Department of Health and Human Services

Now that Healthcare.gov is working, those projections for private plan enrollment don't look so crazy.

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Two Thumbs Up

On the morning of June 2, 1929, a detachment of federales gunned down a middle-aged former army general outside a hacienda chapel in the Mexican state of Jalisco. Enrique Gorostieta was the commander of a Catholic peasant militia known as the Cristeros, which had been fighting the government of President Plutarco Calles for three years. In 1926, the fiercely anti-clerical Calles had moved to curtail the Catholic Church’s activities in Mexico, demanding the registration of the clergy and stripping the Church of the right to own property.

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When President Obama signed the Affordable Care Act two years ago, the law's proponents (including me) were confident of two things: That it would become more popular with time and that it would make our health care system more humane and efficient. History has not been kind to the first prediction. Most of the law’s components command broad support: Overwhelming majorities still support the requirement that insurers cover people with pre-existing conditions, for example. But overall the Affordable Care Act is unpopular.

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[with contributions from Matt O’Brien and Darius Tahir] Now that I’m finally done with that feature article, which you’ll be able to read here next week, I want to circle back to a few items I put aside because I was busy reporting. One of them is Ezra Klein’s article on the Obama Administration’s economic policy failures, real and imagined. Actually, it’s a pair of articles. One was a lengthy, stand-alone piece in the Washington Post. The other was a review of Ron Suskind’s book, Confidence Men.

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Inequality, as my colleague Tim Noah will tell you, reflects many factors. But one of them is education, particularly early childhood education. Young children from more affluent families get quality care and teaching, while less affluent children do not. And that disparity inevitably affects how these children fare later in life -- intellectually, emotionally, and, ultimately, financially. But what do we do about it?

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In one of its many attempts to get its budget deficit under control, in 2008 California decided to cut its reimbursement rates to medical providers for poor and disabled persons enrolled in the state’s Medicaid program. The result was that providers began to cut back on services, and pharmacists stopped filling prescriptions because the reimbursements came to less than the cost of the drugs. California, for all intents and purposes, was no longer upholding the federal mandate to provide Medicaid patients with “meaningful access” to care.

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Free Birth Control!

No, that headline is not link bait. It’s breaking news. On Monday the Obama Administration announced that it would require health insurance plans to cover a variety of preventative services for women – basically, everything from screening for gestational diabetes to counseling on domestic violence.

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If Republicans in the House want to thwart health care reform, they have all sorts of options at their fingertips. They can vote—boldly but quixotically—to repeal the whole thing. (Um, check.) They can kick up their heels and pray that the Supreme Court strikes down the Affordable Care Act. (That might take awhile.) They can try to block new funding for the bill.

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Who is responsible for an outbreak of salmonella that's sickened 1,500 people and led to the recall of a half-billion eggs? Last week, I suggested that a significant portion of the blame belongs with the administration of George W. Bush--which was, in turn, channeling the anti-regulatory zeal of the Bush Administration. Tevi Troy held several positions in the Bush Administration, culminating in the two years he spent as deputy secretary at the Department of Health and Human Services. In other words, he's familiar with these issues and what was going on behind the scenes.

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One of the central challenges of health care reform is getting insurers to behave better. And it's really a round-peg-into-square-hole sort of problem. The primary obligation of a for-profit insurer is to satisfy its shareholders and make a lot of money. But that's not always, or even usually, good for the people who want or need insurance. To take one classic example, somebody with a serious chronic disease will need expensive, ongoing care.

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