Our Common Good


The Obama administration gave conditional approval on Monday to health insurance marketplaces being set up by six states led by Democratic governors eager to carry out President Obama’s health care overhaul. The six are Colorado, Connecticut, Maryland, Massachusetts, Oregon and Washington.

OK, these states are now my favorites as the best in the U.S. They actually care about their citizens.

By the way, I’ve only lived in one of them but have had happy moments in each of them. I encourage everyone to visit and enjoy and also to stay away from states that are dragging their feet or not willing to participate in increased access to health care for all.

Although the Supreme Court upheld the bulk of the landmark health reform law last summer, Obamacare’s proposed Medicaid expansion was scaled back when the court ruled that states should be able to decide whether or not to expand their programs. Since then, GOP governors have been digging in their heels against reform, refusing to expand their states’ Medicaid pools to extend affordable insurance to millions of low-income Americans. That’s led lawmakers in several GOP-run states, such as Texas and Louisiana, to toy with the idea of partially expanding Medicaid in individual counties as a way of overcoming their governors’ continued obstruction.

But Sebelius has confirmed that pursuing that option will make states ineligible for the matching funds that the federal government will offer to the states that choose to fully expand Medicaid:

[W]e explain how Exchanges and Medicaid administrative costs will be funded and how we will continue exploring opportunities to provide States additional support for the administrative costs of eligibility changes. We clarify in our new guidance that states have the flexibility in Medicaid and the Children’s Health Insurance Program to provide premium assistance for Exchange plans as well as to adopt “bridge plans” that offer coverage through both Medicaid and Exchanges – keeping individuals and families together when they cross the line between Exchanges and Medicaid. And, while the law does not create an option for enhanced match for a partial or phased-in Medicaid expansion to 133 percent of poverty, we will consider waivers at the regular matching rate now and, in 2017 when the 100 percent federal funding for the expansion group is slightly reduced, broad-based State Innovation Waivers.

We hope states will take advantage of the substantial resources available to help them insure more of their residents. As an independent report highlighted, “Accounting for factors that reduce costs, states as a whole are likely to see net savings from the Medicaid expansion.”

After making a big deal of publicly supporting the Affordable Care Act, Walmart—the nation’s largest private sector employer—is joining the ranks of companies seeking to avoid their obligation to provide employees with health insurance as required by Obamacare.

It was not all that many years ago that Walmart announced, in response to harsh criticism over the low pay provided to Walmart ‘associates’, that the company would provide a healthcare benefit to its part-time, low earning employees. The uncharacteristically generous nod to worker needs was short lived as the company partially pulled back on the commitment in 2011, citing premium rate increases that Walmart deemed beyond their capacity to pay.

Now, Huffington Post is reporting that the party is over for many more existing Walmart employees, along with all employees hired after February 1, 2012 that the company can classify as “part-time.”

According to the 2013 Walmart “Associate’s Benefit Book”— the manual for low-level Walmart employees—part-time workers who got their jobs during or after 2011 will now be subject to an “Annual Benefits Eligibility Check” each August.

Employees hired after Feb. 1, 2012, who fail to average the magic 30-hours per week requiring a company to provide a healthcare benefit, will lose their healthcare benefits on the following January. Part-time workers hired after Jan. 15, 2011, but before Feb. 1, 2012, will be able to hang onto their Walmart health care benefit if they work at least 24 hours a week.

Anyone hired before 2011 will not be cut off from the company provided health insurance.

Of course, Walmart carefully controls employee work schedules and will have the opportunity to design worker hours in a manner that will keep employees at a level below the threshold required to accomplish company healthcare benefits pursuant to the law.

While there have been increasing reports of American employers reacting to the requirements of the Affordable Care Act by making plans to cut employee work hours so that these companies may deny health insurance as a benefit of employment—particularly in the restaurant and fast food industries—it appears that Walmart has been planning this move all along.

Federally-funded community health centers (CHCs) are a significant part of the safety net. They provide care to low-income Americans, most of whom either have no health insurance or rely on Medicaid. The G.W. Bush Administration expanded CHCs dramatically, and the Affordable Care Act signed by President Obama does so even further, to the point they may serve as many as 30 million Americans a year in the near future. While seeing CHCs as laudable, many progressive health care policy analysts have fretted that the care provided in these centers is not at the same level of quality as that received by privately insured patients in other settings. A new study published in the American Journal of Preventive Medicine shows that this is indeed the case.

The research team examined over 30,000 ambulatory care visits to assess quality measures such as providing adequate medications for chronic illnesses, screening for high blood pressure, counselling patients about the need for exercise and the like. The quality of care provided in CHCs was compared to that provided by primary care doctors in private practice.

The difference in health care quality across the two settings was profound: CHCs provide much better primary care than do private practice doctors. Of the 18 quality measures examined, CHCs were superior on 11, equal on 6 and inferior on 1. When the researchers adjusted the findings for difference in patient characteristics, private sector care was not superior in any respect, and was on most indexes significantly worse.

Consumers saved nearly $1.5 billion in 2011 as a result of rules in President Obama's healthcare law that limit what insurance companies can spend on expenses unrelated to medical care, including profit, a new analysis shows.

