Checking Up On Health: February 24, 2015

Health Policy News and Views
Compiled by Benita M. Dodd



Dealing with insurance companies in the ObamaCare era has become convoluted and messy, as many have discovered. Time was the physician’s was the last word. No longer, I’ve discovered.

After a year of a painful shoulder and elbow, I finally bit the bullet last week and decided I needed to graduate from Aleve to some orthopedic help. The orthopedist diagnosed tennis elbow and bursitis, recommended some exercises and prescribed a topical NSAID for the elbow problem.

Imagine my surprise when I picked up the medication at Costco and was informed the insurance company was refusing to pay for it. When I called, I was told the claim was denied on the grounds that I should try other therapies first. The representative said the doctor could call and get prior authorization if I still wanted the medicine. I paid for the prescription ($58) with HSA dollars, but I am outraged that the insurance company would second-guess the orthopedic specialist.

Insurance refused to pay for a topical NSAID.

Insurance refused to pay for a topical NSAID.

But doctors aren’t surprised: Practicing medicine has become a numbers game, according to cardiologist David Motokoff. “The practice of medicine deals with human beings who are imperfect and cannot be engineered around milligrams or millimeters of surrogate numbers. Patients are not cars or jets, and no matter how fascinated the insurance and government policy makers might be with exact numbers, as physicians we can never lose sight of the fact that we are treating flawed organisms: our patients.” Source:

Vaccination accusation: Actress Amanda Peet of, “Whole Nine Yards,” took parents in Los Angeles’ upscale neighborhoods to task recently for (and rightly so) refusing to vaccinate their children against measles. Since December 28, 2014, at least 117 measles cases were reported in California, part of a measles outbreak affecting seven states and linked back to Disneyland. “I can’t tell you how many people have said to me, ‘But these diseases are so rare,’” said the mother of three. “Of course they’re rare – vaccines made them so!” A supporter of the U.N. Shot@Life vaccine campaign, she argues that doctors who support a parent’s decision not to immunize their kids also share the blame. “Most of the nonvaccinating parents I know of go to the same couple of pediatricians. If, as a pediatrician, you keep insisting that these diseases are rare, and you persist in spreading the message that the measles outbreak is a case of media hysteria, that’s tantamount to encouraging people not to vaccinate,” Peet said. Source: Daily Mail


Making the case: The U.S. Supreme Court is set to hear oral arguments on March 4 in King v. Burwell, with a decision expected in June. The court could give its decision earlier, but typically, decisions in big cases come at the end of its term.  King v. Burwell is one of four lawsuits (including Halbig v. Burwell, Pruitt v. Burwell, and Indiana v. IRS) to argue that the text of the Affordable Care Act only allows for subsidies on state-run exchanges, and that therefore the regulation as implemented by the IRS – offering subsidies through both state and federal exchanges – exceeds the authority granted by Congress. This is critical for states because 37 currently operate under a federal exchange, including Georgia. Expect pressure on those states to build their own state exchange if the Court supports the IRS stance – and not everybody is hoping the IRS/Obama administration loses. In January, the American Hospital Association, joined by the Federation of American Hospitals, Association of American Medical Colleges and America’s Essential Hospitals, filed a friend-of-the-court brief in the case. Ruling for the plaintiffs, “would be a disaster for millions of lower- and middle-income Americans,” the groups argued o doctor’s late.  in their brief. As Michael Cannon of the Cato Institute explains, states are not seeking to deny health insurance: “If the Supreme Court vacates the IRS rule, it would be recognition that the ACA itself denies subsidies to those four million federal-exchange enrollees – just as the statute denies exchange subsidies to millions of Americans for other reasons, and denies Medicaid coverage to the poor in states that fail to cooperate.”

King v. Burwell is seeking to allow more Americans the freedom to choose the best health plan for them and their families without the government forcing them to either enroll in health coverage or pay a tax penalty. Ask YOUR friends and colleagues whether the Affordable Care Act has made health care easier, cheaper, better or more accessible for them or their families. I’ve heard more horror stories than helpful ones …

What if mechanics were paid like doctors? It’s difficult to explain the red tape physicians must endure. Pediatrician Chad Hayes describes the scenario, concluding:

He’s doing alright now; he doesn’t really enjoy his job, but he makes enough to get by. If you talk to him about his shop, he slips into a state somewhere between nostalgic fondness and post-traumatic stress. He’s glad that he made the decision he made, but disappointed that things didn’t work out like he’d hoped they would. He often wonders what other paths he could have taken that would have led to better job satisfaction. And unfortunately for other guys like Trent, the warranty company (along with many others like it) is talking about reducing the nation’s auto repair expenditures by cutting back on payments to mechanics. But that’s OK — who needs to make a profit, anyway?

The books on doctoring: An article in noted last year, “[C]onsider the significant human and financial capital it takes to become a doctor in the U.S: The median 4-year tuition of a private American medical school is $286,806, and physicians must complete a three to seven-year residency after medical school and undergraduate studies before they can practice independently. Christopher Conover, a research scholar at Duke University, calculated whether physicians’ eventual pay was worth the exorbitant investment.  While this professional rate of return was certainly respectable for doctors, it paled in comparison to those who pursued degrees with shorter and less expensive training, such as business or law.”

Why’s your doctor late? It’s a domino effect. Family physician Sanaz Majd recounts a typical day in the life of a physician and explains why it’s an unfortunate series of events that ends up delaying your appointment.

Quotes of Note

“Of interest, recently Governor Chris Christie of New Jersey said that he thinks [vaccinations] should be a parent’s personal choice. It is odd that he lives in a state that also has a law requiring people to put children in car seats. The reason that law is there is that if a child is in an accident but in a car seat, that child is much less likely to suffer harm than if the child is not in a car seat. I don’t see how vaccines are any different. I am not sure why the Governor makes a distinction between car seats and vaccines, because both provide protection should the child be challenged.” – Paul A Offit, M.D.

“Companies have 60 days to inform affected individuals of a data breach, dating from the first day employers know about it or should reasonably have known about it. HIPAA requires notification by first-class mail, including information about the date of discovery, the date of the breach, a description of how it happened, the data elements exposed, how affected individuals can protect themselves and contact information for Anthem.” – Elizabeth Earl

Benita Dodd is vice president of the Georgia Public Policy Foundation.