Medicare reimburses for cancer and other screenings as part of routine care for older adults. Of course, the goal is to catch diseases in their earliest, most treatable stages. But can preventive care become too much of a good thing?
Yet despite this news, Medicare continues to reimburse for many common tests like PSA and screenings for breast cancer – as well as MRIs, and CT scans in older adults that are not medically necessary, or sometimes, even appropriate.
Atul Gawande reports in this New Yorker article about the many tests that are wasteful, irrelevant for the patient’s condition, or detect cancers so tiny that they will never develop into a more serious form of the disease. Women over age 75 are still routinely screened for breast cancer, in spite of indications (and U.S. Preventive Services Task Force recommendations) that there is no conclusive evidence on about the efficacy of mammograms in that population. The costs of Medicare-funded breast cancer soared over a 10-year period but did not lead to an increase in early detection, according to a study from Yale University. This U.S. News & World Reportstory tries to explain why old practices die hard.
Reporter Alan Cassels has developed this comprehensive tip sheet that explores issues of unnecessary cancer screenings, and in particular, breast cancer screenings, in older adult women. Any journalist looking into this issue should check out the facts and figures he puts in context, as well as some terrific story ideas and resources. See the tip sheet.
All eyes were on the U.S. Supreme Court last week as it handed down its highly anticipated decision in King v. Burwell, affirming subsidies in the Affordable Care Act. The justices upheld the financial assistance, saying Congress saw it as critical to a functioning health insurance market. But could the court’s other big ruling have an equally profound impact on another group?
On Friday, the court ruled 5-4 in support of same-sex marriage, saying the Fourteenth Amendment gave such couples the right to marry and legalizing marriage in all 50 U.S. states. While an affirmation of LGBT rights, the decision could also be the first step in improving the health of same sex couples, according to several health provider organizations that released statements soon after the landmark ruling.
The American Public Health Association (APHA), which had filed a friend-of-the-court brief in the case, Obergefell v. Hodges, said that not only did the decision chip away at discrimination and stigma that can harm health, it also could “extend the health benefits of marriage to all couples.”
“Research has shown that marriage contributes to better health and longevity. Discriminatory marriage policies are detrimental to the LGB population and contribute to poor health outcomes. No American should be denied the opportunity to attain their highest level of health, and thanks to this ruling, same-sex couples can now enjoy health benefits of marriage equal to those of opposite-sex couples,” APHA Executive Director Georges Benjamin, M.D., said in a statement on Friday.
The American College of Physicians, in its statement on Friday, noted that the decision to allow same-sex marriage would also have the benefit of extending equal access to health care. “The denial of such rights can have a negative impact on the physical and mental health of these persons and contribute to ongoing stigma and discrimination for LGBT persons and their families,” the group wrote in a position paper in May on health disparities in the lesbian, gay, bisexual and transgender community, published in the Annals of Internal Medicine.
Research has shown the health issues for those in the LGBT community go beyond discrimination and stigma. LGBT individuals report overall poorer health, are at higher risk for some cancers, and have higher rates of heart disease, researchers with the Kaiser Family Foundation said in an April 2015 review of available literature.
To be sure, not all of the nation’s medical associations reacted publicly to the ruling, supportive or not. Even as polls show growing acceptance of gay marriage, many such groups have said they are nonpartisan and may be reluctant to wade into what is still a thorny political issue.
The American Medical Association, which posted a statement on King v. Burwell on its website, has not posted any statement on Obergefell v. Hodges. But representatives for the AMA, asked about the group’s reaction, offered a statement from one of its board members, Jesse Ehrenfeld, M.D., M.P.H. The group was pleased with the court’s decision on same-marriage, he said, “because it ends a form of discrimination and will help reduce health care disparities among same-sex couples and their families” and adding that the AMA has long supported polices that offer same-sex families equal access to health care, health insurance and survivor benefits.
Other medical associations also did not release public statements, although some posted news about the decision on their Twitter feeds.
