Friday Night Short Cuts

Things weren't looking great eight months ago for Dr. Peter Beilenson and Evergreen Health Co-op, the insurance company he created from scratch.

The brand-new insurance company had been counting on Maryland's health exchange to bring in its first members. But the online marketplace was a nightmare for people trying to sign up. With higher prices and less name recognition than competitors like CareFirst BlueCross BlueShield, Evergreen ended the exchange's open enrollment period with just 400 members.

...Fast-forward to today and business is looking up for Evergreen. The companyshifted focus to small business groupsonce it realized it couldn't rely on the exchange alone. Evergreen lowered its premium prices for 2015 individual plans and is locking in the rates on both its individual and small group plans for two years. About 800 people have signed up for Evergreen health plans through the exchange since it opened in mid-November.

At first glance, the 2015 health plans offered by the Ohio nonprofit insurer CareSource look a lot like the ones it sold this year, in the Affordable Care Act’s first enrollment season.

The monthly premiums are nearly identical, and the deductibles are the same.

But tucked within the plans’ jargon are changes that could markedly affect how much consumers pay for health care. Generic drugs will soon be free, but the cost of expensive specialty medications will increase. Co-payments for visits to primary-care doctors will go down, but those for emergency room trips will be higher.

For years now, Democrats have mocked Congressional Republicans for voting to repeal the Affordable Care Act – a.k.a. Obamacare -- a hundred million bajillion times without offering any alternative of their own. And now they have.

It’s no improvement.

The salvo came in a New York Times commentary late last week, where narrowly defeated Virginia Senate candidate Ed Gillespie proposed what he called an Obamacare “do-over.” Trouble is, the details of his plan mean millions fewer Americans covered, a big tax hike for the upper-middle class, and — hey, whaddaya know? — a new tax credit for top brackets. The idea is to cut the ACA’s health-care subsidies — but his plan really just moves them up the income chain.

Attempting to play Chief Justice Roberts for a fool, Mitch McConnell (R-KY) has been suggesting Republicans will craft a health care plan.

In the early days of the software business, the large companies would announce that they were developing a certain software package to dissuade users from purchasing others' already-released products.

These non-existent products became known as "vaporware."

McConnell's health care plan is its kissing cousin: "VaporCare."

Politically, Obamacare has had a terrible past few weeks. First there was inaccurate enrollment data (the administration wrongly included dental plans). Then there were Jon Gruber's comments on "the stupidity of American voters." And it was capped off with Sen. Chuck Schumer saying that passing the law was a mistake. That led to headlines like: "Dark days ahead for Obamacare," "The Obamacare controversy grows" and my own "Obamacare's terrible, horrible, no good very bad month."

But if you look beyond the political fights, the picture looks very different. Obamacare is, policy-wise, having a great month — maybe even the law's best month ever.

Hospitals and health systems across the country are divided over whether to deny financial aid to uninsured patients who are eligible for subsidized health insurance under Obamacare but did not buy a plan. While a growing number of hospitals are adopting such policies, others have chosen not to as uninsured Americans grapple with the cost and complexity of obtaining coverage.

In the second year of Washington's state-run exchange for health insurance, changes in premiums and the number of plans available for enrollees led to tweaks in how the Washington Health Benefit Exchange approached the process of enrollment this year.

That's just one of the findings in a report by the Urban Institute and the Robert Wood Johnson Foundation on health insurance exchange renewals in the second year of the Affordable Care Act's implementation. The report, which compares how the state exchanges are comparing to the federal marketplace, examines six states with exchanges to understand what the second year of the ACA looks like.

Dental care is a peculiar niche of the U.S. healthcare system. Even though teeth and gums are just as much part of the human body as kidneys or elbows, they are insured differently — a lot differently.

When the Patient Protection and Affordable Care Act was written and debated, comprehensive dental insurance never really became a focal point. Lawmakers ultimately created a few provisions that may boost access to oral care, but dental coverage still escapes the grasp of millions of Americans.

Lost in all the deconstruction of the gubernatorial election and the angst about its effects on legislative support for a $2 billion single payer system is that due to a confluence of factors, now presents the best historic opportunity we have ever had to achieve universal health insurance coverage.

In the past universal coverage confronted two objections. The first was that we needed to get the explosive growth in health care spending under control because it was crowding out any ability to finance universal coverage. The second was that we needed significant assistance from the federal government because a single state could not do it alone.

Well both have now materialized.