Fox Shocked That Obama Would Point Out Their Misinformation On Affordable Care Act

Obama is pushing back against the misinformation spread by Fox about the Affordable Care Act in a speech at Northwestern:

There’s a reason fewer Republicans are preaching doom on deficits — because the deficits have come down at almost a record pace, and they’re now manageable. There’s a reason fewer Republicans are running against Obamacare – because while good, affordable health care might seem like a fanged threat to the freedom of the American people on Fox News, it’s working pretty well in the real world.

He repeated the criticism of Fox on Twitter:

Fox was stunned, with Gretchen Carlson asking reported Ed Henry, “My question to you, Mr. Henry, is why would he do this?”

Most likely they will continue to report the same misinformation about both the deficit and Obamacare, with their viewers remaining out of touch with reality. While a futile gesture, it is good to see Obama respond to all the misinformation spread by Fox.  Fox is certainly not going to admit that it was George Bush and the Republicans who were to blame for running up the deficit, or how much it has fallen under Obama’s far more conservative spending. Nor are they going to talk about how many more people are now covered under Obamacare, and how all the right wing predictions of doom have failed to come true.

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Another Activist Conservative Judge Attempts To Destroy Obamacare

A federal judge in Oklahoma, appointed by George W. Bush, has repeated the same ridiculous argument given by previous activist conservative judges to attempt to stop Obamacare. The claim is that the Affordable Care Act only provides for subsidies for policies purchased on state-run exchanges and not the federal exchange. This is based upon taking one portion of the law, which is poorly written and might suggest this, while ignoring all the other portions of the law which do not make such limitations on who can qualify to receive subsidies.

Previously the 4th Circuit Court of Appeals in Richmond, Virginia ruled that subsidies should be available for policy holders regardless of whether they were purchased on a state or the federally run exchange.  The D.C. Court of Appeals ruled in the opposite direction, with two Republicans voting that subsidies should be limited to policies purchased on state exchanges and one Democrat backing the Affordable Care Act. Subsequently the court vacated that decision in order to have the full court rule on this.

Think Progress has more on the case, and the arguments against the view which has only been supported by Republican judges.

The partisan divide on this issue raises some concern about how the Supreme Court might rule. I suspect that Chief Justice John Roberts would again break with the other Republicans and oppose such an effort which would destroy Obamacare as he has done in the past. If for no other reason, he might not want his court to go down in history for keeping the United States as the only major industrial nation without anything approaching universal health care based upon such a frivolous argument. However it is not entirely reassuring to have to hope that Roberts will vote in a reasonable manner.

While Republicans in public would probably support destroying Obamacare in this manner, those who are not totally out of touch with reality might actually prefer that this case does not succeed. While they wouldn’t mind seeing their party take credit for destroying Obamacare in general, despite how successful the law has been, would they really want to be responsible for increasing taxes on millions of Americans by taking away their tax subsidies which help pay for health care coverage?

Republican backers in the insurance industry are also likely to want to see this case fail. The worst case scenario for the insurance industry would be if they are required to provide health insurance to everyone who applies without regard to pre-existing conditions but if they don’t see increased business, and expansion of the risk pool, from sales to those receiving subsidies.

 

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Small Business Exchanges Providing Coverage To Small Business At Lower Cost

SHOP Marketplace

With Obamacare having been such a success on the individual market, providing coverage for millions of people, generally at a lower cost than previously, some opponents of health care reform have concentrated on scare stories claiming that the cost of coverage will harm small business. While not many states had the small business exchanges operational in the first year, a study has now shown that the small business exchanges are offering coverage at a lower cost where available:

Health plans available to small businesses on the law’s new health marketplaces are on average about 7 percent cheaper than comparable plans offered elsewhere, according to analysis conducted by a team of researchers at the National Opinion Research Center at the University of Chicago. For middle-tier plans, for instance, the disparity translates into about $220 in annual premium savings for plans purchased on the SHOP exchanges.

“It’s definitely surprising,” said Jon Gabel, a senior fellow at the center, noting that many insurers had expressed disinterest in selling plans on the SHOP exchanges. “So, I expected them to price those plans higher than the plans sold off the SHOP, but it didn’t turn out that way — in fact, just the opposite.”

