Why conservatives are so obsessed with guns.

The Fiscal Facts about Medicaid Expansion – Doctors for America

Currently, the federal government requires that Medicaid be available to adults who 1) fall under the federal poverty line and 2) who have children, are pregnant, or are disabled. Although Medicaid is almost entirely administered by the states, including actual enrollment of beneficiaries and reimbursement to health care providers, the cost is split between the federal and state governments, with the federal government shouldering, on average, about 57% of cost.

There are two ways that the ACA will expand enrollment in Medicaid. First, the ACA makes more Americans eligible for the program by 1) increasing the income standard to 133% of the federal poverty level (in 2011 this was $10,890 for individuals and $22,320 for a family of four), and 2) doing away with the requirement that you must have children, be pregnant, or be disabled. The ACA ensures that the Federal government would pay for 100% of this the first 3 years, then phase down to 90% after 2020 and beyond. According to the Congressional Budget Office and the Center for Budget and Policy Priorities, this averages to the Federal government paying for 93-94% of the expansion over the rest of the decade.

The second way is that the ACA simply makes it easier for eligible Americans to enroll in the program. The little known truth is that there are millions of Americans who are already eligible for Medicaid but are not enrolled because of complicated paperwork for potential beneficiaries and for state agencies and providers. In fact, a New England Journal of Medicine paper reports that only 62% of all eligible individuals are enrolled in Medicaid, with some states like Oklahoma, Texas, and Florida enrolling under 48%. The issue is even more is true for children; 60-70% of uninsured children are eligible for Medicaid or State Children’s Health Insurance Programs (CHIP) eligible but are not enrolled.

Affordable Care Act will expand mental health coverage, but budget cuts a worry – Philly.com

Mentally ill people will have a much easier time accessing care two years from now, thanks to the new federal health care law. But advocates worry that current budget cuts may create a shortage of the very mental health services the newly insured will want to use. In 2008, 67,560 uninsured people in Pennsylvania did not get mental health care because they could not afford the services, according to the Pennsylvania Insurance Department. That number should drop dramatically by 2014, when the Affordable Care Act (ACA) requires all American citizens to have health coverage that will include mental health services.

The Conservative Misinformation Campaign About Obamacare Has Worked Really, Really Well | Mother Jones

Andrew Sprung draws my attention to a Kaiser quiz about Obamacare from a few months ago, and you’ll be unsurprised to learn that most Americans don’t know much about it. I put the responses into graphical form, and what’s most interesting, I think, is to look at the right side of the chart: the questions that were most frequently gotten wrong.

All of them are tied together by a single thread: they’ve been the main targets of the conservative misinformation campaign against the Affordable Care Act. The tea party folks have never spent much time talking about low-income subsidies or tax credits or Medicaid expansion or pre-existing conditions. And guess what? Most people know how the law works in those areas.¹

But conservatives do spend a lot of time rabble-rousing about death panels and illegal immigrants and Medicare cuts. And they also spend a lot of time bewailing the “government takeover” of healthcare, which includes things like the public option (“a new government run insurance plan”) and a supposed mandate that small businesses will all be required to offer health insurance for their employees. Sure enough, those are the areas where misunderstanding is highest.

That’s why I disagree with Andrew that misinformation about small businesses amounts to a “foot fault” by current standards of public discourse. In a way, he’s right, of course: it’s not a major flash point and it hasn’t gotten a lot of news coverage. But there’s a reason it’s the single most misunderstood issue. The Rush/Fox/Drudge axis has been screaming about the government takeover of healthcare for three years now, and it’s sunk in. Most people believe it. That’s why, faced with a question most of them really have no idea about, their immediate reaction is to believe that, in fact, government is once again planting its jackboot directly on the necks of America’s small businesses. It’s a small issue, but it’s also a bellwether that the broader conservative misinformation campaign has burrowed very deeply into the American psyche.

After the ACA Ruling: Next Urgent Steps for Cardiologists

Medscape: What was the reaction from the ACC to the Supreme Court ruling on the ACA?

Dr. Zoghbi: We are pleased with the ruling, particularly from the angle that we are not setting back the clock on healthcare reform. However, we have a lot of work ahead. All the stakeholders — professional societies, payers, healthcare professionals, hospitals, device and pharmaceutical companies — have to work together to develop a sustainable healthcare system. The ACA doesn’t necessarily give us all the solutions. It is a step in the right direction that would need adjustment and refinement. We need to work on payment reform that rewards quality rather than volume, with the ultimate goal of having a sustainable system that provides win-win situations and aligns incentives of all involved, eliminating waste and rewarding quality and value. I think you won’t see too many people disagreeing with that. Where I see the need to focus is spreading the message that we need to work together; we cannot target one or the other segment of the stakeholders involved in healthcare.

Medscape: What are the ACC’s specific goals in the coming year in regard to the ACA? What is particularly important to focus on?

Dr. Zoghbi: The immediate urgent matter, which Congress keeps kicking down the line, is the flawed sustainable growth rate (SGR) formula. It is not part of the ACA directly, but it will impact it. The growth of the debt is always in the background and it gets worse and worse over time. We need a solution, paired with good payment reform, that would emphasize quality, integration of care, and, importantly, elimination of waste. Administrative costs and hassles to provide care have to decrease significantly.

