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What Health Policy Wonks Are ‘Thankful’ for This Thanksgiving

In fall 2011, the president was seen as a 50-50 proposition to be re-elected. The Affordable Care Act’s future was yet to be decided by the Supreme Court. The term “Obamacare” was viewed as somewhat of a slur.

What a difference a year makes.

Of course, President Obama’s re-election and the legal battle over health care reform were well-chronicled, in California Healthline and elsewhere, and will continue to be studied for years to come.

But a small moment — perhaps destined to be overlooked — marked a turning point for how we talked about the law, at least. In October 2011, health advocates at the Colorado Consumer Health Initiative and ProgressNow Colorado Education launched a “Thanks, Obamacare” campaign.

“‘Obamacare’ turned into a dirty word, but it’s not,” CCHI’s Serena Woods said at the time. “It’s something positive,” she added, “so we wanted to turn the word into something positive, too.”

That campaign may not have shifted public perception, or affected the election. But within a few months, the president chose to embrace the term. News organizations followed suit. And the Obamacare moniker continues to be embraced.

Supporters Are Grateful for Law’s Survival This Holiday Season

A Twitter “Thankful4Obamacare” hashtag briefly trended across Tuesday, even as more regulations — including a ban on insurers from denying coverage for preexisting conditions — were released.

“People like my mom will finally have access to health coverage!” wrote one grateful user. Another was thankful “my preexisting condition won’t keep me from quality care.”

“Road to Reform” also heard from supporters of the law like Anthony Wright, director of Health Access, about how they’re feeling this holiday season.

“I’m thankful for the voters — for recognizing the stakes in this election, at both the national and state levels,” Wright told California Healthline. “At the national level, it wasn’t just ‘Obamacare’ — as dramatic and important as its continuation and implementation is — but also Medicaid and Medicare on the line.”

But there’s also “a lot to be thankful for that stems from the election results,” he added. “For the 15,000 folks on [the Pre-existing Coverage Insurance Plan] who won’t lose coverage and become uninsured and uninsurable; the 500,000-plus Californians in Low-Income Health Programs; the millions with new consumer protections; and yes, the thousands of folks, like me, whose life work to improve our health system is affirmed.”

Opponents Are Grateful the Law Can Still Be Slowed Down

Of course, critics of the law were … less thrilled with the “Thanks, Obamacare” campaign.

“Thanks, Obamacare,”’s Guy Benson wrote this summer, citing how the law may worsen the U.S. doctor shortage and push some employers to drop coverage. “Obamacare takes our demographic struggles … and makes them even more acute, much sooner,” Benson argued.

So while the past few months have been less rosy for conservative health policy advocates — who are now grappling with the prospect of ACA implementation — they’re still grateful for small blessings: The law can be derailed, thanks to its staggered implementation and a shift that takes decision-making power away from federal officials and gives it to the states.

State governors should seize that power and choose to let the federal government run the ACA’s health insurance exchanges, the American Enterprise Institute’s James Capretta and National Review‘s Yuval Levin urge in the Wall Street Journal. By making that choice, governors “would effectively be repealing a large part of the law — [and] sparing their citizens from the job-killing employer mandate and from assaults on their religious liberty.”

Or Congress should repeal community rating to make health insurance more affordable for young Americans, Avik Roy suggested at Forbes. “My guess is that, if [community rating is repealed], Obamacare’s subsidies would cost much less than they are expected to today.”

Looking Forward

But with the political battle mostly over, some health wonks are grateful for less-prominent pleasures brought by the ACA’s survival, like:

  • The “cool new ACA actuarial value calculator,” which was released on Tuesday, health policy analyst Josh Fangmeier chimed in via Twitter. 
  • “We don’t have to [spend] another year on will-the-ACA-get-repealed stories,” one “Road to Reform” reader wrote in.
  • “That the next step on health reform was not back to nothing,” Duke University professor Don Taylor told California Healthline. “[And] also for my wife and three kids.”

What are you thankful for this holiday season? Let “Road to Reform” know in the comments. Here’s what else is happening around the nation — and happy Thanksgiving.

Eye on the Courts

  • On Monday, a federal judge rejected retail chain Hobby Lobby’s legal challenge to federal contraceptive coverage rules in the reform law, ruling that the company’s Christian owners are not exempt from offering employees coverage because they operate a secular business (Olafson, Reuters, 11/19). The suit argued that providing contraceptive coverage for Hobby Lobby’s workers would violate the freedom of speech and religious beliefs of founder and CEO David Green and his family (Mecoy, The Oklahoman, 9/12). In a 28-page ruling, U.S. District Judge Joe Heaton said that while churches and other religious institutions qualify for constitutional protections related to the requirement, “Plaintiffs have not cited, and the court has not found, any case concluding that secular, for-profit corporations such as Hobby Lobby and Mardel have a constitutional right to the free exercise of religion” (Talley, AP/San Francisco Chronicle, 11/19).

Rolling Out Reform

  • The Obama administration in the near future is expected to announce several decisions on how provisions of the Affordable Care Act will be implemented. The government will determine contraceptive coverage rules for religiously affiliated entities and likely will issue guidance on bundled payments, hospital payments, insurance plans in state health insurance exchanges and the medical device excise tax (Rau, Kaiser Health News/Washington Post, 11/18).
  • The total number of accountable care organizations that contract with Medicare under the Medicare Shared Savings Program could increase from 153, to as many as 300 by January, when CMS awards a third round of contracts, according to Center for Medicare and Medicaid Innovation Director Richard Gilfillan. The shared-savings model sets spending targets and then equally distributes savings achieved by the ACOs between the federal government and the participants if quality targets are met. Gilfillan said CMMI is trying to expand the reach of innovative care models beyond Medicare by drawing other payers (Adams, CQ HealthBeat, 11/13).

Studying Its Effects

  • Care costs at hospitals participating in a CMS bundled-payment initiative vary by up to 100% and hospitals that successfully coordinate care are best positioned to benefit from the model, according to a study in the New England Journal of Medicine (Pittman, MedPage Today, 11/15). Under Medicare’s Bundled Payments for Care Improvement initiative, CMS sets target prices for episodes of care at individual hospitals and assesses whether organizations are spending above or below those targets. Hospitals spending above the targets will have to give back excess payments, while hospitals spending below the targets will receive additional payments (Mechanic/Tompkins, New England Journal of Medicine, 11/15).

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