Gabel’s team conducted the analysis using information pulled from state insurance databases in 26 states, 15 of which built their own exchanges and 11 of which defaulted to the marketplace built and run by the federal government. States not included in the study were ones in which health insurance data wasn’t made available.

So what’s behind the lower rates on the new exchanges? In part, Gabel said, the results can likely be attributed to the one of underlying premises behind the exchanges — that is, to drive up competition among insurance carriers by placing their rates next to one another for shopping comparison. Indeed, health officials have reported cases of insurers revising their rates on the marketplaces after seeing lower prices from their competitors.

However, there are likely some other factors at play, too. In many cases, Gabel said, the plans available on the exchanges may have a more narrow provider network, which would drive down the price but perhaps leaving small employers and their workers with more limited options when they need to visit a physician. In addition, he noted that some of the plans offered in the non-exchange marketplace may offer more non-essential benefits.

Despite the potential trade-offs, offering plans at even slightly lower rates than what’s available in the private market could make all the difference for the SHOP exchanges, most of which have thus far failed to gain any real traction with employers. Another recent study conducted by research center showed that, among small business owners who do not currently offer health coverage, 82 percent said their decision to start providing insurance would depend on prices being lower than they are today.

In addition, 83 percent said that the availability of tax credits would be an important factor and 90 percent say they would want to send only one check per month to cover all their workers’ premiums — both features that available to small businesses only through SHOP marketplaces. More than four in five said being able to compare different plans online would make a difference — an option that will eventually be available nationwide.

Allowing small businesses to obtain less expensive health  care insurance will help them become more competitive in hiring compared to larger businesses, which historically have been able to obtain insurance coverage for their employees at a lower cost.

Of course all the benefits of the Affordable Care Act won’t stop conservatives from continuing to attempt to cripple Obamacare.

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Two Successes For Obamacare In Reducing Health Care Costs

Two stories today show further areas where the Affordable Care Act was successful, with both helping to reduce health care costs. While conservatives claim that Obamacare is a government takeover of health care, it actually expands market choices. In the past it was very common for one insurance company to dominate an area, contributing to high prices. Selling health policies through exchanges, and expanding the market of those having coverage, is leading to more insurance companies which plan to sell insurance. From Kaiser Health News:

The number of health insurance companies offering plans in the marketplaces this fall will increase by 25 percent, giving consumers more choices for coverage, Health and Human Services Secretary Sylvia Burwell announced Tuesday.

When the marketplace enrollment reopens in November, 77 new insurers will be offering coverage in the 44 states for which HHS had data, which includes the 36 states that use the federal marketplace and eight states that run their own, the department reported.

The number of competitors on the marketplaces is considered important because it signifies the vitality of the exchange and can mean increased competition and lower prices for consumers. It also means that insurers see the health law’s online marketplaces or exchanges, as a good business opportunity, senior HHS officials said…

Burwell sought to cast the increase as one of a number of recent announcements suggesting that the 2010 health law has been successful in improving health care options for Americans.  She pointed to figures announced last week that 7.3 million people who signed up for the exchanges and paid their premiums, findings that HHS released Monday that 8 million people enrolled in Medicaid or the Children’s Health Insurance Program since the beginning of open enrollment last year, and a 26 percent reduction of uninsured adults.

“I think we need a bit of a course correction in this country when it comes to how we talk about these issues — and it starts with collectively turning down the volume a bit,” she said. “Surely, we’d all agree that the back-and-forth hasn’t been particularly helpful to anyone — least of all the hardworking families who we all want to help.”

She also said that backers of the law “haven’t done a very good job of explaining why middle-class families who already had insurance are better off.” Families are paying less for coverage, Burwell said, and they benefit from knowing they “no longer have to worry about losing their homes or having their hard-earned savings wiped-out by an accident, or unexpected diagnosis.”

The New York Times showed how Accountable Care Organizations which were organized under the Affordable Care Act can save money:

IT may have been the most influential magazine article of the past decade. In June of 2009, the doctor and writer Atul Gawande published a piece in The New Yorker called “The Cost Conundrum,” which examined why the small border city of McAllen, Tex., was the most expensive place for health care in the United States.