And, as some gay rights groups noted in the shadow of Friday’s ruling, the Supreme Court legalized gay marriage but it did not address other forms of LGBT discrimination, from workplace policies to being refused service, that could still impact health.
So, while many health journalists and organizations are understandably chasing follow-up stories on Obamacare, now is also an opportunity to pay attention to SCOTUS’ other big ruling and its potential on health. Here are some thoughts:
Reach out to health organizations, providers and associations and see if or how the ruling is changing their approach, message, health care and education efforts.
Ask your audience if the ruling is or will affect their health care – will people who had trouble before accessing care see a difference now that they can marry? What about their dependents?
Find researchers who have been studying LGBT health – are any planning new research given the marriage ruling? Or have any been studying the impact of LGBT marriage in states where it was already legal (and when are their results due)?
Are there ways to document how the ruling – and its affect on discrimination and stigma – are playing out, even anecdotally, on LGBT health?
What has data on LGBT families with children shown in the past – and what changes might the future bring?
As you probably know, I’m a proud Canadian girl. I was born in Mississauga and have lived in Toronto for the better part of my adult life. I love my city, Toronto and I believe we have one of the most beautiful and diverse (okay I’m slightly biased) countries on planet earth.
To celebrate Canada Day I wanted to share with you eight Canadian superfoods. While not all of these foods originated in Canada, they are now grown in Canada. It is important to think about where your food is grown and purchase as much locally grown food as you possibly can to support the local economy. And remember, the less travel time to your dinner plate the more nutrient dense the food.
I bet you’ll be surprised to know that quinoa is now grown in the prairies. While it does require a little more love to cook it because it’s a hardier plant when grown in Canada, it’s just as delicious. I also included delicious and nourishing recipes for every Canadian Superfood.
So here goes — eight Canadian superfoods plus their amazing health benefits!
Wild Blueberries
Also known as lowbush blueberries: They are smaller and more tangy-tasting than their cultivated cousins and one of the few fruits native to North Amercia.
Blueberries in general are 2nd most popular fruit (no kidding!) — they sure are in my home, next to strawberries of course as you may have noticed from my recent strawberry love affair — recipes, recipes, recipes!
Extremely high in antioxidants (especially vitamin C), more so than their cousins. These antioxidants protect cells from damage and have these benefits:
May help improve memory and prevent many diseases associated with an aging brain
Strengthens cardiovascular system
Low on glycemic index:
Helps regulate blood sugar
Good source of fiber. Fiber slows the release of glucose into the blood stream
Maple Syrup
This is so Canadian that we’ve got a maple leaf on our flag!
High in antioxidants, in fact as much as red Gala apples, broccoli or bananas and contain. Some experts estimate maple syrup has over 54 antioxidants. The darker the better (and tastier too, in my opinion)
Wide range of nutrients including: riboflavin, zinc, magnesium, calcium and potassium
If you shop at farmers markets then you likely know all about wild mushrooms, or perhaps you forage for wild mushrooms? My favourite wild mushrooms are chanterelles, but equally as nutritious and delicious are: morel, hen of the woods, oyster and horn of plenty native to Canada
DON’T JUST EAT ANY OLD MUSHROOM YOU FIND IN THE WILD! Make sure you get your wild mushrooms from a reliable source!
Mushrooms are a very rare source of vitamin D, I say rare because plant-foods are not a good source of D
Promote immune function by increasing the production of antiviral and other proteins that are released by cells while they are trying to protect and repair the body’s tissues
Very high in antioxidants, in fact as many total antioxidants as red bell peppers
High in anti-inflammatory plant-based omega-3, a form called ALA
Rich in lignans, which are fiber-like compounds that also provide antioxidant protection against free radicals
Contains mucilage, a soluble, gel-forming fiber that can help protect the intestinal tract
If you buy them whole, be sure to grind them before eating to release their beneficial omega-3 content. Otherwise they come out the other end the same way they went in
I first triedSaskatoon berry juice at a health show out west and was blown away by the richness of the flavour. As the name suggests, these berries are native to western Canada and they are deeelicious!
