Obamacare was a complicated monstrosity-- now they're arguing that its language was perfectly clear.

Conservatives once said that Obamacare was too complicated to understand– now they’re arguing that its language was perfectly clear.

We’ve been hesitant to write much about the latest Obamacare lawsuits working their way through the courts– mostly because they seemed unlikely to go anywhere. The issue in these cases is whether certain Obamacare exchanges are allowed to provide the subsidies that make premiums affordable for most people. Unlike the big Supreme Court decision a couple years ago, these lawsuits don’t involve whether or not the law is constitutional; instead it has to do with interpreting what Congress meant in a section of the law that’s somewhat unclear, and the case that Congress intended not to provide the subsidies is very, very slim.

Yet… here we are. Yesterday the D.C. Circuit Court of Appeals, in Halbig v. Burwell, ruled that Congress did in fact only mean for subsidies to go to certain exchanges. Then, just two hours later, the 4th Circuit Court ruled the exact opposite, saying the same thing as other lower courts: subsidies should be available in all 50 states.

So what happens now? Probably still not much– the D.C. Court decision will almost certainly be overruled soon– but since it now looks like there’s a slight chance the case could make it before the Supreme Court, here’s an explainer on what’s at stake.   [click to continue reading...]


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...]

{ 1 comment }

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.

[click to continue reading...]


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...]

{ 1 comment }

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.

[click to continue reading...]


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.

[click to continue reading...]

{ 1 comment }

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...]