Viewpoints: The Political Mojo Of Obamacare’s Recent Troubles; How HIPAA Helps Doctor-Patient Communication

The Washington Post: Obamacare Reemerges As An Issue For Republicans
While most of the political universe is distracted by the rearranging of deck chairs, a few have noticed that a vital issue is reemerging that could be important come November. Specifically, the issue is the continuing implosion of Obamacare. This week, the health insurer Aetna announced it was quitting Obamacare in 11 states. This is another failure that was predicted by health-care policy experts but willfully ignored by the partisan liberal architects of Obamacare. As with other signs of economic malaise, the Democrats have to pretend it’s not happening and to say that more of the same or incremental tweaks are all we need. Health care is still an economic issue at the heart of family financial decisions. All politics is local; all health care is personal. (Ed Rogers, 8/18)

The New York Times: Obamacare Hits A Bump
More than two and half years have gone by since the Affordable Care Act, a.k.a. Obamacare, went fully into effect. Most of the news about health reform since then has been good, defying the dire predictions of right-wing doomsayers. But this week has brought some genuine bad news: The giant insurer Aetna announced that it would be pulling out of many of the “exchanges,” the special insurance markets the law established. This doesn’t mean that the reform is about to collapse. But some real problems are cropping up. They’re problems that would be relatively easy to fix in a normal political system, one in which parties can compromise to make government work. But they won’t get resolved if we elect a clueless president (although he’d turn to terrific people, the best people, for advice, believe me. Not.). And they’ll be difficult to resolve even with a knowledgeable, competent president if she faces scorched-earth opposition from a hostile Congress. (Paul Krugman, 8/19)

Lincoln Journal-Star: Obamacare On The Brink?
Outside the legal challenges it previously faced, the Affordable Care Act has never been as threatened as it is right now. President Barack Obama’s signature law has so destabilized the individual market for insurance that three large companies have announced they are better off not participating in the exchanges. Aetna earlier this week announced it will exit 11 of the 15 states where it has offered plans through ACA exchanges, while UnitedHealthcare plans to exit 30 of its 34 states, and Humana is pulling out of 88 percent of the counties where it offered coverage. (Brian Blase, 8/19)

Dallas Morning News: Why Some Insurers In Texas Won't Stick With Obamacare, Yet Blue Cross Remains
Health insurance can be a greedy business. When Aetna Inc. announced plans to pull out of HealthCare.gov in Texas and 10 other states, it cited  $200 million in recent losses from Obamacare. But the nation’s third-largest insurer didn’t remind people that it earned $2.4 billion last year, in part because Medicare drove strong results. That means Aetna could handle the growing pains of this emerging segment if it wished. But it’s a free country and a free market, and health care has to deal with the consequences. (Mitchell Schnurman, 8/18)

The New England Journal Of Medicine: Counting Better — The Limits And Future Of Quality-Based Compensation
A physician in our medical group recently complained about the quality-based component of his pay: “I spent 2 1/2 hours last night looking at my compensation statement, and I found 12 patients that shouldn’t have been included [on my list],” he lamented. He’d narrowly missed his payout threshold and was convinced that his recorded quality performance was inaccurate. Such sentiments are new to Swedish Medical Group, a Seattle-based, 1200-provider multispecialty group that is part of Providence St. Joseph Health. In 2015, we began redesigning compensation to include performance on a specialty-specific quality metric in clinicians’ contracts. The process uncovered a latent hunger for compensation strategies that reflect clinicians’ complex impact on health and high-value care. It also revealed a threat to the joy and meaning of practicing medicine — and a potential path forward. (Christopher R. Dale, Michael Myint and Amy L. Compton-Phillips, 8/18)

Stat: HIPAA Opened The Door To Better Doctor-Patient Communication
Before August 21, 1996, it was a huge hassle for most people to see their medical records — if they could see them at all. ... HIPAA basically said that every US resident, with very few exceptions, has the right to see his or her medical records. What HIPAA didn’t do was make it easy to see them. ... The development of electronic medical records made possible a simpler way to share information between doctors and patients. (Janice D. Walker, Catherine L. Annas and Tom Delbanco (8/19)

The New England Journal Of Medicine: The Cost Of Residency Training In Teaching Health Centers
Policymakers have long been concerned about the adequacy of the U.S. primary care workforce, especially in rural and low-income areas. In an effort to respond to increased demand for primary care services from new private health insurance markets and Medicaid coverage expansions under the Affordable Care Act (ACA), Congress authorized the creation of the Teaching Health Center (THC) Graduate Medical Education (GME) program, a $230-million, 5-year initiative that began in 2011. The program was designed to increase the number of primary care physicians and dentists trained in community-based settings, on the basis of the well-documented principle that doing so will build long-term clinical capacity in those communities. (Marsha Regenstein, Kiki Nocella, Mariellen Malloy Jewers and Fitzhugh Mullan, 8/18)

Los Angeles Times: Whistle-Blowing: Insurer Gets Smacked For Bullying Employees
Seems like every time conservatives make the case for less regulation of business, some well-known company gets caught breaking rules intended to protect consumers, workers or the general public. This time, it’s Woodland Hills insurer Health Net Inc., which was busted for strong-arming employees into keeping quiet about questionable company practices. Health Net agreed to pay a $340,000 penalty this week after the Securities and Exchange Commission determined that the company illegally linked severance payments for hundreds of employees to their agreeing not to seek whistle-blower awards. (David Lazarus, 8/19)