Saskatoon Berries rank the highest in antioxidants in both fresh fruit and fruit pulp relative to other common fruits
Saskatoon Berries are rich in dietary fibre. 100 grams of Saskatoon Berries contain 24% of the daily fibre requirement.
Good source of minerals including magnesium, calcium, potassium and iron which all contribute to heart health
Cranberries
Cranberries are sweet and tart – one of my favourite ingredients in healthy muffins, cookies and granola
You’ve probably heard of the health benefits as it relates to prevention of UTIs. This is because they have a high level of proanthocyanidins which helps reduce the adhesion of certain bacteria to the urinary tract walls, in turn fighting off infections
These same proanthocyanidins may also benefit oral health by preventing bacteria from binding to teeth
The polyphenols in cranberries may reduce the risk of cardiovascular disease by preventing platelet build-up and reducing blood pressure via anti-inflammatory mechanisms
Research has shown that cranberries are beneficial in slowing tumor progression and have shown positive effects against prostate, liver, breast, ovarian, and colon cancers
What’s more Canadian then hemp? Hemp seeds, when the outer shell is removed leaves you with a soft nutty like small seed.
Hemp is a wonderful source of good fats, plant-based protein and it’s yummy!
Very recently I posted this recipe: Sweet Pea Dip with Mint and talked about all the health benefits of this Canadian superfood! You can read more here.
The court ruled that the subsidies were integral to the functioning of insurance markets under the ACA, and that Congress constructed the law with that in mind. The Court did not use an alternative legal argument to uphold the subsidies – saying that the law was ambiguous but the executive branch (in this case the IRS) had the right to interpret it so that subsidies are available in both state and federal exchanges. This is not a minor distinction – that latter interpretation (used by one of the lower courts) would have meant that a future administration could come in and change the subsidy policy. The 6-3 court ruling bars a future administration from doing so. (A future Congress could still change the law regarding subsidies but a future administration couldn’t just flip a switch and stop them.)
The politics won’t go away. There will be more votes in Congress (though Obamacare won’t be repealed) and more political debate over provisions in the law, such as the Cadillac tax and the medical device tax. There will be attacks on the law over affordability as well. The 2016 race is already well underway and the ACA will be a theme.
President Barack Obama said immediately after the ruling that he would make it a priority to work with states that have not expanded Medicaid to date, to see if he could persuade them to do so now. It’s unlikely a host of states that have resisted this long will change in the next few months but a few might.
Some states that are still having technical or financial difficulties with their own exchanges may migrate, at least in part, to HealthCare.gov. Four states – Nevada, New Mexico, Oregon and, soon, Hawaii – will be using HealthCare.gov for enrollment and eligibility but will still control enough of the exchange themselves to be technically considered a state exchange. Margaret Sanger-Katz wrote about this in the New York Times’ Upshot and Stephanie Armour in the Wall Street Journal. Some experts, such as Tom Miller at the American Enterprise Institute, have speculated that CMS will allow more varieties of state-federal partnerships.
The ruling does gives the states and the health plans more certainty about the 2016 signup season. Some of the rate proposals have come in quite high – we’ll see whether or how much they come down.
Some states may start looking at 1332 waivers, which let them have more flexibility in how they achieve ACA coverage goals in their state, starting in 2017. The final rules haven’t come out so we don’t know how much flexibility they’ll have – and, in this case, a future administration can change the regulations, up to a point. We’re written about this here and a Health Affairs blog post has been updated with the latest.
In short – the King ruing may have avoided chaos. But we’ll still have plenty to write about.
Photo: Pia Christensen/AHCJMedical student Russell Stanley (left) and Dr. Kevin Blanton (right) share the stresses and triumphs of providing care in rural settings at AHCJ’s June 19 Rural Health Journalism Workshop.
Distance dominated much of the conversation at AHCJ’s recent Rural Health Workshop in Fort Worth, Texas, a vast state with wide open spaces and far-flung cities.
