SCOTUS ruling prompts renewed calls for Medicaid expansion.
Velandy Manohar
Retired First Medical Director, Aware Recovery Care, and President, ARC In Home Addiction Treatment PC
AMA Morning Rounds
Good Morning Dr. Velandy Manohar. Here are today's top stories.
Monday June 29 2015
Leading the News
SCOTUS ruling prompts renewed calls for Medicaid expansion.
National Journal (6/27, Owens, Subscription Publication) reported that in the wake of last week’s Supreme Court ruling upholding the ACA’s subsidies, “some are looking to stretch Obamacare further.” In particular, governors in several states are renewing their effort to expand Medicaid eligibility. Virginia Gov. Terry McAuliffe (D) called the ruling a “clear sign that now is the time to drop cynical efforts to prevent families from accessing care that will make their lives better,” while Alaska Gov. Bill Walker (I) said, “Now it’s important that we continue to work toward Medicaid expansion, so more Alaskans can receive the health coverage they need.”
The Tennessean (6/29) reports that ACA supporters in Tennessee “were quick to use the court’s ruling to make a renewed push for Gov. Bill Haslam’s Insure Tennessee plan to use the ACA’s Medicaid expansion funding to provide health insurance to several hundred thousand Tennesseans.”
The Augusta (GA) Chronicle (6/28) reported that Cindy Zeldin, executive director of Georgians for a Healthy Future, said the ruling removes uncertainty surrounding the law, adding, “From our perspective, it really is time to move on and make sure that it works for all Georgians, and that means people who are currently in the coverage gap.”
Government and Medicine
State exchanges may look to Federal marketplace after King ruling.
The Wall Street Journal (6/27, Armour, Subscription Publication) reported that the Supreme Court decision upholding subsidies in the Federal health insurance marketplace may spur state-run exchange to form regional networks or shift to the Federal exchange. The Journal notes that many of the states running their own exchanges are running into financial difficulties linked to expensive technology and lower-than-expected enrollment.
The Washington Times (6/27, Howell) reported that Pennsylvania Gov. Tom Wolf (D) “said he will withdraw his blueprint for a state-run exchange, a backup plan he submitted to the Health and Human Services Department in case the justices struck down” the ACA’s subsidies for the Federal exchange. Delaware officials said they will continue to weigh “the costs and benefits” of a state-run exchange, while Arkansas Gov. Asa Hutchinson (R) “threw cold water on talk of a state-run marketplace.” The Washington Times (6/29, Howell) also reports the story in a separate article.
The AP (6/28) reported that the Supreme Court ruling “has renewed calls from critics of Vermont Health Connect to move onto the federal exchange.” Vermont House Speaker Shap Smith “announced plans earlier this week to meet with officials for a briefing on the progress with the exchange’s software fixes.” Although “it may be premature to eliminate the exchange after its infrastructure has cost more than $125 million to create,” Lawrence Miller, the chief of healthcare reform for Gov. Peter Shumlin’s (D) Administration, “said the administration’s contingency planning will include the option of switching to the federal exchange.”
The Minneapolis Star Tribune (6/29, Snowbeck) reports that in the wake of the high court’s ruling, Minnesota Republicans have called for dumping “the state’s MNsure system in favor of the federal government’s online marketplace for health insurance,” while supporters of the system argued “the switch could be costly, and a bad fit with Minnesota’s large public health insurance programs.”
CMS eases rules for rural ACOs.
Modern Healthcare (6/27, Subscription Publication) reported that the CMS “is making it easier for rural healthcare providers and small physician groups to participate in Medicare accountable care organizations.” The agency is making changes to the ACO Investment Model, which provides loans to rural “and underserved communities that would otherwise lack the capital to participate in the ACO program.” The two changes “will allow ACOs already participating in the 2015 Medicare Shared Savings Program to apply in the next application round” and “they remove the restriction that requires rural ACOs to have 10,000 or fewer assigned beneficiaries.”
Medical-Legal Landscape
ACA continues to face legal, political challenges after King.
The New York Times (6/27, A14, Pear, Subscription Publication) examined the remaining legal challenges facing the Affordable Care Act, despite a favorable King verdict. Experts claim that “one of the more significant tests is a lawsuit filed by Speaker John A. Boehner and other House Republicans who contend that the Obama administration is spending billions of dollars without the necessary appropriations from Congress.” In addition, “the government is also juggling more than 50 cases involving the requirement for coverage of contraceptives.”
Still, the AP (6/29) said none of the remaining challenges “seems to pose the same threat to the law as the challenge to nationwide subsidies that the court rejected on Thursday, or the constitutional case that the justices decided in favor of the law in 2012.”
The Wall Street Journal (6/27, A4, Armour, Subscription Publication) reported that ACA opponents are likely to pursue narrower attacks against the law going forward, targeting individual provisions like the medical device tax and the so-called Cadillac tax on high-cost health plans. Conservatives are also looking forward to Federal waivers that may let states opt out of some parts of the law beginning in 2017. The AP (6/27, Fram) noted Sen. John Barrasso (R-WY) said, “We’ll continue to pick away at the law,” adding, “But ultimately our goal is to repeal and replace, and that’s not going to be possible until after the 2016 elections.”
Stating that the ACA’s “troubles are far from over,” Politico (6/27, Haberkorn, Pradhan) reported that the health law “is still highly unpopular, and significant structural issues remain: Health insurance rates are rising, many people don’t have as much choice of doctors and hospitals as they’d like, some states continue to struggle with their exchanges, and 21 states still haven’t backed Medicaid expansion.”
Likewise, the AP (6/27, Johnson) reported that, after the Supreme Court’s ruling on Thursday, many consumers “expressed somewhat conflicting views: They were happy their monthly premiums would continue to be affordable but exasperated by the coverage the policies purchased on the new health care exchanges provide.”