After ACA Ruling: Next Urgent Steps for Internal Medicine

Medscape: We’re very interested to hear what the ACP thought about the Supreme Court ruling on the ACA.

Dr. Bronson: I think the decision is highly supported by our organization and we can now move forward.

Medscape: Will the ruling have any impact on internists or internal medicine?

Dr. Bronson: I think it will be positive for internal medicine, broadly speaking, because it gives more patients access to care through insurance. It will increase demand for services, but that’s a positive thing.

After the ACA Ruling: Next Urgent Steps for Family Medicine

Medscape: What was your initial impression when you learned of the Supreme Court ruling on the ACA?

Dr. Stream: I didn’t know what to expect. I had a difficult time separating what I wanted the outcome to be from what I could intellectually predict it would be. I’m pleasantly surprised.

Medscape: Will this ruling change any of the AAFP’s expectations about the impact of the ACA on family physicians?

Dr. Stream: I don’t believe so. We’ve been working for over 2 years under a strategy that the ACA was the law of the land, and we wanted to focus on those areas important to family medicine and patients and to make those areas as successful as possible. We also wanted to work on provisions that weren’t part of the ACA or were not fully addressed by it, particularly replacing the sustainable growth rate (SGR) formula and achieving meaningful medical liability reform.

Having the mandate upheld is consistent with what has been AAFP policy for over 20 years. We have advocated for healthcare coverage for everyone and access to at least basic health services, including good primary care with prevention and chronic illness care. You can argue whether the mandate is the only means to get there, but at least in the analyses that I’ve seen, it was one of the best identified ways to get everyone covered.

Next Steps in Healthcare Reform: Repealing IPAB and SGR

Medscape: When Medscape interviewed AMA CEO Dr. James Madara in April, he reiterated the AMA’s support of the ACA, but he stressed that like all things, it’s a work in progress. Now that the law has been upheld, what are the next steps to improving the healthcare system? What areas of healthcare are in most need of improvement?

Dr. Lazarus: We think the things in the act that we’d like to get rid of, like IPAB, would help. We would like to see comprehensive medical liability reform, which we think would help on the cost side and bring down the cost of care. We would like to see a repeal of the SGR in Medicare. And we, in our own strategic planning, are looking at new delivery and payment models that will work better, both for physicians and patients. We think this will give physicians more satisfaction in whatever kind of practice situation they’re in, and it will enable them to deliver better care to patients at a reduced cost. We need to have time to do that. It’s a 5-year plan, and we’re excited about that part of our strategic plan.

Medscape: Do you have any parting thoughts on the future of medicine and the ACA?

Dr. Lazarus: This is something that we had been working on for a long time. We had been advocating for health insurance coverage for all Americans for many years, and we were pleased with the outcome. It gives us at least a roadmap to where we’re going. It eliminates the uncertainly about where things were going. As the law is implemented, we’ll see what other changes need to take place. But we were pleased at the outcome.

AlterNet: 10 Reasons Most People Like Obamacare Once They Know What’s Really In It

There are two Affordable Care Acts. There’s the legislation passed by Congress in 2009, and then there’s the mythical Affordable Care Act – the perfidious “government takeover” decried and demagogued by so many conservatives (and quite a few liberals). The former is quite popular, the latter gets decidedly mixed reviews.

Don’t take my word for it. A recent poll by the Kaiser Family Foundation found Americans split down the middle, with 41 percent approving of the law, and 40 percent saying they didn’t like it (PDF). But then Kaiser asked about 12 specific provisions in the legislation, and found that, on average, 63 percent of respondents approved of the nuts and bolts of Obamacare. Of the 12 measures they tested, only one – the controversial mandate to carry health insurance or pay a penalty – received the approval of less than half of Americans (35 percent).

Or consider this divide: while only 12 percent of Republicans had a positive view of the law overall, 47 percent, on average, viewed its specifics favorably.

Follow the link to read the ten reasons…

Ezra Klein: No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)

No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)

Since the Supreme Court decision, Republicans have been calling the Affordable Care Act “the largest tax increase in the history of the world.” Politifact rates this false. Kevin Drum’s got a table of the 15 significant tax increases since 1950, and the Affordable Care Act, which amounts to a tax increase of 0.49 percent of GDP, comes in 10th. Austin Frakt took Drum’s table and made a chart:

So no, the Affordable Care Act isn’t the “biggest tax hike in history.” It’s not even the biggest tax hike in the past 60 years. Or 50 years. Or 30 years. Or 20 years.

Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion — Center on Budget and Policy Priorities

Claims that states will bear a significant share of the costs of the Affordable Care Act’s (ACA) Medicaid expansion — and that this will place a heavy financial burden on states — do not hold up under scrutiny. Congressional Budget Office (CBO) analysis indicates that between 2014 and 2022, the ACA’s Medicaid expansion will add just 2.8 percent to what states spend on Medicaid, while providing health coverage to 17 million more low-income adults and children. In addition, the Medicaid expansion will produce savings in state and local government costs for uncompensated care, which will offset at least some of the added state Medicaid costs.