The article became mandatory reading in the White House. President Obama convened an Oval Office meeting to discuss its key finding that the high cost of health care in the country was directly tied to a system that rewarded the overuse of care. The president also brought up the article at a meeting with Democratic senators, emphasizing that McAllen represented the problem that needed to be fixed.

Five years later, the situation has changed. Where McAllen once illustrated the problem of American health care, the city is now showing us how the problem can be solved, largely because of the Affordable Care Act that Mr. Obama signed into law in 2010…

One of its provisions created the Medicare Shared Savings Program, which rewards doctors for keeping their patients healthy. Participation in the program requires primary care doctors to create networks, called accountable care organizations, or A.C.O.s, to better coordinate patient care. These networks are reimbursed for delivering high-quality care below a baseline of historical Medicare costs.

In 2012, doctors in McAllen formed the Rio Grande Valley Accountable Care Organization Health Providers, and signed up for this experiment. The early results are in, and they are stunning: From April 2012 to the end of 2013, the Rio Grande Valley A.C.O. saved more than $20 million from its Medicare baseline.

This is just two more ways in which the real world successes for Obamacare show a totally different picture than the right wing media has been portraying.

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Health Care Advocates File Suit Against California For Lag In Enrollments In Expanded Medicaid Program

By most measures the Affordable Care Act has been a success, increasing the number insured without the problems predicted by Republicans. However not everything has worked out perfectly to date. The biggest problems have been with the expansion of Medicaid. The worst problem has been seen in the Republican controlled states which have blocked Medicaid expansion, but there are also problems in some states which are attempting to participate in the program. Last May, Joe Gandelman reported at The Moderate Voice on a case in which someone he knew who was in need of immediate medical attention had difficulty obtaining coverage. It turned out that the problem was that he qualified for the expanded Medicaid program in California. As he qualified for this, he could not receive subsidies in the exchanges, but he did not receive timely coverage due to a backlog of around 600,000 people who qualified but were not processed for the program.

Since then I have looked at this backlog periodically as data came out and while the number has decreased, hundreds of thousands of people have still not received coverage. A coalition of health care advocates has now filed a suit against the state in response to this backlog. Kaiser Health News reports:

California’s lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the health care they are entitled to receive, according to a lawsuit filed Wednesday by a coalition of health advocates and legal services groups.

The lawsuit, filed in Alameda County Superior Court, says the state is failing to process applications within 45 days as required by law. Some applicants have been waiting to receive their Medi-Cal cards since the end of last year, according to the suit. The applicants include children, pregnant women and adults with life-threatening health conditions, who advocates say are either postponing treatment or paying cash to see doctors.

Medi-Cal is the state’s version of Medicaid, the publicly funded health insurance program for low-income Americans. About 11 million people receive Medi-Cal benefits in California, including 2.2 million who applied since January. Roughly 350,000 applications are still pending.

The lawsuit cites several cases, including that of Tulare County resident Robert Rivera, who applied for Medi-Cal in January but died of a pulmonary embolism while the state was determining if he was eligible for the insurance. Two months after his death, Rivera’s mother received a letter saying that the benefits had been approved.

Los Angeles County resident Mark Mullin submitted an application in February 2014, but wasn’t approved until four months later — after he sought legal help. During the time his application was stuck in the backlog, Mullin had to undergo an emergency appendectomy.

The suit is asking the state to process cases within 45 days and to grant people Medi-Cal benefits while officials verify applicants’ incomes. The coalition is also asking the state to send notices to Medi-Cal applicants who have been waiting for 45 days notifying them of their right to go before an administrative law judge.

The long wait is “unacceptable,” said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County. Murphy said she is concerned that the problems will get worse as more people apply for Medi-Cal. “If they are not fixed, more people will continue to wait and more will continue to suffer medical emergencies,” she said.

California Department of Health Care Services officials said they have been working closely with the counties and have reduced the backlog by 250,000 since early July. Many of the cases are still pending because of incorrect or incomplete information.