California vaccine bill may face challenges if signed into law.
The San Diego Union-Tribune (6/28, Sisson) reported that on June 25, the California “Assembly approved Senate Bill 277, which would do away with ‘personal belief’ and religious exemptions from vaccination.” The measure “would prevent children from attending public schools if they have not received the full schedule of 10 vaccinations, from diphtheria to varicella.” Should the bill be signed into law by Gov. Jerry Brown (D), legal experts believe it “could end up becoming the test case for the nation.” For example, “there would likely be a challenge under the free exercise clause of the First Amendment which forbids laws that seek to restrict acts of faith.”
Health Coverage and Access
Same-sex marriage ruling puts domestic partnership benefits in doubt.
The New York Times (6/29, A11, Bernard, Subscription Publication) reports that the fate of domestic partner benefits is in doubt following the Supreme Court’s ruling on same-sex marriage. Some large employers such as Corning, Delta, IBM, and Verizon “rescinded domestic partner benefits to employees living in states where same-sex marriage was legalized and replaced it with spousal coverage,” and “many employers extended the benefits only to partners of gay employees because they did not have the option to legally wed.”
Bloomberg News (6/27, Green, Black, Hymowitz) reported that with marriage now legal for all workers, “surveys suggest that more than one-fifth of large employers may drop health coverage for unmarried workers’ domestic partners of either sex.” According to Bloomberg, research suggests that employers are less willing to cover unmarried couples when legal marriage is an option.
Meanwhile, USA Today (6/27, O'Donnell) reported that some same-sex marriage supporters saw the ruling “as another step forward for health care.” Georges Benjamin, executive director of the American Public Health Association, “said research shows marriage contributes to better health and longevity.”
Dozens of California counties to provide healthcare to undocumented immigrants.
The Los Angeles Times (6/27, Karlamangla) reported that “a group of 35 mostly rural counties in California agreed this week to grant healthcare to immigrants in the country illegally.” The County Medical Services Program, which manages healthcare services in 35 of the state’s smallest counties, voted Thursday to offer low-cost primary medical care to these uninsured immigrants. The Times noted this population is barred from signing up for insurance through the ACA. State legislators this year considered a bill “that would have provided healthcare to more than a million immigrants in the country illegally,” but when Gov. Jerry Brown (D) “signed the new state budget this week, it was pared down to cover only children here illegally.”
Public Health
Effects of gut bacteria on brain getting increasing attention.
The New York Times Magazine (6/28) reports in an over 3,000 word article in its “Mental Health Issue” on the microbiota, and contemporary research, specifically, the work of Mark Lyte at Texas Tech University, who studies whether and how “gut microbes communicate with the nervous system.” Tom Insel, the director of the National Institute of Mental Health, commented, “We are, at least from the standpoint of DNA, more microbial than human.” The piece explains that “anxiety, depression and several pediatric disorders, including autism and hyperactivity, have been linked” to the bacteria in the gut. It describes at some length Lyte’s work showing the effect of bacteria in the gut on mental states.
Study: Consumers unclear about health risks, benefits of e-cigarettes.
Reuters (6/26, Rapaport) reported that a 64-smoker study published online June 8 in the journal Tobacco Control suggests that smokers do not agree on the possible benefits or harms posed by electronic cigarettes.
Meanwhile, Vox (6/26, Belluz) contributor Julia Belluz “read through more than 60 studies, articles, and reviews, and interviewed nine researchers and health experts about their work” concerning the health effects of e-cigarettes. She concluded that “e-cigarettes are probably better for you than conventional cigarettes, but worse for your health than not smoking or vaping at all,” although long-term effects are currently unknown.
Growing number of patients are seeking help in EDs for dental problems.
The Louisville (KY) Courier-Journal (6/28, Ungar) reported that “a growing number of patients” are “seeking help in the” emergency department (ED) “for long-delayed dental care.” According to an “analysis of the most recent federal data by the American Dental Association...dental” ED “visits doubled from 1.1 million in 2000 to 2.2 million in 2012.”
VA working to deal with problem of overmedicating psychiatric patients.
In a four-minute segment, NBC Nightly News (6/28, story 8, 4:10, Quintanilla) reported that last year, the VA was “rocked by allegations with problems in its medical system, including long waits for patient care,” while “another controversy” was in Wisconsin, where allegations from whistle blowers claimed that the “chief of staff and other medical personnel have been overmedicating” psychiatric patients. The piece interviewed the father of a former Marine who died from “mixed drug toxicity” seven years ago, and added that the VA has started an initiative to reduce narcotics given to patients with mental health disorders.
Massachusetts hospital collaborative seeks to set policies, standards for caring for infants born dependent on drugs.
In a 2,100-word story, the Boston Globe (6/28, A1, Freyer) reported on its front page that “the rate of drug-dependent newborns is two to three times the national average in Massachusetts,” a state particularly challenged by an “opioid epidemic.” A 42-hospital collaborative in that state is “working on setting policies and standards” on how to handle the problems of such babies and their mothers. For its part, “the American College of Obstetricians and Gynecologists advises against withdrawing from drugs during pregnancy.” Withdrawal poses physical challenges for expectant mothers and may lead to “miscarriage or preterm labor.”
Health and Diet
USDA proposes new Child and Adult Care Food Program guidelines.
The AP (6/28, Hollingsworth) reports that the USDA has proposed new Child and Adult Care Food Program guidelines that call for “more vegetables and less sugar.” The changes to the program “were called for by the Healthy Hunger-Free Kids Act, passed in 2010 at the urging of First Lady Michelle Obama.” It is unclear when the USDA will issue a final decision on the new guidelines.