Much of those savings — an estimated $1.1 billion — came in rebates to consumers required because insurers had exceeded the required limits.

The study by the New York-based Commonwealth Fund also suggests that the Affordable Care Act forced insurers to become more efficient by limiting their administrative expenses, a key goal of the 2010 law.

In some cases, insurers passed savings on to consumers in the form of lower premiums and higher spending on medical care, the researchers found. This was primarily true in the individual market, where consumers buy health insurance on their own.

The rules “appear to be producing important consumer benefits,” concluded the report’s authors, Michael McCue, a professor of health administration at Virginia Commonwealth University, and Mark Hall, a healthcare law professor at Wake Forest University.

Darden Restaurants, the company that owns Olive Garden and Red Lobster, revised earning projection downwards today. The culprit, at least in part: Negative media attention that the company received after promising to test limiting workers’ hours as a way to dodge Obamacare’s insurance mandate.


The Supreme Court has ordered the 4th Circuit to hear a challenge by Liberty University to the Affordable Care Act.

In September 2011, a federal appeals court in Richmond, Virginia, said it lacked jurisdiction because challenging the mandates would have violated the federal Anti-Injunction Act’s ban on lawsuits seeking to halt collection of a tax.

The Supreme Court did not include Liberty’s appeal among the cases it reviewed earlier this year, which led to its upholding of the individual mandate by a 5-4 vote. A day after it ruled, the court formally declined to review Liberty’s appeal.

But the university asked for a rehearing, saying that because the 4th Circuit was wrong to decide it lacked jurisdiction, its decision should be thrown out, and a new lawsuit should proceed. The Supreme Court’s order on Monday allows that to happen.


Ok.  I don’t see why this is being brought up as an issue.  Two economic issues were discussed during the election:  raising taxes on income over $250 thousand and Obamacare.  True, we didn’t really delve too far into either, but both Dems and Republicans railed against both.  Romney even promised to repeal Obamacare right when he entered office if elected.  Obviously, the people rejected that idea when they elected Obama.  Of course the White House isn’t going to go with this.  Why start with conflict.

The worst part is that they aren’t making proposals to improve on the legislation by helping to bring costs down.  No!  They just want to repeal it outright, maybe keeping some of the more popular parts.  This is completely unproductive and it’s been rejected.  So why pick this fight?  Because they learned nothing.  Get prepared people.  They’re about to double down on stupid.

It felt, a bit, like stepping into a scene in “Mad Men”: A dimly lit room with three rows of chairs, all hidden behind a two-way mirror. There, experts watched focus groups shuffle in and out in 90-minute intervals. They pointed at logos they did like, logos they didn’t like and tried to explain the difference between the two. 

These focus groups were not under the supervision of Don Draper, but rather Enroll America.  And the nonprofit was trying to figure out how to sell a product that was never available in the 1960s: Universal health insurance.

My story in Wednesday’s paper looks at the how little the public knows about the Affordable Care Act, with those most likely to gain new coverage options least aware of the changes ahead.

Enroll America is one nonprofit trying to change that: It was founded last year with the express goal of maximizing insurance enrollment come 2014. Before that heavy lifting starts, they still need to figure out how to convince people to sign up.

Hence, the focus groups. Enroll America held 10 of them, across the country last week, all with Americans likely to qualify for new coverage options in 2014. I attended two in Philadelphia last week. I found them a hugely interesting window into how Americans think about health insurance, and what that means for the Affordable Care Act.

The knowledge gap was clear from the beginning: None of the 31 participants knew about the health law’s new coverage options, like subsidies for those earning below 400 percent of the poverty line, and Medicaid for the lowest income Americans. It was not, however, a complete knowledge vacuum: When a researcher asked how many people had heard about the mandate to buy insurance, a flash of hands went up.

“Virtually no one who is uninsured understand how health reform will affect their lives,” Ron Pollack, who chairs Enroll America’s board, told me after the focus groups. “While some focus group participants have heard the term Obamacare, literally none of them have an inkling about whether, and how, their lives will be affected.”

This is a huge challenge for the health-care law but it’s not necessarily surprising. The health-care law is complex, and the big benefits don’t even roll out until 2014. For most Americans, it’s hard to see a practical reason to become informed when the benefits don’t yet exist. 

Rather, what I found most interesting was the deep skepticism of the health law’s benefits as the researchers began to explain them.

Part of the problem, experts say, is that people who will be affected don’t realize the urgency because the subsidies won’t begin for another year. But policy decisions are being made now that will affect tens of millions of Americans, and the lack of public awareness could jeopardize a system that depends on having many people involved. Low enrollment could lead to higher premiums, health policy experts say. Hospitals worry that, without widespread participation, they will continue getting stuck with patients’ unpaid medical bills. And advocates say the major purpose of the Affordable Care Act – extending health insurance to more Americans – will go unmet if large numbers of vulnerable people don’t take advantage of it.

