Thursday, December 5, 2013

KPBS and others on the ACA for the week of Thanksgiving

I reminded my readers at the end of San Diego election news from KPBS that "this is still a Detroit-based blog, even when observing other cities' politics from afar."  Here is another entry in that vein, as I pass along KPBS's reporting on the implimentation of the Affordable Care Act AKA Obamacare in California.  It makes for a good mirror in which to see the process as it was intended.  That means any issues will be the result of intrinsic factors, not outside interference.

There have been some of the latter going on here in Michigan, for while Medicaid was indeed expanded here, it took a big fight between Governor Snyder and the state legislature, and the expansion didn't have immediate effect.  Also, there is no state insurance exchange; people from Michigan have to rely on the federal site, which has been having its issues.  That means that there are too many confounding variables to use Michigan to judge the merits of the program.

I begin KPBS's coverage with this video, which comes first under my preference that "if it moves, it leads."

Second Opinion: Will Obamacare Help If My Company's Plan Is Too Expensive?

Doug Blackwood and his wife have a great deal on a rental in Ocean Beach. But their rent is going up in January. The couple hopes to qualify for an Obamacare subsidy that might keep their budget in check.
Unlike the video like this I posted in Questions answered about the Affordable Care Act, KPBS does not provide a response.  Too bad.

Follow over the jump from more from KPBS that I first included in Overnight News Digest: Science Saturday (Comet ISON at perihelion) plus bonus articles from the University of Massachusetts and Texas A&M.

NPR via KPBS: Breaking Up With Is Hard To Do
Annie Feidt / NPR
Thursday, November 28, 2013
Enrolling in is not easy, and it's been particularly difficult in Alaska. Just 53 people enrolled in the first month.

Anchorage hair stylist Lara Imler is one of the few who got through, as we previously reported. But Imler discovered problems with her application, and now she wants to cancel her enrollment.

"I don't even know how to feel about the whole thing anymore because I can't even get anyone who has an answer to help," she says. "It's just such a lost cause at this point."
Remember what I wrote above outside interference?  This article is a perfect example of the results.

KPBS: Why San Diego County Will Lose Half Its State Health Funds (And Why It Might Not Matter)
By Megan Burks
Wednesday, November 27, 2013
California has given San Diego County two options: Take a clean 60 percent cut in health care funding next fiscal year or negotiate a smaller, more complicated cut.

The state will reduce the amount of healthcare dollars it gives to all California counties beginning next fiscal year to recoup savings under the Affordable Care Act.

Whichever formula it chooses, the region is poised to lose at least half of the state funds it uses to provide medical care to the homeless and uninsured and to run programs that help control the spread of infectious diseases.

But the cut — between $40 million and $48 million — sounds scarier than it really is, said Andrew Pease, executive finance director for the county's Health & Human Services Agency. He's tasked with figuring out which new funding option makes sense for San Diego.
There is no such thing as a free lunch.

KPBS: Latino Enrollment Lagging On Covered California
By Kenny Goldberg
Tuesday, November 26, 2013
Latinos make up nearly half of California’s 7 million uninsured population but Latino enrollment on the online Covered California web site has been dismal.

Nearly 80,000 people have signed up for health insurance on Covered California since Oct. 1, but Latino enrollment at the online health exchange has been dismal.

Latinos make up nearly half of California’s 7 million uninsured population. Under Obamacare, many of them are eligible for federal subsidies, or Medi-Cal, which doesn’t charge a premium.

Even so, Covered California spokesperson Santiago Lucero said in October, less than 1,000 enrollees were primarily Spanish speakers.
This is an example of an intrinsic problem that has to be overcome.

Now, the bonus items.

University of Massachusetts, Worcester: Universities can help state Medicaid programs manage health care transformation
By Tom Lyons
UMass Medical School Communications   
November 27, 2013
At a time when the health care landscape seems to be changing by the day, partnerships between universities and state Medicaid programs may help serve the missions of both.

That’s the message of a column in the latest edition of Academic Medicine authored by Jay Himmelstein, MD, MPH, professor of family medicine & community health and chief health policy strategist for UMass Medical School’s Center for Health Policy and Research, and Andrew Bindman, MD, professor of medicine and health policy and director of the California Medicaid Research Institute at the University of California Medical School.

States expanding Medicaid as a result of the Affordable Care Act will have to manage a number of new requirements as they seek to cover previously uninsured residents. These operational requirements will come at a time when many Medicaid agencies are stretched thin and not properly resourced to manage rapid growth.
Finally, something that could also go under technology and security.

Texas A&M University: Big Data: Preserving Privacy by Design
by Rae Lynn Mitchell
November 26, 2013
Information systems in the health sector have undergone significant changes making it possible to collect, store, and process huge amounts of digital records that may hold the key to future population health breakthroughs. However, linking between diverse data systems is complicated by privacy issues as well as data being recorded differently (10/12/58 or Oct. 12, 1958), changing over time (maiden vs. married last names), erroneous (transposed dates during data entry) or simply not included. So how do we use this new wealth of data, commonly termed “big data,” in a way that maintains privacy and assures it is accurate as well?

Hye-Chung Kum, Ph.D., associate professor at the Texas A&M Health Science Center School of Rural Public Health, thinks the answer lies in developing new methodologies for extracting information and outlines her framework in the Journal of the American Medical Informatics Association.

In “Privacy Preserving Interactive Record Linkage (PPIRL),” Kum emphasizes that it is critical to understand the distinction between identity disclosure (e.g., who the person is) and sensitive attribute disclosure (e.g., does this person have cancer). She maintains that identity disclosure has little potential for harm on its own though the sensitive attribute disclosure is what results in harm.
Speaking of technology and security, I have some items about both for holiday shopping.  Stay tuned.

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