Michigan Disability Resistance

Donald Trump has been predicting Obamacare's collapse since he began his presidential campaign more than two years ago — and certainly, no one has done more than he has to make that prophecy come true.

But Michigan's biggest health care providers and insurers still believe the health care framework the state put in place to comply with the stringent requirements established by the Affordable Care Act can be made to work for their patients and policyholders — if Congress takes steps to shore up the support beams President Trump seems determined to sabotage.

At least 900,000 more Michiganders have health coverage today than before the ACA kicked into high gear three years ago. Most joined the ranks of the insured when Michigan, in league with other states, extended Medicaid benefits to working families whose modest incomes had previously left them stranded between Medicaid eligibility and affordable health coverage.

When Trump and other critics talk about the imminent implosion of Obamacare, they're really talking about the fragility of the state exchanges where small businesses and individuals who enjoy neither Medicaid eligibility nor employer-provided health insurance must go to purchase coverage that meets the requirements established by the ACA. 

Michigan's Health Insurance Marketplace and similar exchanges established by other states were supposed to make health care more affordable by throwing hundreds of thousands of young, relatively healthy people into the same insurance pool as their older, sicker neighbors. But even Obamacare's most enthusiastic champions concede that three years of real-world experience has revealed weaknesses in that theory.

Part of the problem is that the so-called individual mandate doesn't really require young people (or anyone else) to buy health insurance; it simply threatens to exact a tax penalty every April 15 if they fail to do so. The more people who elect to take the tax penalty rather than purchase health insurance policies, the smaller and riskier the pool of policyholders insurance companies have to provide for becomes. 

TIC: For auto insurance now, but how soon for health insurance claims????

https://goo.gl/Xfz67f

Using my insurance company's app I sent in pictures (including the one shown above) the next day and within a few hours had an estimate that I could take to repair shops. It didn't do much to speed up the process, unfortunately, as part shortages kept my car in the shop for over a month. Also, my photos of the outside of the car didn't reveal the damage to internal parts like the radiator and turbo mount, which may have caused more back and forth later, but weren't much of a factor in how much time the repairs took. It was more convenient than needing to arrange an appointment with an agent, but it still shows that some things are better done by an expert.

TIC: Tongue in Cheek

What is going on at the Michigan health department about designing four pilot programs to test a controversial plan to combine physical and behavioral Medicaid services among mental health agencies, providers and HMOs?

So far, nothing, at least on the selection and design of the pilots. That was the official word from Matt Lori, senior deputy director for policy planning and legislature services with the state Department of Health and Human Services. Lori is a former state representative who was on the House community health appropriations committee from 2009 to 2014.

More on the design of the pilots later.

But Phil Kurdunowicz, policy analyst with MDHHS, said staff is making good progress in selecting a project facilitator and a project evaluator — two key requirements set by the Legislature in June when they approved the so-called Section 298 that Gov. Rick Snyder last month signed into law with the state's 2018 fiscal budget that begins Sept. 1.

MDHHS has $2.8 million the first year as a supplemental to the fiscal 2017 budget to plan the pilots, and $3.1 million for fiscal 2018 starting Oct. 1 to fund the pilots themselves. The $5.9 million total includes $2 million in general state tax funds.

Many doctors blame ignorance and the media for these phenomena, but this is simply a patronizing attitude. The truth is this. Many people simply do not believe doctors any more.

But why? The answer is $$$$. Simply, the public does not trust doctors because they know that many doctors, especially those in academic medicine and the universities are on the take. A terrific study from Dr. Vinay Prasad illustrates the problem precisely. He reviewed 37 ‘expert’ physicians who spoke on behalf of drug companies. Not surprisingly, they were all getting significant amounts of money from Big Pharma — a median of $39,316. These were not simply run of the mill doctors either.

The court’s Public Information Office boasts that the site update includes “a more consistent menu structure, a more interactive calendar, faster access through Quick Links, improved page load times, and reduced page scrolling.” For example, instead of indicating only that the court will hear oral argument on a given day, the updated calendar provides case names for each argument day, with links to the docket entries and the questions at issue in each case.

The homepage also provides access to transcripts, audio and other case information. In a tweet, Orin Kerr suggested that a new case-citation system, which lists internet sources cited in opinions, represents “a good effort to fight linkrot.” In 2013, Jonathan Zittrain, Kendra Albert and Lawrence Lessig released results of a study indicating that half the links in Supreme Court opinions no longer work.