While such expanses can offer a quiet alternative to urban areas, panelists at #ruralhealth15 also noted that such isolation can impact not only health, but education and other community resources. And that can present another challenge: attracting health professions to rural pockets to provide needed care for residents.
Kevin Blanton, D.O., who has spent the past decade working at a medical clinic in Clifton, home to about 3,400 residents in central Texas, said that, although he practices in the largest city in Bosque County, it still often feels like a “battlefront.”
Blanton said that doctors and other health care workers must not only provide a wider range of care and juggle more jobs than their city counterparts, they often get paid less and must travel farther (and pay more) for their certifications.
A typical day for Blanton, who serves as the county’s head medical officer while juggling teaching duties at the University of North Texas Health Science Center as well overseeing medicine at the local EMS and nursing home, outlined an exhausting picture of rural providers. And then, he said, other challenges surface – like tornados.
But Blanton offered a heartfelt take on practicing in such communities and sharing the benefits of smaller town life to medical students who have the desire to take up rural medicine. “You can’t make up passion,” he said.
One of his students, Russell Stanley, offered journalists his own view of training in rural towns and how it influenced his choice in osteopathy with the more holistic approach needed for care in remote areas with few, if any, nearby specialists.
In particular, experts at the workshop highlighted the growing need for mental health services in such areas, where not only access but cultural resistance to care can limit care.
Photo: Len Bruzzese/AHCJDr. Alan Podawiltz, chairman and associate professor for psychiatry and behavioral health at the University of North Texas Health Science Center, highlights mental health hurdles.
Mental health issues – drugs, domestic violence, post traumatic stress syndrome (PTSD), trauma, anxiety or suicide – affect nearly 20 percent of rural Americans, said Alan Podawiltz, D.O., chairman and associate professor for psychiatry and behavioral health at University of North Texas Health Science Center.
But many residents tend to wait before seeking care and even then, worried about stigma, view doctors as a last resort.
“It’s hard to hide in a rural community from seeing people like me,” Podawiltz said of concerns potential patients might have in seeking care. Telemedicine has helped provide access to mental health care for more people and, surprisingly, sometimes helped reluctant patients open up more than they might have in person. “It’s almost like I’m not real” to them, he said.
Health management and policy expert Erin Carlson, Ph.D., also told attendees seeking to pinpoint underserved populations in areas near them to consider factors other than geography that can play an outsized role in rural health, including age, race and poverty.
Carlson, an assistant professor at University of North Texas Health Science Center’s School of Public Health, pointed to issues such as aging populations and obesity to medicine access and pollutants as ones journalists should also weigh when looking into rural health care stories.
“How does socioeconomic status play into this?” reporters need to ask, she said. “Because it always does.”
“Poverty will trump everything else,” Carlson told attendees.
Denna Wheeler, director of rural research and evaluation at Oklahoma State University’s Center for Health Sciences, also offered attendees a host of sources to gather local statistics and data. We’ll offer those in an upcoming tip sheet.
As a reader of Joyous Health, I’m going to assume that you take an active interest in your health and wellness. Regardless of where you are in your own personal wellness journey, you’re here because you care about you!
We strive to make positive choices everyday that take us closer to joyous health, but our environment often plays an influential role in these choices and how effectively we’re able to execute them. Take the workplace for example: for many of us, the majority of our days are spent here where we may not always have as much control as we like – whether it be our activity levels, the people we’re surrounded by…the list goes on.
Companies are starting to realize that the health of their workforce is more important than ever, and while some are quicker to act than others, I have some easy ways that will give you a head start on creating your own healthy haven at work.
Take Control of Your Personal Space
Whether your in a cubicle, or corner office – these are some easy ways you can turn your personal workspace into a healthy haven.
Move more: Yes, we’ve heard it all before – we need to exercise more often. I covered a few ways we can fit more exercise into our busy schedules in my last post, but I failed to mention one strategy that we use on a regular basis at the Joyous HQ. With so much of our work being done sitting at a computer, every 90-minutes an alarm goes off in the office reminding everyone to get up and move. It doesn’t matter if you stretch, walk in circles or do a few pushups – the key is to break the routine of whatever you’re doing and move. Not only is it great for your body, but it’s also refreshing for the mind and allows you to sit back at your desk with a clear mind.
