Health Affairs

What options does Congress have to insure the public if the Supreme Court rules unconstitutional the Affordable Care Act mandate that individuals purchase insurance?  Could Congress create a national public insurance program funded through a payroll tax? Well, yes.  It already does.  Medicare covers all Americans over 65, (also individuals with permanent disabilities or end-stage... Read the rest of this entry »

The much-anticipated argument over the constitutionality of the Affordable Care Act’s insurance centerpiece, the minimum coverage requirement or “individual mandate,” took place Tuesday morning.   It was an entertaining but messy affair, with several individuals often speaking at once and answers to questions frequently getting lost in subsequent comments and inquiries.   Analogies buzzed dangerously around the... Read the rest of this entry »

“Reading between the lines” of the Supreme Court arguments seems to be everyone’s favorite pastime this week.  For health lawyers, these three days are heady times, a chance to revel in exquisitely crafted briefs and complex legal theories, consummately argued in a way that lifts the entire profession.  Rarely has the public paid such rapt... Read the rest of this entry »

In Rashomon, the classic film exploration of truth, director Akira Kurosawa offers a meditation on the degree to which point of view colors reality.  A Rashomon of sorts played out during the second day of Supreme Court oral arguments on the Affordable Care Act.  For reasons that are not entirely clear other than pure sensationalism,... Read the rest of this entry »

The central issue in the Affordable Care Act (ACA) litigation, or at least the issue that has received the most media and public attention, is the constitutionality of the minimum coverage requirement, commonly called the individual mandate.  Section 5000A of the Internal Revenue Code, added by the ACA provides: An applicable individual shall for each... Read the rest of this entry »

The U.S. Supreme Court held oral arguments on Tuesday on the constitutionality of the minimum coverage provision of the Patient Protection and Affordable Care Act (ACA). Not since the New Deal has the Supreme Court considered such a fundamental challenge to the federal government’s power to regulate individuals. It is not surprising, therefore, that the... Read the rest of this entry »

Mission creep is the expansion of a project or mission beyond its original goals, often after initial successes. Mission creep is usually considered undesirable due to the dangerous path of each success breeding more ambitious attempts, only stopping when a final, often catastrophic, failure occurs. Health Information Technology (HIT or health IT) is one of... Read the rest of this entry »

On February 1, the American Medical Association’s Relative Value Scale Update Committee (RUC), Medicare’s primary advisor on physician payment, announced the addition of two seats: a permanent one for geriatrics and a rotating one for primary care. The American Geriatrics Society and the American College of Physicians praised the move as a step forward that... Read the rest of this entry »

Our recent Health Affairs article linking increased test ordering to electronic access to results has elicited heated responses, including a blog post by Farzad Mostashari, National Coordinator for Health IT.  Some of the assertions in his blog post are mistaken.  Some take us to task for claims we never made, or for studying only some... Read the rest of this entry »

Adoption of health information technology (IT) throughout the health care system is “on the march,” according to Farzad Mostashari, the national coordinator for health IT. Nearly 2,000 US hospitals and more than 41,000 doctors have now met the standards for achieving meaningful use of health IT, and have received $3.1 billion in federal incentive payments... Read the rest of this entry »

Public reporting of providers’ performance has been a key development over the past decade in efforts to improve the quality of health care and lower its cost. It’s been widely assumed that by making this data public, underperforming providers will be motivated to improve, and consumers will use the information to pick the highest-quality providers... Read the rest of this entry »

Despite the widely held assumption that physicians having computer access to patients’ test results will reduce testing, doctors who have such access to tests in the ambulatory care setting are more likely to order imaging and lab tests. That’s the finding of a study in the March issue of the Health Affairs, released today. The... Read the rest of this entry »

The Health Insurance Exchanges required under the Patient Protection and Affordable Care Act (ACA) have the potential to create markets that will help millions of Americans get affordable health insurance coverage and access to high-quality care. The exchanges can enhance consumer and employer buying power to improve the overall quality and efficiency of the health... Read the rest of this entry »

Editor’s note:  The ideas expressed in this post draw on the “IPAB Working Group,” a panel of health care experts supported by Pfizer and charged with identifying strategies the Independent Payment Advisory Board might use to lower Medicare spending. Though many of the ideas that follow stem from that meeting, the authors take sole responsibility... Read the rest of this entry »

As the debate over Medicare continues in connection to America’s fiscal problems, it is critical to understand how Medicare differs from commercial health insurance for working people.  There is a fundamental difference between these two types of health insurance plans, one social and one commercial. The basic difference between Medicare and commercial insurance is that... Read the rest of this entry »

Spurred by the nation’s federal deficit, unsustainable healthcare costs, and other economic challenges, America’s healthcare system must change from a fee-for-service to a fee-for-value system, challenging all industry participants to make healthcare more efficient, effective, accessible, and affordable. While patients, employers, and payers clearly benefit from lower costs, the fee-for-service system in place since Medicare’s... Read the rest of this entry »

The Affordable Care Act’s state health insurance exchanges for small businesses present a host of opportunities for states now creating them, but they also present design and regulatory challenges that could make or break the success of the program, according to a cluster of articles in the February issue of Health Affairs, released yesterday. The... Read the rest of this entry »

November 9, 2011. Time fell back three days ago, leaving me one less hour of daylight to enjoy on a gorgeous Indian summer Wednesday. I’m the attending physician on a busy family medicine inpatient service, and it’s been a long week of patient care and meetings. I rush out of the hospital somewhere near 5 pm,... Read the rest of this entry »

Last Thursday’s Republican Presidential Debate in Florida included a lively, but not always accurate, exchange on health reform in Massachusetts.  In particular, Senator Santorum reported that one in four Massachusetts residents were going without needed care because of high costs; he also implied that the share of residents choosing to pay the fine for failing... Read the rest of this entry »

Video of the release event for the January issue of Health Affairs, “Confronting The Growing Diabetes Crisis,” is now available on the Health Affairs Web site.