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Daily Briefing Blog

Who's saying no to the ACA? The states that might need it the most.

July 24, 2014

Dan Diamond, Managing Editor

Reformers hoped that the Affordable Care Act would empower the states to experiment with their health systems. And sure—there's a "private option" here, a coordinated care organization demo there.

But rather than lend itself to 50 different laboratories, Obamacare is generally setting up a stark divide across the nation.

(The "Two Americas," you might call it.)

About half of the nation's Americans are living under the ACA's full coverage expansion.

The other half is missing out, as their state's leaders have opted out.

Two-dozen states have said no to Medicaid. Three dozen have decided not to run their own exchanges, which could become a much bigger deal pending the outcome of Halbig v. Burwell and this week's associated court cases.

Like a funhouse mirror, where the states stand on Obamacare has led to two versions of American health care that increasingly look very different.

  • In the pro-ACA states, the uninsured rate is rapidly falling, even as the share of government reimbursement is quickly rising. 
  • In the states sitting out, uncompensated care remains a serious issue—and hospitals and doctors may be more rapidly pushed to try their own reforms as a result.

Most media attention of this issue has focused on the politics of reform; some coverage has played up the finances, too. But remember: There's more at stake than just the optics of coverage expansion.

Based on measures of mortality and other health outcomes, the states that are generally saying no to Medicaid—the ones that are resisting the ACA—are the states that might need it the most.


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A DC court ruled against Obamacare. Here's what happens next.

July 22, 2014

Dan Diamond, Managing Editor

For the second time in three years, a major component of the ACA's coverage expansion is in jeopardy, after an appeals court struck down the law's premium subsidies in 36 states.

In Halbig v. Burwell, the U.S. Court of Appeals on Tuesday morning ruled 2-1 that the IRS illegally concluded that the ACA's federal subsidies for exchange plans should apply in those states that have a federally run exchange marketplaces. (See coverage in today's Daily Briefing.)

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Why good leaders embrace the 'cringe moment'

July 16, 2014

Dan Diamond, Managing Editor

Hey, readers.

This story is going to make some of you angry.

Ok—that's not how I'd normally start a blog post. But it keeps with advice from Peter Bregman, a CEO coach writing at Harvard Business Review last week.

Bregman was discussing how leaders—or really, anyone—can "start a conversation you're dreading." Too often, he says, mangers don't directly address difficult staff issues because the conversations makes managers feel awkward or uncomfortable. 

Alternately, managers may try to have those conversations...but spend so much time building up to their primary message, or delivering it so circuitously, that staff end up confused and without enough time to grapple with what their manager is actually saying.

According to Bregman,

    Next time you have a conversation you’re dreading ... [g]et to the conclusion in the first sentence. Cringe fast and cringe early. 

    It’s a simple move that few of us make consistently because it requires emotional courage. At least the first time.

As evidence of why a manager needs to broach difficult conversations with staff, Bregman relates an example from his own career. One of his employees had steadily underperformed and didn't meet expectations, but Bregman had kept putting off his tough feedback. 

By the time, Bregman was able to sit down to deliver his message to the employee, "the conversation promised to be even more awkward and uncomfortable" because he had waited so long to have it. "The cringe quotient had gone up," he adds.

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Another hospital tops U.S. News rankings—again. But does it matter?

July 15, 2014

Dan Diamond, Managing Editor

Another year, another edition of the U.S. News "Best Hospital" rankings.

And once again—a new organization named #1.

It's the third straight year that there's been a shift at the top of the rankings. And that's a bit unusual, because the best of all the U.S. News "Best Hospitals" had been somewhat of a formality for decades: Johns Hopkins led the rankings every year from 1991 to 2012.

But Mass General ascended to the top spot in the rankings two years ago, before Hopkins reclaimed the lead position in 2013. This year, it's Mayo Clinic's turn at #1.

See: U.S. News names its 2014 'Best Hospitals' list

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The new profile of America: Older—and more chronically ill

July 7, 2014

Juliette Mullin, Senior Editor

As you well know, America's elderly population is growing.

There were more than 40 million people over age 65 in the United States in 2010. That's 13% of the country's population. By comparison, that age group made up just 8% of the population in 1950, when there were 12 million elderly Americans.

Aging in health: The five best states for seniors

But the population is doing more than growing. It's also getting sicker. New Census Bureau data offer insight into the new profile of elderly Americans—and it's not great news for the providers trying to treat them.

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The states with the most opioid painkiller users

July 7, 2014

Paige Baschuck, Daily Briefing

Nearly 50 U.S. residents die each day from an overdose of prescription painkillers, according to new CDC data. A shocking fact, but less so when you consider that health providers in 2012 wrote enough prescriptions to give every American adult access to a bottle of painkillers—about 259 million.

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How many people will be affected by Supreme Court's Hobby Lobby decision?

June 30, 2014

Dan Diamond, Managing Editor

In a 5-4 decision, the Supreme Court on Monday ruled that the federal government cannot compel "closely held corporations" to provide contraception coverage under the Affordable Care Act.

Specifically, Burwell v. Hobby Lobby turned on the 1993 Religious Freedom Restoration Act (RFRA), which "protects a person's exercise of religion" and had been the focus of oral arguments back in March. Facing off with the Obama administration, Hobby Lobby's lawyers argued that because the ACA's contraception policy went against the personal religious beliefs of the for-profit company's owners, it violated RFRA—and the Court ultimately agreed.

The ruling frees Hobby Lobby from paying for several contraceptive drugs and devices, including the morning-after pill, that the company's owners found troubling under the ACA's mandate. (Hobby Lobby already doesn't cover these drugs or devices for its 13,000-plus employees, who are spread across 628 stores in 47 states. However, TIME's Kate Pickert notes that the company still pays for most kinds of birth control.) A fellow plaintiff, Conestoga Wood Specialties, also gained an exemption from the contraception mandate.

Get a summary of Monday's Hobby Lobby decision 

But how many other Americans will be affected? 

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The Affordable Care Act: Two years after the Supreme Court ruling

June 27, 2014

Juliette Mullin, Senior Editor

A year ago, we published a popular infographic on the state of the Affordable Care Act (ACA) one year after the Supreme Court ruled to uphold the law. With the two-year anniversary of the decision coming up tomorrow, we thought we'd update the graphic with data from the past year.

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