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On Obamacare’s fifth anniversary a few months ago, we noted that so far it’s doing exactly what supporters claimed: between 16 and 17 million more Americans now have coverage, spending on healthcare has slowed dramatically, and the quality of care we get seems to be improving.

That said, the Affordable Care Act was never going to solve every problem with our healthcare system. Now that we know the law is here to stay (thanks Supreme Court), it’s past time we look at some of the biggest gaps in our health system post-Obamacare, and how we might fix them.   [continue reading…]


trans health now sign

Since the transition of celebrity Caitlyn Jenner, and the popularity of shows like Orange is the New Black and Transparent, transgender people have been much more visible lately. With this new spotlight, we realized that while we’ve covered how the Affordable Care Act affects many other groups who have traditionally had trouble accessing care (for example, women, immigrants, and gay couples before the Supreme Court decision), we’ve never looked at how it affects transgender Americans.

Partly that’s because under the Affordable Care Act, things should be pretty straightforward. Insurers can no longer deny coverage based on gender or pre-existing conditions, and back in May the White House released further guidance clarifying that insurers cannot deny coverage of sex-specific preventive services to transgender people. Yet as a report from the nonprofit news service Kaiser Health News shows, insurance company rules are still preventing some from accessing those services. [continue reading…]

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cigna gavel

Well this report from The New York Times about a recent wave of mergers among giant insurance insurance companies sure sounds ominous:

The nation’s five largest health insurance companies are circling one another like hungry lions closing in on prey.

On Friday, Aetna said it would acquire its smaller rival Humana to create a company with combined revenues of $115 billion this year. Anthem is stalking Cigna. UnitedHealth Group, now the largest of the five, is looking at its options. At the end of the maneuverings, three national behemoths are likely to emerge.

Senate majority leader Mitch McConnell (who represents Kentucky where Humana is headquartered) was, of course, quick to blame Obamacare, saying, “The many layers of regulation spawned by the law mandate less choice and reward bigger scale over more competition.” McConnell is mostly wrong– new regulations aren’t the thing motivating insurers to consolidate. Insurers, like companies in any industry, have always eyed mergers as a way to increase market share and profits. The timing of the current deals is related to Obamacare though. The law’s coverage expansion has poured a lot of money into the insurance industry, meaning big insurers have a lot of cash available to acquire other companies.

What’s more interesting though, is the underlying assumption that these mergers are bad news everywhere. If health insurance worked like most other industries, that might be true. However– and this is pretty much our mantra on this site– healthcare is weirdly complicated. In certain places, less competition between insurers could actually be good for consumers.   [continue reading…]


In a 6-3 decision, the Supreme Court ruled in favor of the government in King v. Burwell, a lawsuit that had threatened to take the Affordable Care Act’s subsidies away from more than 6 million people. Our prediction from yesterday was correct— the court upheld the subsidies, but in a way that limited the power of the executive branch. Here’s a quick breakdown of key points of the decision and what it means going forward.   [continue reading…]


[UPDATE 6/25/14: In a 6-3 decision, the Supreme Court has ruled to uphold the subsidies. They went with the second option below.]

With the Supreme Court set to issue a decision tomorrow or Monday in the latest Obamacare case– this one over federal subsidies that help 6.4 million Americans afford coverage— we figured it’s a good time to take another look at what the case is about and all the different ways the court could rule.   [continue reading…]

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grocery shopping

If you follow health and wellness news on TV or other websites, this has likely happened to you: you come across a story saying that you should eat more of some food, say chocolate, because a new study shows it may help lower your risk of cancer or heart disease… but you swear that just a few months ago you read another article on a study saying you should avoid that food because it causes those diseases. This new article doesn’t mention that last study, so then you think maybe you’re just misremembering– after all it was a while ago, and there are so many studies about so many ingredients that it can be hard to keep track.