But because “Obamacare” has been so controversial, and its fate caught up in the presidential campaign, there has been little public discussion about the specifics of putting it into action. States such as Texas and Florida, where opposition to the legislation was strong, have been slow to embrace the law and critics have been loath to promote it.

Initial White House efforts at outreach caused congressional Republicans to accuse the administration of using taxpayer money for political gain. In mid-November, Ways and Means Committee Chairman Dave Camp (R-Mich.) subpoenaed Health and Human Services Secretary Kathleen Sebelius, demanding information about how her agency has used federal money to promote the Affordable Care Act. The administration is preparing a final budget for an outreach program focused on the opening of the exchanges in October.


Even as Congress was finishing the debate that led to the law, a coalition of health-care advocates formed to help promote it. Led by Families USA co-founder Ron Pollack, the group started Enroll America, a nonprofit largely funded by health-care industry and philanthropy groups.

In the coming months, the group will begin an advertising campaign meant to encourage Americans to sign up for the health-care law’s subsidized insurance coverage. Still in its planning stages, it is likely to start in the summer or fall of 2013, just before the state-based insurance marketplaces open for enrollment.

The still-unnamed campaign is likely to put more intensive resources toward a handful of key states. Those could include Florida and Texas, which have a combined 10 million uninsured residents, and have made little effort to do such outreach.

The group has raised $6 million from a coalition that includes the American Hospital Association, pharmacy chain CVS-Caremark, physician groups and individual health insurance companies. Although that initial funding has covered survey research and the hiring of seven staff members, board chairman Pollack said the group hopes to raise “tens of millions” more for the outreach campaign.

“We know now that the Affordable Care Act has to be implemented,” said Rachel Klein, Enroll America’s executive director. “It’s imperative that the people who will benefit hear about the new coverage available and learn how to sign up.”

Currently, 48.6 million U.S. residents lack health insurance. The Congressional Budget Office estimates that 30 million will gain coverage. That would leave nearly 19 million uninsured.

About a quarter of those are illegal immigrants, who aren’t eligible for the reform law’s subsidies. Two million, the CBO projects, live in states that will opt out of the Medicaid expansion.

The rest, however, probably are eligible for new benefits. The CBO, for example, expects that nearly 6 million of those newly eligible for Medicaid just won’t sign up for the program.

Even though the subsidies for currently uninsured people won’t go out until Jan. 1, 2014, the state exchanges that will offer health plans are being set up now, and participants will need to start signing up next Oct. 1. Supporters of the health-care law say the plan won’t be a success without a massive public relations campaign to build awareness.

Unfortunately, the comments of this franchisee, who represents less than 1 percent of our system and who owns restaurants in other concepts, has been portrayed as reflective of the entire Denny’s brand. I am confident his perspective is not shared by the company or hundreds of franchisees/small business owners who make up the majority of the Denny’s community. Specifically, his comments suggesting that guests might reduce the customary tip provided to their server as an offset to his proposed surcharge are inconsistent with our values and approach to business throughout our brand.
Denny’s CEO John Miller • In a statement addressing the controversy surrounding Denny’s franchisee John Metz’s comments about The Affordable Care Act. A number of Denny’s locations around the country have faced boycotts and/or barrages of angry phone calls from people outraged by Metz’s suggestion of adding a “5 percent surcharge for Obamacare” to menus at locations he owns. source  (via shortformblog)

A federal judge Monday rejected Hobby Lobby Stores Inc.’s request to block part of the federal health care overhaul that requires the arts and craft supply company to provide insurance coverage for the morning-after and week-after birth control pills.

In a 28-page ruling, U.S. District Judge Joe Heaton denied a request by Hobby Lobby to prevent the government from enforcing portions of the health care law mandating insurance coverage for contraceptives the company’s Christian owners consider objectionable.

The Oklahoma City-based company and a sister company, Mardel Inc., sued the government in September, claiming the mandate violates the owners’ religious beliefs. The owners contend the morning-after and week-after birth control pills are tantamount to abortion because they can prevent a fertilized egg from implanting in a woman’s womb. They also object to providing coverage for certain kinds of intrauterine devices.

Americans for Prosperity, a conservative organization backed by the billionaire Koch brothers, took aim at Florida Gov. Rick Scott (R) on Monday, accusing him of working against his state’s interests with his apparent change of heart on Obamacare.

In a statement, AFP said that Scott’s recent signal that he was willing to consider implementing key provisions of President Barack Obama’s health care reform law was a step in the wrong direction.


Scott had stood as one of the most stubborn adversaries of Obamacare, even in the wake of the president’s reelection, which effectively secured the law’s existence. But after first vowing to reject moves to set up a state-run health insurance exchange and expand Medicaid rolls under the Affordable Care Act, Scott said last week that he was ready to “have a conversation.” Leaders in the state legislature have also signalled a willingness to take steps toward implementation.

…evidence from San Francisco suggests we should be very suspicious of firms pleading poverty as they charge surcharges. The city adopted pioneering universal health care legislation that, like Obamacare, imposed higher costs on some classes of employers. Many of them responded with special health care surcharges. Upon investigation, much of this surcharge money just ended up in the pockets of business owners, as with any other price increase.