Department spokesman Tony Cava said people who need immediate care can get in-person assistance with their application at a county social services agency. They also can get their medical bills covered for care received while their applications were pending, he said.

The lawsuit was filed by several organizations throughout California, including Neighborhood Legal Services of Los Angeles County, the National Health Law Program and Bay Area Legal Aid.

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Response To Republican Support For Making Birth Control Pills Available Over The Counter

While Republicans have generally been trying to restrict access to contraception, recently some Republicans have been promoting making oral contraceptives available over the counter without prescription. Many people quickly saw through this. It gives the Republicans a way to claim they are removing a barrier to receiving contraception and avoid situations like the Lobby Hobby case. It also does something else–make contraception less accessible for many women. While the Affordable Car Act requires that contraception be covered without out-of-pocket expense to the woman, many insurance plans do not cover over the counter medications. This is also an incomplete response to the issue as there are many other types of birth control, including forms which many Republicans are attempting to restrict.

The Guttmacher Institute issues a statement regarding this topic (via Talking Points Memo):

Birth Control Pills Should Be Available Over the Counter, But That’s No Substitute for Contraceptive Coverage

September 11, 2014

By Adam Sonfield and Sneha Barot, Guttmacher Institute

In recent weeks, some opponents of the Affordable Care Act’s (ACA) contraceptive coverage guarantee have promoted the idea that oral contraceptive pills should be available to adult women without a prescription. Sens. Kelly Ayotte (R-NH) and Mitch McConnell (R-KY), for example, recently introduced the so-called Preserving Religious Freedom and a Woman’s Access to Contraception Act, a bill that would urge the Food and Drug Administration (FDA) to study whether to make contraceptives over the counter (OTC)—though for adults only.

Making birth control pills available over the counter, if done right, would meaningfully improve access for some groups of women. However, such a change is no substitute for public and private insurance coverage of contraceptives—let alone justification for rolling back coverage of all contraceptive methods and related services for the millions of women who currently have it.

The Policy Behind Over-The Counter Contraception
Making birth control pills available OTC has merit, and the Guttmacher Institute is part of a coalition that has been working toward this goal for years. Leading medical groups have also endorsed such a move, including the American Medical Association and the American Congress of Obstetricians and Gynecologists. By removing the need to obtain a prescription, OTC status would eliminate this potential barrier to contraceptive use and thereby increase access.

This is especially true for uninsured women and those who don’t have time for a doctor’s visit or otherwise can’t readily reach a health care provider. However, if the goal is to truly expand access to contraceptive care—and not just provide cover for undercutting insurance coverage for contraceptives—the case to move birth control pills to OTC status should proceed alongside several other important policies and goals:

Protect contraceptive coverage and full method choice: The ACA requires most private health plans to cover the full range of women’s contraceptive methods and services, without out-of-pocket costs for the patient. This policy eliminates cost as a barrier to women’s ability to choose the method that is best for them at any given point in their lives, an approach that has been proven to make a substantial difference in facilitating access to and use of contraceptive services.

Contrary to what some policymakers and commenters have claimed, giving the pill OTC status would not be an effective substitute for the ACA policy. First, it would do nothing to help women access any contraceptive method other than the pill. This matters, since most women use four or more different contraceptive methods over their lifetime to meet their changing needs. If only the pill were available OTC and contraceptives were no longer covered by insurance, women would face significant new barriers in choosing the method that best suited their needs. Cost is a particularly steep barrier for highly effective methods like the IUD or implant that not only have high upfront expenses, but also require a trained provider for insertion and therefore are not candidates for OTC status.

Even for the pill itself, there is no convincing evidence to suggest that moving it to OTC status would substantially lower out-of-pocket costs to patients, let alone come close to the $0 out-of-pocket cost guaranteed under the ACA policy. Rather, making the pill available OTC, if done at the expense of insurance coverage, would replace one barrier (ease of access) with another (cost). Likewise, greater reliance on Health Savings Accounts or Flexible Spending Accounts, as some opponents of insurance coverage have proposed, would also merely replace full insurance coverage with patient out-of-pocket costs—leaving most privately insured women, particularly low-income women, worse off. Uninsured women on average pay $370 for a full year’s supply of the pill, the equivalent of 51 hours of work at the federal minimum wage of $7.25.