Don’t think you can get your office on board with 90-minute alarms? Use your phone or computer to set a personal alarm.
Make your workspace work for you: It’s a reality of many offices that we need to be at our computers to get the job done. This is the case with me, and I’m sure it’s the case with many of you as well. Since this isn’t something we can avoid, it’s important that we do whatever we can to set ourselves up the best we can. Here are a few places to start:
Ergonomics – chair, desk and screen height are all crucial for setting up a proper workspace. Basic points to remember: Feet should be flat on the floor, arms should be supported and relaxed, and screen height should be no higher than eye level (you shouldn’t need to tilt your head back). Standing desks are also a great way to break the monotony of sitting all the time and can be quite cost effective to implement.
Awareness – Even if you have a workspace that’s been configured by an ergonomic prodigy, it will mean nothing if you’re not aware of your body position and posture. It’s easy to slump in your chair, hunch your shoulders and crane your neck towards the screen. My favourite trick is to put a sticky note on the corner of my screen reminding me to sit up straight.
Make Healthy the Easy Choice
We want easy and we want convenient. This holds especially true when we’re immersed in an environment that can be demanding, stressful and mentally taxing. With a little preparation and a few tricks you can help make the healthy choice the easy choice every time.
Provide better options: This is where it all starts. Instead of indulging in your standard workplace treats, give yourself an alternative. Simple ideas include:
These are also more nutritionally balanced snacks, helping control those mid-afternoon cravings.
Make it visually appealing: Instead of placing your new healthy alternatives next to them, create a visually appealing display for your new snacks right on your desk. A simple mason jar with nuts is a great start, or perhaps a nice basket with fruit. Eating is as much a visual experience as it is one of taste – if your food looks good you’ll be more inclined to eat it vs. digging in your desk for that smushed chocolate bar.
A bonus to having your snacks on a beautiful display is the positive re-enforcement and comments you’ll receive from your co-workers as they pass by.
These are just a few of my go-to tips for keeping the Joyous HQ healthy and happy…
Now is your turn!
What do you do to make your workspace a healthier place for you?
Have a great day!
Walker
Walker Jordan
Walker knows the ins and outs of running a successful business. The owner of a boutique health and wellness studio which he sold in 2011, Walker now oversees growth and strategy, runs day-to-day operations and manages new business for Joyous Health. He is the most organized person we know! He has a love of shiny fast cars and he can make Brussels sprouts taste like heaven.
Want to stay healthy as you age? Move to Minnesota. Or perhaps Hawaii. These states rank number one and two in a new report on the health status of women. Minnesota was tops in the nation with an “A-“ on a composite index of women’s health and well-being, according to research compiled by the Institute for Women’s Policy Research.
The North Star State has the lowest female mortality rate from heart disease and ranks in or near the top ten almost all of the other nine component nine indicators covering chronic disease, sexual health, mental and physical health.
States in the South have the lowest composite scores on women’s health status. Alabama, Arkansas, Kentucky, Louisiana, Mississippi, South Carolina, Tennessee, and West Virginia were rated most poorly, with grades of “F” or “D-.”
Mississippi was number 51 out of all places in the nation for women’s health. It was ranked worst for mortality from heart disease, and had the second to worst ranking on the percentage of women with diabetes. The state also ranks in the bottom ten for mortality from breast cancer, the average number of days per month on which health status limited women’s activities, incidence of AIDS and chlamydia, and poor mental health. The District of Columbia and Oklahoma are also in the bottom ten.
While multiple factors shape women’s health, environment, socio-economic status, and access to affordable health care strongly influence healthy aging. (See this tip sheet from Eileen Beal on other factors that influence healthy aging). Older women are also more likely to have at least one chronic condition and limits on activities of daily living. According to the American Heart Association, heart disease is the leading killer of older women, as it is for women of all ages.