The Fiscal Times: Zika Could Make Puerto Rico’s $70 Billion Debt Crisis Look Like Chump Change 
President Obama has until Sept. 15 to choose the seven-member fiscal control board that will be empowered to effectively control the Puerto Rico’s finances and devise a solution to the island’s $70 billion-plus debt crisis. Six of the seven members will come from lists provided by House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell. Obama gets to appoint the other, subject to confirmation by the Senate. Given the events of the past few weeks in Puerto Rico, at least one if not all of the members of that board should specialize not in debt or finance, but public health, which at this point is a far bigger danger to the future viability of the commonwealth. (David Dayen, 8/19)

The Washington Post: The Opioid Epidemic: For Whites Only?
Prescription opioid overdoses killed almost 19,000 people in the United States in 2014. The terrible toll is traceable in large part to excessive prescribing by physicians and dentists. No less an authority than the Centers for Disease Control and Prevention has recently issued guidelines urging health care practitioners to be much more cautious about passing out what the CDC called “dangerous” medications, whose brand names include Vicodin and OxyContin. So how come the New York Times has chosen this moment to announce, on its prestigious front page no less, that some Americans might not be getting their fair share of opioids? (Charles Lane, 8/18)

Stat: Do Incentives Nudge Physicians To Prescribe Opioids For Pain?
The Centers for Medicare and Medicaid Services currently makes incentive payments to hospitals based partially on how well they do on patient satisfaction surveys. These surveys ask patients how they feel their pain was controlled and whether providers did everything they could to help with pain. ... Patient satisfaction scores didn’t create the opioid epidemic, nor will removing them solve it. Nonetheless, removing payments for pain control may be an important step because even the perception that financial incentives are tied to pain scores may contribute to opioid prescribing. (Dhruv Khullar and Anupam Jena, 8/18)

The New England Journal Of Medicine: Assessing Homicides By And Of U.S. Law-Enforcement Officers
“Legal intervention deaths” of civilians — cases in which someone is killed by a law-enforcement or other peace officer while that officer is on duty — and occupational homicides of law-enforcement officers have garnered increasing attention in the United States, owing to numerous recent high-profile incidents. ... Though these killings account for a small percentage of total U.S. homicides, they represent a significant public health burden and can incite further violence in which more people are killed. The most recent events have raised a number of critical questions. Among the first ones we need to answer are these: What is the true magnitude of the problem? And what are the circumstances associated with these events? A public health approach — a comprehensive method for studying and addressing a health problem — can be applied here. (Alex E. Crosby and Bridget Lyons, 8/18)

The Hill: Attention Needed To Help Combat Leading Cause Of Death Among Those With Mental Health Issues 
It has been 52 years since the Surgeon General first issued a warning regarding the long-term health consequences of tobacco use. Due to great strides in smoking prevention and cessation treatments, the United States as a whole is closer to going smoke free than it has ever been. However, one vulnerable population may require additional policymaker attention and resources if it is to realize a decline in smoking rate: those living with mental or behavioral health issues.  (Charles Debnam, 8/18)

The New England Journal Of Medicine: Tobacco Control In The Obama Era — Substantial Progress, Remaining Challenges
The steady decline in smoking rates among U.S. adults that began in the early 1960s has accelerated substantially during the 7 years of the Barack Obama presidency. Since 2009, the prevalence of cigarette smoking in the United States has fallen at a rate of about 0.78 percentage points per year — more than double the rates observed during the administrations of Bill Clinton and George W. Bush. If the current rate of decline were to continue, the prevalence of smoking among U.S. adults would fall from its current level of 15.3% to zero by around 2035. In contrast, at the slower rates of decline observed during the Clinton and Bush years, smoking would not reach zero until approximately 2070 and 2057, respectively. (Michael C. Fiore, 8/17)

Houston Chronicle: To Live And Die In Houston 
In Texas, the state with the most people without health insurance in America, the poor and the uninsured are at least able to go to emergency rooms and receive care once their condition becomes life threatening. It's a wildly inefficient and costly way to treat sick people, leaving aside arguments about basic humaneness. But the emergency room safety net enables defenders of the health care status quo to make the argument that no one is just allowed to die without care in America. (Vernon Loeb, 8/18)

Dallas Morning News: Grieving Father's Commonsense Message About Mental Illness Is A Wake-Up Call 
If you live in tight proximity to mental illness — either in your own life or in that of a dearest loved one — you probably have noticed the growing number of heartbreaking, courageous pieces such as the one in yesterday's Washington Post titled: She 'loved life:' A grieving father wrote openly about suicide and mental illness in daughter's obituary. It seems that hardly a week passes these days without a similar story. And no wonder, when you consider the number of Americans fighting through these baffling conditions. (Sharon Grigsby, 8/18)

Los Angeles Times: Medical Marijuana Ruling Is A Temporary Win
A federal appeals court gave medical marijuana advocates what seemed like a big win this week with a unanimous ruling that the federal government may not prosecute people who grow and distribute medicinal cannabis if they comply with state laws. The decision affirms a mandate from Congress, which barred the U.S. Department of Justice in 2014 and 2015 from bringing cases against legitimate pot shops in states that have medical marijuana laws. It makes clear that if operators are meticulously following the rules, they shouldn’t have to worry about the feds coming after them. (8/18)