Millions of women already benefit from the ACA’s contraceptive coverage guarantee and these hard-won gains must be protected. Rather than substituting for contraceptive coverage of all methods and related services, OTC status for birth control pills should complement and enhance such coverage.

Strengthen coverage for over-the-counter methods: While the ACA’s preventive care provision specifically requires private health plans to cover certain products with over-the-counter status (including the emergency contraceptive Plan B, folic acid, aspirin to prevent heart disease and tobacco use cessation products), a prescription is needed for these items to be covered—essentially negating the benefits of OTC status. This prescription requirement should be eliminated for any current and future over-the counter contraceptives. Coverage of over-the-counter products without a prescription is already the norm in some state Medicaid programs and in the U.S. military’s Tricare insurance program. Further, ensuring full coverage for over-the-counter contraceptives would prevent “free-riding” by insurance companies that benefit from not having to cover pregnancies that were averted through patient out-of-pocket expenditures.

Ensure equal access for young women: Adolescents and young women, who face greater risk of unintended pregnancy and more barriers to accessing contraception than older women, have among the most to gain from a switch to OTC status. However, recent calls to give birth control pills OTC status as a substitute for contraceptive coverage have specifically excluded minors. That would require women 17 and younger to obtain a prescription, without providing any medical evidence to justify such restrictions. This approach would be harmful to adolescent women and would be counterproductive to helping them avoid unplanned pregnancies and the negative health, social and economic consequences that often follow.

In addition, excluding minors would likely not result in a true over-the-counter status, but instead could put contraceptive pills behind the counter, much as happened when the emergency contraceptive Plan B was first approved for OTC sales. To comply with an age restriction, stores would have to require proof of age via a valid picture ID from any woman who looks young enough to potentially be barred from purchasing birth control pills without a prescription. This would be an added hurdle for millions of women, and it ignores the reality that many young women do not have government-issued forms of photo ID.

Keep politics out of FDA decision making: To switch any drug to OTC status, the typical process involves the drug’s manufacturer submitting an application to the Food and Drug Administration (FDA), which—based on several criteria, including the safety and efficacy profile of the medication—decides whether to grant the request. The evidence is quite strong that providing birth control pills OTC would be safe and effective, including for minors. The FDA process should be driven by the evidence and free from political interference by the administration, Congress and others.

It is troubling but not at all surprising that Senator Ayotte and others who purport to be interested in contraceptive access would preempt the FDA with unfounded calls to bar minors from benefiting from any future OTC status for birth control pills. This echoes the longtime political and legal wrangling over minors’ access to OTC emergency contraceptive pills, despite clear evidence that minors could safely use these products without a prescription.

It is also noteworthy that there are dozens of brands and formulations of birth control pills, most of which would likely have to undergo the lengthy and expensive FDA process to gain OTC status separately. Because formulations of the pill are not medically interchangeable, with some women tolerating specific pills better than others, making one or several versions of the birth control pill available OTC would not benefit all current pill users.

Not A One-Size-Fits-All Policy Solution
Just as birth control methods are not “one size fits all” at any point in a woman’s life, let alone for all of her reproductive years, neither is there a one-size-fits-all policy solution to enhance access to the full range of methods, information and services for women of all ages and income levels, regardless of where they obtain their care. A wide range of approaches is necessary to meaningfully respond to women’s family planning needs in a comprehensive way.

One such approach includes making birth control pills available over-the-counter, if done so without additional costs or barriers to women. Doing so can complement and enhance current efforts to help more women become effective contraceptive users, including the ACA’s significant gains for comprehensive private and public insurance coverage for contraceptive counseling, services and supplies.

If anything, contraceptive coverage should be broadened to cover more women and strengthened to eliminate the prescription requirement for OTC methods that are covered. Other urgent priorities include expanded access to Medicaid, public support for safety-net family planning centers and the Title X national family planning program, comprehensive sex education and the development of new contraceptive technologies.