Other findings from the report include:
Slightly less than half (47.8 percent) of older women in the U.S. (65+) report getting least 150 minutes of physical activity per week outside of their jobs, a similar proportion to women overall (48.2 percent) but a lower proportion than older men (55.1 percent).
Older women in Oregon are the most likely to get this amount of exercise (62.2 percent), and older women in Mississippi are the least likely (30.8 percent).
Sixty percent of older women are overweight or obese, compared with 72.1 percent of older men and 57.6 percent of women overall.
It’s as high as two thirds of older women in Louisiana (65.8 percent) and in Michigan.
In Hawaii, the state with the smallest proportion, fewer than half of older women (44.4 percent) are overweight or obese
One in five women aged 65 and older in the United States (19.8 percent) report having diabetes.
Incidence is highest in Mississippi (24.6 percent), South Carolina (23.9 percent), and Georgia (23.6 percent); it is lowest in Colorado (14.2 percent) and in Montana and Vermont (14.8 percent each).
Among Medicare beneficiaries, older women have higher expenses than older men, with the difference in out-of-pocket expenses the largest among women and men aged 85 and older ($7,555 for women and $5,835 for men), according to data from the Kaiser Family Foundation.
The average out-of-pocket expenditures for older women who receive Medicare increase with age, meaning that the highest expenditures come as some women’s financial resources are becoming more limited or depleted.
The report also looks at improvement or decline in women’s health status among these indicators in recent years, and highlights those places where women’s health status varies by race/ethnicity and age as well as those who identify as a LGBT.
Check out this interactive map to find out how your state performs on any or all of the nine health indicators for women.
Here are some ideas for stories:
Reporters can use any or all of the data as the basis for stories on policy, health disparities, funding, access, or the effects of Medicare reimbursement, among other ideas.
Speak with policy experts, care providers, advocates and women in these age groups to find out how they interpret the data, and whether or how they plan to address it.
How do the provisions of the Affordable Care Act come into play? What about states where there is no Medicaid expansion? What is the difference between urban and rural, ethnicity and income?
Look at how states improved or declined from previous years. Why?
G. Lawrence Atkins, Ph.D. executive director, Long-Term Quality Alliance and president, National Academy of Social Insurance, reviewed key lessons from the Federal Commission on Long-Term Care and aging services innovations to frame future care delivery.
Atkins is the former chair of the commission, which issued a comprehensive report in 2013 calling for more funding and services for care and caregivers of older adults. About 78 percent of adults over age 65 has some type of unmet care need, requiring help with independent household activities of daily living. More than a quarter of older adults rely on outside help; 75 percent turn to family members to help meet their needs.
The number of older adults requiring some type of long-term care is projected to double by 2050, presenting “a major challenges to the financing and delivery of services,” Atkins said. Nearly one-third (30 percent) of people currently residing in the community or assisted-living facilities receive a combination of paid and unpaid care, and nearly two-thirds (65 percent) get help only from family members.
Atkins spoke during a web briefing on Thursday for policy stakeholders, aging experts and journalists. The session was sponsored by the Gerontological Society of America.
“Older adults and caregivers need more support to handle the growing complexities of arranging for and providing long term services and supports and what can be frequent care transitions,” he said. There’s a need for service delivery reform. Financial pressure from new payment models, like ACOs, and challenges of Medicaid’s long term services financing are driving a search for savings and efficiencies.
“We need to eliminate duplication, unnecessary cost and poor results of siloed care,” Atkins said. Better integration of LTSS with medical and health-related care, including effective management of care transitions, is critical to cost- effective improvement of quality and care delivery.
Medicaid finances over 60 percent of LTSS today, according to Atkins. A substantial portion is for the “dual eligibles,” those seniors who qualify for both Medicare, (which does not pay for most long-term care) and Medicaid. As demographics shift, the Medicaid burden on state budgets — including LTSS — will grow substantially as family caregiving becomes less available.
