Friday, April 18, 2014
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Bob Doherty

POSTED: Monday, March 10, 2014, 6:00 AM
Filed Under: Bob Doherty

With the first annual open enrollment period for the Affordable Care Act down to its final few weeks, you are going to hear a lot of spin about the numbers.  The end of March will be the first real test of ACA enrollment, because as of April 1, most people will have had to enroll in a health plan that meets the law’s requirements or pay a fine (equal to 1 percent of their taxable income, or $95, whichever is greater). 

By the end of March, will the administration be able to say that it met its latest marketplace enrollment target of 6 million (which was lowered from its original 7 million)?  As of February 25, the administration reported that 4 million had signed up.

How many who selected a plan will have paid their premium, and if they haven’t, how many will end up being dropped from the enrollment totals?  How many will receive tax credits to help them afford the marketplace plans?  How many will choose a plan in each tier?  Will there be enough younger and healthier people enrolled to offset the costs of covering older and sicker people?  If that number falls short, will it lead to a “death cycle” in premiums because insurers will have to raise rates to everyone else?

POSTED: Friday, January 10, 2014, 6:00 AM
Filed Under: Bob Doherty

On Tuesday of this week, as I was starting on my way to Reading Hospital to give a Grand Rounds presentation to physicians and nurses on the Affordable Care Act, I was involved in an auto accident that totaled my car.  Due to driver error (mine), I inexplicably side-swiped another vehicle that was in my blind spot, left the road, and hit a tree at 30 MPH.  All of this in broad daylight, modest traffic, and no roadway ice.

Fortunately, I am generally okay--some bruises and a fractured sternum, and associated aches and pains being managed with painkillers, but that's it.  I have full collision damage and personal injury coverage from my car insurance company, and excellent health insurance paid for by my employer, the American College of Physicians.  I will end up paying only a $500 collision deductible when all is said and done.

For obvious reasons, I had to reschedule my presentation to the good doctors and nurses at Reading.  But this accident taught me some valuable lessons that I might mention next time I give a talk about Obamacare.

POSTED: Friday, November 15, 2013, 6:00 AM
Filed Under: Bob Doherty

Much of the news lately about the Affordable Care Act, also called Obamacare, has been about the troubled rollout of the web marketplace enrollment and the cancellation notices going out to a segment of the 5% of Americans who get coverage from the individual health insurance market. (Read this for an accurate explanation of what is going on with the cancellations. And this about President Obama’s announcement of a policy change that may allow some people to keep their cancelled policies for at least another year.)  But there is another Obamacare story that has gotten much less attention: enrollment in Medicaid, which is being expanded in many states, is going like gangbusters.

Nine out of 10 new Obamacare enrollees have signed up for Medicaid, the Washington Post reports, compared to only “a trickle of sign-ups for private insurance.” Oregon, for instance, cut its uninsured “without signing up a single person for private health insurance.”

This is a potentially watershed development, because Medicaid is Obamacare’s only true public option: a program jointly administered and funded by federal and state governments. (Although many liberals had sought to have another public option added to compete directly with the private plans offered in the state marketplaces, that version of a public option never made it into the final law). But Medicaid, which even before the ACA was the largest insurance program in the United States with 62 million enrollees, is central to Obamacare’s goal of providing health insurance to nearly all Americans.

POSTED: Friday, October 25, 2013, 6:00 AM
Filed Under: Bob Doherty

Most presidents encounter an event that solidifies the public’s view of their competence, for good or bad. Some events are so big that once the public makes up its mind that a president and his team are in over their heads, it becomes impossible to restore confidence.

This was the situation that President George W. Bush found himself in when Hurricane Katrina devastated New Orleans and the Gulf Coast in 2008, leaving nearly 2000 persons dead and some 400,000 displaced from their homes.  The Pew Research Center for the Public and the Press found that “What might have damaged Bush’s legacy most was his administration’s mixed record of competent governance. Between Iraq, the government’s flawed relief effort in the aftermath of Hurricane Katrina, and more minor missteps over the Dubai ports issue and other matters, the government ‘brand’ deteriorated badly during the Bush years. In late April 2008, just 37% expressed a favorable view of the federal government, about half of the percentage of five years earlier (73%).”

Some pundits and reporters today argue that the technological problems plaguing the rollout of the Obamacare web portal is President Obama’s Katrina moment.

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
Neil I. Goldfarb President & CEO of the Greater Philadelphia Business Coalition on Health
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
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