Truly increasing access to contraceptive care requires a multifaceted approach to meet the needs of all women throughout their reproductive lives. Political talking points will not do it.

This article was originally published on Health Affairs Blog at this link.

Click here for a recent statement from the American Congress of Obstetricians and Gynecologists (ACOG) supporting over-the-counter access to birth control pills as part of a broader dialogue about improving women’s health care as opposed to a political tool.

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Big Hype For Apple Today

applewatch-32-580-100

There was certainly a lot of ridiculous hype today. Apple had their big announcement that their phone and watch can now do what Android devices could do for months, if not years, as long as you don’t want the freedom to configure things the way you want them to work, as opposed to how Apple thinks your devices should work. They were even doing their own live tweeting of the event, showing what control freaks they are.

There might have been a time when Apple was on the leading edge. Now they are just charging more for old tech which has an Apple logo on it. The Apple watch will start at $349–well more than the cost of my Sony Smartwatch II, even with the more expensive metal wrist band. The only real surprise was that the watch will be called the Apple Watch and not iWatch.

When I first responded to the event on Facebook and Twitter as the news came in, I did get a comment questioning the value of a smartwatch. I’ve been using a smartwatch for over two years and do find it to be of value, but I suspect that the majority of people do have little real need for one.

For me, the smartwatch essentially replaces my beeper. I receive many messages a day on my phone, including Facebook notifications, personal text messages, news bulletins, along with messages from the hospital or answering service which previously went over a pager. I need to both make sure I don’t miss any important messages, and know when an incoming message is important enough to respond to immediately versus letting it sit on the phone.

The smartwatch allows me to very quickly see whether an incoming message is urgent, and is far more discreet to check than pulling out a phone every time it vibrates. In some situations this is especially important, such as in a dark movie theater where it would be awkward to turn on the phone every time a message comes in. It also comes in handy if at the pool. I can put my phone safely in a nearby bag, and pick up messages on my waterproof smartwatch. In the event anyone does see me checking messages, people tend to think it is cool to see a message come in over a watch due to the novelty factor, while it often looks tacky to look at a phone when with other people.

Under some situations I just want to use the watch to monitor for important messages. At other times I can read more. This includes text messages, email, RSS feeds, and any notifications which a smartphone app can make.

Plus my smartwatch has an advantage which the Apple Watch does not–it is connected by blue tooth to an Android phone.

Of course there are many other things it can do. Some try to respond to tweets on their smart watch, but personally I think that if you are actually following an ongoing discussion, and especially if you want to type responses, at that point it makes more sense to just use your watch. (I also prefer to use a blue tooth keyboard if doing very much typing). Fitness apps are popular on Android smartwatches and I’m sure that many will use them on the Apple Watch. Some use their watch for fitness apps which track their foot steps every day but I found a limitation to this. I sometimes take the phone out of my pocket to charge during the day, preventing a complete count. While my LG G3 will generally last all day, I hear bigger fears that the iPhones will not do so, and changing the battery during the day is not an option as on many Android phones.

While certainly not essential, my smartwatch will also tell me the weather and remotely control my phone. I haven’t yet used the apps to remotely see the view screen of the camera or take pictures, but I can see situations where this might come in handy. I do use it to remotely control music sent from my phone to a blue tooth speaker. I have impressed friends over for football games when, after a score, I tap my watch and a speaker across the room starts playing Hail to the Victors. Sadly, for the first time since 1984, there was no opportunity to do this last Saturday.

Update: Reading more about the Apple Phone, it does look like some of the fitness/health capabilities are beyond what is currently available for Android. Of course, by the time the Apple Watch makes it to market, there are likely to be even more advanced Android apps. Plus, trusting your private health information with Apple sounds as sensible as sharing your nude selfies with them. Just ask Jennifer Lawrence.

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Another Survey Shows Decrease In Obamacare Insurance Premiums For 2015

There is yet more good news on the Affordable Care Act. Rather than the “death spiral” which so many Republicans warned about, yet another study shows an average decline in health insurance premiums next year:

An early look at the cost of health insurance in 16 major cities finds that average premiums for the benchmark silver plan – the one upon which federal financial help under the Affordable Care Act to consumers is based – will decrease slightly in 2015.  The new study from the Kaiser Family Foundation analyzes premiums in the largest cities in 15 states and the District of Columbia where information from rate filings is available.

