The Health Information Exchange Deadline

Friday’s deadline, November 16, calls for each state, including Wisconsin, to give the federal government a “blueprint” for a Health Information Exchange.  State exchanges compare the benefits and costs of insurance policies and post the results online so people and employers can choose which are the best values for them.  They will also make electronic patient records accessible for treatment and research for the public health.   As I noted in my election-eve blog post, exchanges (also called HIEs) are central to health care reform by making better consumer choices possible.

State blueprints would resolve such choices as whether the exchange will be a private non-profit company or a state agency, and what consent and protections are in place for patient privacy.  Overall, a state can choose whether its exchange will be run by the state, in a partnership with the federal government, or by the federal government.  If a state doesn’t provide a blueprint, its exchange will be formed and run according the rules and models in federal regulations that will be issued soon. 

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Health Care Access and Payment–November 2012

A good question posed: What really happens to healthcare when the election dust settles? The continued implementation or the repeal of Obamacare, the Affordable Care Act, is proposed as a difference that turns on the tally of the votes for president for 2013 to 2017. I think the answer is yes, but for reasons not included in the rhetoric of party platforms.

The chances of outright repeal are slim to none, because the math doesn’t work. The votes for repeal have split along party lines. The House with its Republican majority has voted repeatedly for repeal but can’t effect it. The votes needed must be found in the Senate. A supermajority of 60 out of 100 senators is needed to repeal a law. There are 47 Republican senators, and 51 Democrats plus two independents with Democratic-leaning views. Thirty-three seats are at issue in the election and a Republican majority is possible, but a change of views by voters will not produce sixty Republican-leaning senators.

A procedural option theoretically can reduce the votes needed for repeal to 51, an ordinary majority.  

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U.S. Healthcare Reform Has Just Begun

I wrote here last March 26 about the issues of the anticipated Supreme Court opinion on the Affordable Care Act (ACA). Around the time the decision was announced, it seemed redundant to comment when a barrage of words — first, predictive punditry, then, delight, outrage, and more punditry about the “real” future of U.S. Health care – poured from every news outlet and policy shop that exists to examine the health care industry and its regulation.

In August 2012, implementation is underway, complex and sometimes perplexing. And many problems are not addressed at all.

To recap: On June 28, 2012, the Supreme Court announced its rulings on the constitutionality of the ACA. Most provisions of the law, including the individual mandate, were upheld. One important provision, requiring states to adopt the Medicaid expansion, was struck down. States could refuse to expand their Medicaid benefits and still receive federal funds that` pay at least 50% of the cost of their existing health care program for the poor. Several states have refused the expansion, although the federal government provides 100% of costs until 2020. The objective justification is that such a federal “hook” is eventually reduced, other incremental expansion is likely to follow, and once states begin to accept the funds it is virtually impossible, politically and practically, to stop.

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