What a week. In case you were under a rock, two different courts handed down contradictory decisions on the issue of premium subsidies for people buying coverage on the federal exchange. To recap: The federal appeals court for the District of Columbia overruled the IRS regulation doling out the subsidies in Halbig v. Burwell. Two hours later, the Fourth Circuit Court of Appeals in Richmond, VA handed down a ruling in an almost identical case—King v. Burwell—that ruled in favor of the federal government. Cue an explosion of conjecturing, opinion-giving and frantic phone calls to law professors that caused healthcare journalist Joanne Kenen to ask the federal government to please not do anything drastic for at least 24 hours.
Then, as if that weren't enough drama for one week, an undercover investigation by the Government Office of Accountability revealed that's it not that tough to game the federal exchange. Investigators with fake identities—false or incomplete social security numbers and invalid citizenship info—were still able to get a plan and subsidies. Meanwhile, Johns Hopkins settled in a case against a gynecologist who filmed thousands of patients in the exam room without their knowledge, and a big merger in Arizona might be raising some regulatory eyebrows.
Here are the biggest stories in the healthcare industry this week:
The Halbig and King cases are far from resolved. Check out our handy infographic about the battle to come over insurance subsidies.
It may be the right move for all three, but what will the FTC think?
The settlement is one of the largest on record in a case of physician sexual misconduct.
Our handy infographic shows which Medicare beneficiaries pay relatively more out-of-pocket.
GAO investigators used missing or inaccurate Social Security numbers and invalid citizenship information—and still were able to acquire and keep coverage.
And here's what we were reading:
- Enrollment on the federal exchange remains unexpectedly high, even after the end of the open period, according to Charles Ornstein in ProPublica.
- Health policy expert Aaron Caroll and Eric Seagall, a law profession at Georgia State University College, had a very interesting conversation about the implications and likely outcomes of the Halbig decision on Stand Up! with Pete Dominick.
- The Boston Globe profiled Dr. Ernest Amory Codman, who in the early 1900's pioneered the idea that outcomes should be recorded and made public to prevent patient harm.
- The biggest form of waste in the healthcare system is a busy physician, according to this New York Times op/ed.