Health Wonk Review: The Election Week Edition

imagesBy Jennifer J. Salopek

The frost is on the pumpkin; the Republicans have maintained control of the House and gained control of the Senate; and it’s time for another edition of Health Wonk Review. Surprisingly, few submissions this week actually dealt with the midterm elections, so we’ll lead off with the one that does. Joe Paduda deeply into his crystal ball to author his post on Managed Care Matters, “The GOP Wins the Senate: Implications for the ACA.” Paduda acknowledges the likelihood of efforts to revise or repeal the Affordable Care Act, and tees up some likely—and not-so-likely—targets. He writes:

While some will argue that a GOP Congress will push for repeal, I’m not so sure. With about 10 million more Americans covered under PPACA, that’s a lot of voters that might be upset if their coverage was yanked out from under them.  There are any number of provisions that are quite popular – covering children to 26, eliminating lifetime dollar caps on expenses, no-cost preventive care, no medical underwriting come to mind. Any move to go back to the bad old days would result in a lot of angry insureds.

Two more of this week’s posts tackle aspects of the Affordable Care Act. The ACA has a unique method of calculating modified adjusted gross income (MAGI) for subsidy eligibility. Blogger Louise explains it in detail in her post for Colorado Health Insurance Insider, “How to Calculate ACA MAGI or ‘Household Income’ for Subsidies.”

Blogger Jason Shafrin, on his site Healthcare Economist, wonders, “Who Will Pay the Cadillac Tax?” The ACA mandates the creation of a “Cadillac tax” on high-cost health insurance plans. Shafrin cites a report that concludes that 15 percent of active employee plans for U.S. companies will incur the tax by 2018.

The threat of Ebola in this country remains a popular topic for bloggers. In a Contributing Voices post on the Health Affairs blog, Lawrence Gostin, a professor at the Georgetown University Law Center, warns that the United States may be falling into a “misguided self-interest” on Ebola that is not only selfish but will ultimately decrease, not increase, our domestic safety. He writes:

Our actions (and inactions) could deeply damage the international response to Ebola. This lack of compassion and global solidarity in the face of an unfolding humanitarian tragedy makes many in America appear callous. But what they do not realize is that our self-interest is misguided. In fact, our disengagement would increase, not reduce, domestic risk.

Meanwhile, Brad Wright at Wright on Health blogs about “Why You Should Be More Afraid of the Flu than Ebola.” He presents some objective numbers about case fatality rates and ease of transmission that show that, while we worry about a disease with a high case fatality rate that is difficult to transmit (Ebola), we fret not about a disease with a low case fatality rate that is very easily spread (Influenza). On an individual level, that makes sense, but from a population health perspective, the flu is much worse. In fact, it is possible that six times as many people will die of the flu this season in America than have caught Ebola worldwide during this most recent outbreak. “Our fear needs to be put into perspective,” Wright says.

David E. Williams offers a guest post from the Health Business Blog authored by life sciences entrepreneur Mikael Totterman. There is a rush by venture capitalists to invest in eye-related companies. In “When It Comes to Investing, the Eye Has It,” Totterman explains why.

The rules in health care seem to be more about who you are than what you do, observes Roy Poses, MD, of Health Care Renewal. The case that sparked this post resulted in only a $6 million settlement. The charges were that medical device company Biomet gave doctors kickbacks to encourage them to use devices regardless of their benefits to patients. Almost never have any managers of big health care firms been recently subject to any legal penalties, even when the charges were of actions that could have harmed patients. “True health care reform would put patients and the public’s health, rather than the interests of rich health care leaders, first,” Poses says.

Rounding out this week’s Review, three posts that defy any attempt at a common theme:

  • OSHA recently cited an Alabama poultry processor for worker safety violations. Julie Ferguson of Workers Comp Insider tells you why you should care.
  • Recent changes at ONC, HHS, and CCHIT indicate that the federal government may be on the cusp of taking a different approach to Meaningful Use and its health IT leadership in general. Peggy Salvatore explains in “The Best Laid Plans…Laid Waste? ONC, CCHIT and the Future of Health IT” on her blog, Health System Ed: Blogging at the Intersection of Healthcare and Training.
  • At InsureBlog, Henry Stern explores whether or not the Brits’ National Health Care scheme should be saved.

Jennifer-1990-webJennifer J. Salopek is founding editor of Wing of Zock. She can be reached at, or follow her on Twitter @jsalopek.