Turns out you probably weren’t wrong after all. Some recent meta studies (studies of studies) show that there’s conflicting research behind most foods we eat, and the media is terrible at helping us make sense of it all.   [continue reading…]

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aca application form

This week, the Kaiser Family Foundation answered addressed a grab bag of questions related to insurance coverage of hearing aids, doctors who drop out of a plan mid-year, and what happens if you receive subsidies for exchange coverage but learn later on you were eligible for Medicaid all along. It’s all useful stuff to know, so we thought we’d share it here.   [continue reading…]


obamacare laptop conversation

Over the next few weeks, chances are you’re going to see a news article in your local paper about how insurers are planning big rate hikes for their Obamacare plans in 2016. It’s becoming an annual summer tradition: insurers submit their proposed premiums for the following year, and local journalists forget that (1) only the biggest proposed increases get announced at first; (2) many of these increases are unlikely to get approved; and (3) all kinds of important information is missing. And so, just like last year— here’s why you should probably just ignore these articles until we get a more complete picture in a couple months.   [continue reading…]


luis lang

Last week, Charlotte Observer‘s “Health Care Challenge” blog highlighted the plight of Luis Lang, a self-employed handyman who’s slowly going blind from a partially detached retina caused by his diabetes. Lang has never bought insurance and was paying his medical bills out of pocket, and as the Observer explains:

That worked while he and his wife were relatively healthy. But after 10 days of an unrelenting headache, Lang went to the emergency room on Feb. 25. He says he was told he’d suffered several ministrokes. He ran up $9,000 in bills and exhausted his savings. Meanwhile, his vision worsened, and he can’t work, he says.

That’s when he turned to the Affordable Care Act exchange. Lang learned two things: First, 2015 enrollment had closed earlier that month. And second, because his income has dried up, he earns too little to get a federal subsidy to buy a private policy.

Lang, a Republican, says he knew the act required him to get coverage, but he chose not to do so. But he thought help would be available in an emergency. He and his wife blame President Barack Obama and congressional Democrats for passing a complex and flawed bill.

“(My husband) should be at the front of the line, because he doesn’t work and because he has medical issues,” Mary Lang said last week. “We call it the Not Fair Health Care Act.”

The story went viral, particularly on liberal-leaning blogs, since it perfectly captures how misguided some opposition to the ACA has been. Lang could have purchased an affordable insurance plan under the new law– which, as a 49-year old smoker with diabetes, would likely have been impossible before Obamacare– but he chose not to. When his eyesight got so bad that he couldn’t work, his income dropped enough that he’d qualify for Medicaid (which you can enroll in at any time) thanks to Obamacare’s expansion of the program– but he lives in a Republican-led state that rejected it. In both instances he was blocked by Republicans (first himself and then South Carolina lawmakers), yet Lang still blames President Obama and the Democrats for his predicament.

However, we’ve been watching Republicans falsely accuse Obamacare of causing one disaster or another pretty much every day for the past five years– it’s not really news at this point. For us, the interesting part is how Lang’s story illustrates a real shortcoming of the ACA that is often ignored by both parties.   [continue reading…]

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In a video that went viral during the protests over the death of Freddie Gray, Baltimore resident Kwame Rose confronts Fox News’ Geraldo Rivera, telling Rivera:

I want you and Fox News to get out of Baltimore City, because you are not here reporting about the boarded up homes and the homeless people under MLK. You’re not reporting about the poverty levels up and down North Avenue. Two years ago, when the 300 man march, when we we marched[…], you weren’t there. But you’re here for the black riots. You’re not here for the death of Freddie Gray I want the cameras off. I want the white media out of Baltimore city until you’re here to report the real story.

Fox News has yet to report on what Rose calls the “real story,” but the riots did inspire the rest of the national media to finally take a closer look at life in poor, predominantly black West Baltimore neighborhoods. What they’ve found is a health crisis. As the pastor at one Baltimore church put it to The New York Times: “If the statistics that are present in these communities were present in any white community in Baltimore, it would be declared a state of emergency.”  [continue reading…]