Welcome to the “March Madness” edition of the Health Wonk Review. The NCAA college basketball tournament seemed like a natural theme for a health care policy blog post: huge amounts of money floating around in ways that only sometimes correlate with performance, and head-to-head match-ups that can yield results no one expected (though in the tournament those unexpected results produce quicker and more certain changes than is often the case in health care).

We considered illustrating each blog post with pictures of a college basketball team from the author’s home state celebrating a championship, but we thought better of that after seeing this cautionary tale. So let’s get to the great collection of posts from our Wonkers.

The Affordable Care Act  

Joe Paduda at Managed Care Matters suggests that some business executives may well be letting their ideological blinders affect their business decisions.  PPACA is here to stay, and time would be far better spent assessing the potential impact and not hoping it will be repealed or emasculated.

Maggie Mahar at Health Beat asks why so many journalists know so little about the Affordable Care Act. She cites a newspaper story that compared deductibles in ACA bronze plans – excluding gold, silver, and platinum plans – against deductibles for all plans in the pre-ACA individual market. Why didn’t the reporters account for all of the ACA metal levels, and why didn’t the editors call them on their failure to do so, Maggie asks.

Hank Stern at InsureBlog explains how a recent extension of the Pre-Existing Condition Insurance Plan translated on the ground as he dealt with representatives of the Ohio PCIP and insurers on behalf of a client. Spoiler alert: The translation process was more than a bit rocky.

Wonk Review veteran Louise Norris offers two posts stressing the high costs of not getting coverage in the waning days of ACA open enrollment. At the Colorado Health Insurance Insider, Norris warns that the ACA’s penalty for not being insured can be more significant than the oft quoted $95 in the first year. It’s actually $95 per uninsured adult (plus $47.50 per uninsured child), up to a maximum of $285 per family, OR 1 percent of taxable household income, whichever is greater, she writes. And at healthinsurance.org, Norris stresses the risks of going uncovered through sobering stories of her own parents’ experiences with unexpected illness and accidents.

Can Obamacare be fixed? In his eponymous blog, John Goodman answers in the affirmative; he offers four proposed changes to the legislation and describes how they would work. But we’re not talking technical changes here – John’s first suggestion, for example, is replacing income-based premium subsidies with a flat tax credit.

And here at Health Affairs Blog, Fredric Blavin and Urban Institute coauthors offer insights from the Health Reform Monitoring Survey into the challenges of reaching out to Hispanics and persuading them to enroll in the ACA health insurance marketplaces. Topics addressed include health literacy and immigration issues.


David Williams at Health Business Blog offers interviews with all nine Massachusetts gubernatorial candidates. The race features several candidates with health care backgrounds, including Charlie Baker (ex-Harvard Pilgrim CEO) and Don Berwick (former head of CMS). Others, such as Attorney General Martha Coakley, are well-versed in health care as well.

And at HealthBlawg, David Harlow says that Massachusetts is working on implementing a ballot initiative on medical marijuana and so far seems to be stumbling over the dispensary operator selection phase of the process. The state must balance the rights of patients, communities, and dispensaries, he writes.

Other Topics

At Wright on Health, Shirie Gale argues that guidelines in medicine are a good thing, but that quality health care depends more heavily on the intangibles. She writes, “Quality health care is like good pie; you know it when you see it, and you leave it to the professionals.”

At Wing of Zock, Christine Hunter, the chief medical officer of the US Office of Personnel Management, describes what colleges can do to combat the dreaded “freshman fifteen” weight gain.  She offers Boston University as a successful case study.

Does your genetic make-up determine the likelihood you will have a chronic disease later in life? Yes, answers Jason Shafrin at the Health care Economist after reviewing research involving adopted children of parents with chronic conditions, but not as much as you would expect.

Better late than never, Roy Poses writes at Health Care Renewal about a JAMA commentary calling for (mostly) banning the conflicts of interest that arise when leaders of nonprofit health care organizations serve on the boards of for-profit health care-related corporations. Roy notes that HCR has been writing about this issue for eight years.

When it comes to worker health and safety, Julie Ferguson of Workers’ Comp Insider says that it may be time to shake up the film industry again because it is no more acceptable for film employers to try to play fast and loose with worker lives than it is for coal mining, manufacturing, or any other industry. Julie talks about how a recent fatality is sparking calls for safety reforms in the Hollywood film community.

That’s it for this week. Billy Wynne hosts the next Health Wonk Review on April 10 at In The House.