Additionally, “most people reaching age 65 today are not prepared to finance an expensive or lengthy period of long-term care, and future generations will be no better prepared,” Atkins said.
While individual responsibility to plan and save for the future remains the the core component of long-term care services, Atkins cited a real need for public programs to step in and provide a safety net. “We also have to improve support for family caregivers and keep them in the game.”
He called for an affordable, national catastrophic insurance plan to address those at greatest risk, along with a plan for those at intermediate risk which integrates long-term services and supports as a first step to enable health plans to provide the necessary services to better manage complex patients and lower acute care costs.
Long-term services is one of four main topics that the White House Conference on Aging will address. The others are elder justice, healthy aging and retirement security. Policy briefs for each topic are available on the conference’s website.
According to Michele Patrick, director of communications, White House Conference on Aging, who also participated in the briefing, three main themes about long-term care emerged from hundreds of listening sessions and town halls held by conference organizers and aging experts over the past year.
“There’s a need for greater support of formal and informal caregivers, to create a sustainable long-term care financing model and to provide a greater focus on person-centered care that maximizes independence,” she said.
Most older people just hope to maintain their quality of life for as long as possible and to grow old in their community, with a little assistance, Atkins said. Family caregivers remain the foundation of that and they need more support.
The president’s 2016 budget continues to emphasize the importance of caregiver supports, allocating nearly $50 million in new funding for aging programs that provide essential help and supports to older adults and their caregivers, such as respite and transportation assistance. The president’s budget also provides $15 million to a family support initiative focused on assisting family members supporting older adults and/or individuals with disabilities.
Reporters may want to look at how their state budgets and Medicaid programs align with the WHCOA goals, highlight any public and private programs that support aging in place or those that assist family caregivers to help loved ones age in their community.
Jeanne Erdmann, an independent journalist based in Missouri, and Mary Shedden, editor of Health News Florida, join four incumbents in being seated on the Association of Health Care Journalists’ 2015-16 board of directors.
Incumbents starting a new two-year term include AHCJ President Karl Stark, of The Philadelphia Inquirer; AHCJ Treasurer Felice J. Freyer, of The Boston Globe; Gideon Gil, of The Boston Globe; and Maryn McKenna, an Atlanta-based independent journalist.
By Steve Petteway, Collection of the Supreme Court of the United States (Roberts Court (2010-) – The Oyez Project) [Public domain], via Wikimedia Commons
Here just a few notes, key quotes and links to coverage of the Supreme Court’s decision to uphold the subsidies in the Affordable Care Act.
The phrase “death spiral” appears three times in the majority opinion. Also from the majority opinion:
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”
“Here, the statutory scheme compels the Court to reject petitioners’ interpretation because it would destabilize the individual insurance market in any State with a Federal Exchange, and likely create the very “death spirals” that Congress designed the Act to avoid.”
“The Affordable Care Act contains more than a few examples of inartful drafting.”
From the dissenting opinion:
“We should start calling this law SCOTUScare.”
“The Court’s next bit of interpretive jiggery-pokery involves other parts of the Act that purportedly presuppose the availability of tax credits on both federal and state Exchanges.”
“Pure applesauce. Imagine that a university sends around a bulletin reminding every professor to take the ‘interests of graduate students’ into account when setting office hours, but that some professors teach only undergraduates. Would anybody reason that the bulletin implicitly presupposes that every professor has ‘graduate students,’ so that ‘graduate students’ must really mean ‘graduate or undergraduate students’? Surely not.”
“Words no longer have meaning if an Exchange that is not established by a State is ‘established by the State.’”
“But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved.”
From President Barack Obama (some quotes appear here and video is here):
“The setbacks, I don’t remember clearly.”
“The Affordable Care Act is here to stay.”
Since the ACA went into effect, “more than 16 million uninsured Americans have gained coverage.”
“This is not a set of political talking points. This is reality. We can see how it is working.”
“This law is working and it’s going to keep doing just that.”
Healthy and Happy 