Tag Archives: Obamacare

How the NFIB v. Sebelius Ruling Will Increase the Amount of Uninsured under the ACA

In a March 2012 report, the Congressional Budget Office (CBO) estimated that by 2022, the Patient Protection and Affordable Care Act (ACA) would reduce the number of nonelderly people without health insurance by 33 million, leaving another 27 million still uninsured.  A significant part of that 33 million included the 17 million more people the CBO estimated to qualify for Medicaid by 2022 under the ACA.  They had not previously qualified because the ACA increased the eligible income to those making up to 138% of the Federal Poverty Level.  This increase in eligibility would have been implemented by making all federal Medicaid dollars given to the states contingent on states increasing the pool of eligible individuals.

On June 28th, the Supreme Court ruled in National Federation of Independent Business v. Sebelius, however, that the federal government could not withhold current levels of Medicaid funding to force the Medicaid expansion.  Instead, it could only withhold the additional funds it planned to give out, making the Medicaid expansion optional state-by-state.

Based on the Sebelius ruling, the CBO reworked its estimates in a July 2012 report that concluded, because of the Supreme Court ruling, six million fewer people would qualify for Medicaid than previously estimated. Of those six million, however, an additional three million would qualify for the new exchanges.  Therefore, the net loss of insured people thanks to the Supreme Court ruling was three million.  In updating their numbers, the CBO did not attempt to guess which states would or would not expand their Medicaid program, but attempted to “reflect an assessment of the probabilities of different outcomes…and are, in their judgment, in the middle of the distribution of possible outcomes.”

These figures are being discussed again because of a June 2013 study by HealthAffairs, which did attempt to guess state-by-state who would be expanding their Medicaid programs and its affect on the uninsured.  They note that, after the Supreme Court decision, 14 states had announced their intent to opt-out of the expansion, six were undecided, three were leaning against the expansion, and two were leaning toward the expansion.  They found that if all currently undecided states opted in, 29.8 million people would remain uninsured by 2016 (compared to 26 million people uninsured according to the CBO by the same year).  That number would rise to 31 million if all of the undecided states opted out.  They also note that around 80% of those uninsured would be US citizens, and no matter which way the undecided states go, 4.3 million children and 1 million veterans would likely remain uninsured.

As of a September 17, 2013 a report by the Advisory Board Company found that the number of undecided and not participating states had increased. They found 15 (up from 14) states firm in opting out of expansion, seven (three) leaning against expansion, five (six) undecided or exploring an alternative model, four (two) leaning towards expansion, and overall 20 (25) firmly participating.  Therefore, the percentage of states that could be opting out has increased from 34-46% to 44-54% of states.  This will in turn increase the number of uninsured people.  As the merits of the ACA continue to be debated on Capitol Hill in light of the budget debate, and more states become firm in their plans to opt-in or opt-out of the Medicaid expansion, the number of those who are ultimately uninsured could rise and continue to undermine the goal of universal health care.

 

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Breast Pumps For All, But Not Necessarily The Best

The ACA requires insurance companies to provide new mothers with breast pumps and other equipment that is necessary to help them breast feed.

Unfortunately, the law doesn’t specify the type or quality of the breast pumps to be provided, so the companies (with doctors’ recommendations) get to decide. This issue leads to whether a company will provide a manual or an electric pump.

The benefits of an electric pump over a manual pump are several: they’re high-powered and can simulate a nursing child, while manual pumps can be weak, clumsy, and cumbersome for a working mother to use. They take more time to pump than an electrical pump.

The costs are also considerably different, when a high-end electric pump coming in at around $300, and a manual pump costing as little as $35.

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Surprise Benefit of Obamacare: Less Spending

On March 7th, Kathleen Sebelius of Health and Human Services announced that there has been a slowdown in medical spending since the implementation of the Affordable Care Act.

Obamacare, Sebelius said, is due the credit for increased efficiency and slowed medical spending growth.

“The health care law’s push for coordinated care and paying for quality rather than quantity is putting downward pressure on medical costs, the article reports,” Sebelius wrote in a blog post. “It’s improving the way health care providers do business, and that’s good news for patients.”

Sebelius cited a USA Today study that found the ACA’s cost-control measures are working.

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Hobby Lobby Defies Court By Refusing to Cover Morning-After Pill

When the Supreme Court upheld the Affordable Care Act on June 28, 2012, it required employers to provide insurance that covers emergency contraception. The craft store Hobby Lobby refuses cover the morning after pill, citing religious convictions.

In an effort to prevent the $1.2 million daily fines they would be facing, Hobby Lobby took the issue to court. Justice Sotomayor and the Supreme Court refused to grant Hobby Lobby an injunction, and on Friday, December 28, 2012, the company announced its refusal to adhere to the federal order.

Misinformation about the causes and effects of the morning-after pill, often known by the popular brand name Plan B, promulgates the belief that it induces abortions. This is not true.

Hobby Lobby and its sister company, Mardel, have decided to accept whatever fines the government levies against them for failing to follow the law.

Religious organizations that were exempt from implementing the required contraception coverage will no longer be allowed to deny coverage after August 1, 2013. Contraception coverage applies even to organizations and groups run by religious organizations that oppose contraception, including Christian hospitals and charities. This controversial decision was made after the Institute of Medicine found that contraception is medically necessary “to ensure women’s health and well-being”.

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