News Roundup: How the Health Law Is Playing in the States

From Kaiser Health News

The Wall Street Journal: Here Comes The Regulatory Flood
President Obama's hyperactive regulators went on hiatus in 2011 to get through Election Day. Now with his second term secure, they're about to make up for lost time and then some. . . . It begins with the Affordable Care Act, which has been in hibernation because it was the largest campaign liability. . . . Hiding the details paid off politically but also undermined Obamacare's already slim prospects for success. Ahead of the law's go-live date of October 2013, states and industries will have less than a year to prepare to meet the new mandates. Three of the rules were released right before Thanksgiving, so insurers are only now about to learn how they'll design and price coverage, since one new rule defines "essential benefits" they must include. Another deals with limits on how premiums can vary from person to person based on risk. (11/23)

San Francisco Chronicle: Anti-Obamacare Foot-Dragging Must Stop
Obamacare survived a Supreme Court showdown and the presidential election. Now the historic law faces a new test: putting it into operation where red-state governors are uncertain or outright hostile. . . . The Obama administration is loosening the deadlines, giving wavering states more time to decide. But this forbearance shouldn't be misunderstood. Health coverage for the uninsured won in the courts and on the presidential ballot. It's time to put it in practice and not delay it any longer. (11/25)

The New York Times: Care At The End Of Life
Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill. . . . No matter what the death-panel fearmongers say, end-of-life conversations and medical orders detailing what care to provide increase the confidence of patients that they will get the care they really want. In some cases, that could well mean the request to be spared costly tests, procedures and heroic measures that provide no real medical benefit. (11/24)

The New York Times: Health Insurance Exchanges May Be Too Small To Succeed
Certainly, it is hard to be against competition. Economic theory is clear about its indispensable benefits. But not all health care markets are composed of rational, well-informed buyers and sellers engaged in commerce. Some have a limited number of service providers; in others, patients are not well informed about the services they are buying; and in still others, the quality of the service offerings vary from provider to provider. So the question is: What effect does insurer competition have in a marketplace with so many imperfections? The evidence is mixed, but some of it points to a counterintuitive result: more competition among insurers may lead to higher reimbursements and health care spending, particularly when the provider market - physicians, hospitals, pharmaceuticals and medical device suppliers - is not very competitive. In imperfect health care markets, competition can be counterproductive. (Dana P. Goldman, Micheal Chernew and Anupam Jena, 11/23)

The Washington Post: How Fighting Income Inequality Became Obama's Driving Force
Obama's actions as president provide a glimpse of how he views legislation as a means to his end. His health-care reform law, aimed at covering as many of the uninsured as possible, takes a shot at addressing income inequality by imposing new taxes on the wealthiest Americans. . . . The money will help finance insurance subsidies and other coverage in 2014 for people in the lower middle class and below. A recent study by Cornell University's Richard Burkhauser estimates that "Obamacare" will add $400 to $800 in disposable income annually for these Americans. (Zachary A. Goldfarb, 11/23)

Los Angeles Times: Giving Thanks For Our Health Care System - Which Needs Reform
We have two systems - a medical system and an insurance system. They're intertwined, and any decision affecting one inevitably affects the other. The reality is that our medical system is extraordinary, and extraordinarily expensive. Our insurance system, meanwhile, is a model of inefficiency and misplaced priorities (profits over patients). Reform on both fronts is necessary. (David Lazarus, 11/23)

The New York Times: A Shortcut To Wasted Time
The advent of electronic medical records has been a boon to patient safety and physician efficiency in many ways. But it has also brought with it a slew of "timesaving" tricks that have had some unintended consequences. These tricks make it so easy for doctors to document the results of standard exams and conversations with patients that it appears more and more of them are being documented without ever having happened in the first place. (Dr. Leora Horwitz, 11/22)

The Washington Post: It's Time To Accept Obamacare, Virginia
The election is finally behind us, and the Affordable Care Act won. It's time for Virginia's elected leaders - whether or not they supported the law - to take steps to fully implement it. This is not just about providing health care to more than 1 million uninsured Virginians; this is about Virginia's economic interests. (Patrick Hope, 11/23)

Richmond Times-Dispatch: Health Care: Already Sailed
Only two things could explain state Democrats' laughable demand for a special legislative session to set up an insurance exchange only a few weeks before the regular General Assembly session convenes: ignorance or partisan mischief. Under Obamacare, every state must have an insurance exchange where consumers can shop for policies. States can set up their own exchanges, or they can let the federal government set one up for them. There is no reason whatsoever to set up a state exchange. The federal government has imposed so many rules and restrictions that it has left states with little latitude beyond picking what kind of font to use on the exchange's stationery. (11/26)

Journal of the AMA: Women's Health, Contraception, And The Freedom Of Religion
Although the 2012 Presidential election settled many issues related to the health care law, there is one that will linger well into President Obama's second term: contraception and religious freedom. The Affordable Care Act (ACA) requires employers to provide women with cost-free coverage for preventive care and screenings. (Lawrence O. Gostin, 11/21)