Premiums for the second-lowest cost silver plan for individuals will fall by an average of 0.8 percent from current levels in these cities when open enrollment begins on Nov. 15, according to the study. The analysis finds that the premium for the second-lowest-cost silver plan is decreasing in 7 of the 16 areas studied – but also that changes in average premiums will vary considerably across areas. They range from a decline of 15.6 percent in Denver, Colorado (to $211 per month), to an increase of 8.7 percent in Nashville, Tennessee (to $205 per month). In both cases premiums are for a 40-year-old nonsmoker, before taking into account any tax credit.  It is important to note that rate changes may be different in different rating areas in these states.

This is certainly a huge improvement over the double digit increases we typically had on insurance purchased on the individual market. Plus the new plans, as opposed to many previous plans sold, provide real, comprehensive coverage. Unlike any previous plans, they are available to anyone regardless of pre-existing conditions, and cannot be cancelled due to changes in health.

Incidentally, yesterday I also received details on the insurance I purchase to cover my employees which is being improved to become fully compliant with the requirements of the Affordable Care Act. It will cost me an additional $15 a month per employee. Of course for some reason I occasionally receive claims from Republican business owners that they are going to be forced out of business due to the higher cost of health insurance. I suspect that many American Republicans, due to their lack of understanding of how the economy works, and tenuous relationship with reality, are the worst businessmen on earth.

There is one caution in the news about a decrease in the premiums for the benchmark plans. These are used to determine government subsidies. The lower premiums mean that the government will have to pay less on subsidies than planned. However if people receiving subsidies fail to shop around, they are at risk of receiving lower subsidies than this year if they do not have a policy which matches the lower premiums.

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Hundreds of Thousands More People To Obtain Health Care Coverage Under Obamacare With Pennsylvania Joining Expanded Medicaid Program

Pennsylvania has become the 27th state, and 9th with a Republican governor, to accept the expanded Medicaid program. This significantly increases the number of people to receive health care coverage under the Affordable Care Act starting with about 300,000 and increasing to over a half million over the next two years. Some Republican governors are vulnerable for failing to join the program, especially considering that the federal government will pay 100% of the expense for expanding health care coverage through 2016, and afterwards it will gradually fall to 90 percent. Corbett is in danger of losing his reelection bid in Pennsylvania but it does not appear that his late adoption of the program will be enough to save him.

Currently three additional states, Indiana, Missouri, and Utah, are considering expansion and twenty states are not  considering Medicaid expansion at this time.

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Study Shows Reduction In Opioid Overdoses By 25% In States Which Have Legalized Medical Marijuana

A major problem with narcotic pain medications is the risk of overdose. This problem has led to the DEA announcing last week that hydrocodone combination pain medications such as Norco and Vicodin are being reclassified as Schedule II narcotics, with additional restrictions being placed upon prescribing them. Any measures to help control chronic pain while reducing the incidence of overdose would certainly be welcome. The August 25, 2014 issue of JAMA Internal Medicine presents a study of states which have legalized medical marijuana, showing a reduction in opioid overdoses by almost 25 percent:

Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time…

The study did not indicate the cause of this association. It is speculated that some people with chronic pain might use less opioid when medical marijuana is available. More study is needed to confirm this, but considering the problems faced with opioid overdoses, marijuana should be considered as an alternative. At very least, when considering any potential adverse consequences to legalization of medical marijuana, it must be kept in mind that the currently used medications for chronic pain do have a serious potential for adverse effects themselves.

Marijuana is now classified as a Schedule I drug which prevents prescribing it. (In states where medical marijuana is legal, the change in the law protects those using it from prosecution but marijuana still cannot be prescribed). Many have already questioned the classification of marijuana as a Schedule I drug as it appears to show less risk of problems from overdose compared to current Schedule II and Schedule III drugs. This study suggests that marijuana might also help protect against some of the adverse effects of narcotics.

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