In a major shift within the employer-sponsored health benefit model, Sears Holdings Corp. and Darden Restaurants Inc. will begin offering employees a choice of health plans on “corporate exchanges” beginning in 2013.

Although spokesmen for both companies have been quick to point out that, at this point, the firms will still be providing their employees with health benefits and not just a pile of cash with which to buy insurance, the move is largely seen as the first step towards a benefits system in which employers play a less direct role in employees’ coverage, and could influence thousands of other firms to follow suit if succesful. As the Wall Street Journal reports, the basic idea is that by offering employees more flexibility in choosing plans, both workers and employers can save on health costs:

“It puts the choice in the employee’s hands to buy up or buy down,” said Danielle Kirgan, a senior vice president at Darden. The owner of chains including Olive Garden and Red Lobster will let its approximately 45,000 full-time employees choose the new coverage in November, to kick in Jan. 1. Darden says that employees with families to cover will be given more money to buy insurance than employees covering just themselves.

The hope is that insurers will compete more vigorously to get workers to sign up, which will lower overall health-care costs. Darden and Sears are both currently self-insured, meaning that the cost of claims each year comes out of company coffers. [...]

“Within the next two or three years, it’s going to be mainstream,” said Ken Goulet, executive vice president at WellPoint Inc. The insurer will roll out a product next year called Anthem Health Marketplace that lets employers offer a variety of its plans to workers, paired with a fixed contribution. Mr. Goulet said it is close to signing up more than 30 midsize and large employers for early next year, including one with more than 50,000 workers.

This method has innate risks to it, the biggest being the possibility that employer contributions won’t keep up with medical inflation, thus shifting costs onto consumers. But if the corporate exchange model pans out as advocates hope, then it could be a sign of good things to come for similar exchange-driven models, including Obamacare.

An estimated 4,800 people will receive care from a free four-day Los Angeles health clinic next week, The Lead Type reports. The clinic will run from next Thursday to Sunday to provide a variety of health services — including immunizations, women’s health screenings, dental cleanings, and eye exams — to Americans who don’t have medical insurance and can’t usually access this type of care:

Some people began lining up as early as Friday to ensure they obtain a wristband, which will be required for admission to the clinic. Distribution of the wristbands is expected to begin at 1 p.m.

Care Harbor has run several similar clinics in the Los Angeles area over the past few years. A four-day event last October at the Sports Arena was attended by about 5,000 people.

Medical practitioners who take part in the event volunteer their time and services. Care Harbor officials said they are still looking for additional volunteers for this week’s clinic.

The sheer number of participants in the Care Harbor clinic paints a harrowing picture of the human suffering wrought by a broken, Darwinian health care system. Stories like this serve as a reminder that every time the GOP votes to repeal Obamacare, they are voting to deprive Americans of essential screening and public health services — and forcing inadequately insured men, women, and children such as these to resort to desperate measures for fulfilling their medical needs.

A new Urban Institute Health Policy Center study finds that premium support models, such as the proposed Romney/Ryan Medicare plan, are more likely to increase excess costs in the program.

According to the report, turning Medicare into a “premium support” program would encourage private insurers to draw less costly beneficiaries from traditional Medicare, leading to bloated per-beneficiary reimbursements. The study arrives at this conclusion by extrapolating existing trends in Medicare Advantage (MA), which has appreciably higher per-capita costs than traditional Medicare in 75 percent of counties serviced:

The debate around premium support misses the potential within Medicare’s existing structure to harness the market to promote efficiency and to do so on terms that do not put beneficiaries at risk for escalating costs…By design, MA plans have been paid above per capita costs for equivalent beneficiaries in traditional Medicare, and have used these payments to provide extra benefits that have successfully attracted more than a quarter of Medicare beneficiaries into private health plans.

Measures taken by the Affordable Care Act significantly reduce these extra payments. But they do not eliminate the long-standing bias favoring payment policies designed to attract private plans rather than to encourage lower costs. Our analysis of recent MA experience shows that most private plans are more, not less, costly than traditional Medicare. In fact, MA plans with the lowest costs have been found to serve only 10 percent of MA enrollees, despite their attractiveness in the current market, and they do not reflect the typical MA experience. Only in the highest cost areas for traditional Medicare do typical MA plans deliver care at lower costs than the public program. Even this difference is likely exaggerated, given continuing evidence of favorable risk selection (that is, disproportionate enrollment of low cost enrollees) in private plans. In short, overpayment, not lower costs, drives most of MA plans’ success in competing with the public program for enrollees.

The GOP defends premium support models like the Romney/Ryan plan by claiming that they will exert downward pressure on providers and encourage competitive bidding in the insurance industry. The logic is that seniors, whose Medicare subsidies would stagnate relative to the rising cost of health care, will look for the best deals on the market and thus force insurers to compete, lowering overall health care costs.

But as the Urban Institute report demonstrates, private insurance competition is unlikely to yield much in the way of savings since providers would simply adapt their business models to pick up the least costly beneficiaries. Studies have repeatedly shown that this is the exact kind of adverse selection and cost-shifting that occurs in Medicare Advantage plans. Transitioning traditional Medicare away from its current defined-benefit model into a premium support one would exacerbate the problem, leading to increased premiums, more overpayments to private insurers, and even higher costs in the health care industry.

A report from the non-partisan Grand Canyon Institute suggests that if Arizona Gov. Jan Brewer (R) rejects Obamacare’s expansion of the Medicaid program, it could take a toll on more than just the low-income residents of her state who struggle to afford health coverage — in fact, it could also cost Arizona potential savings and new jobs.

According to the nonprofit research institute’s estimates, expanding the Medicaid program could help save Arizona $1.2 billion and create over 20,000 jobs in the state over the next four years. In light of their findings, researchers at the nonprofit institute strongly recommended that Arizona accept the Medicaid expansion under President Obama’s health reform law:

The report’s author, Dave Wells, the Grand Canyon Institute’s Research Director, noted that “by increasing Medicaid coverage to 133 percent of the federal poverty line, the state would reap huge economic benefits. Compared to current policy, it would add 21,000 jobs compared to 15,000 jobs created by following 100 percent of the federal poverty line. The 21,000 jobs would reduce the state’s unemployment rate by 0.7 percent, and increase economic growth in the state during the first year of full implementation by nearly 1 percent.” [...]

George Cunningham, chair of the Grand Canyon Institute, explained, “The payback on the state investment in expanding Medicaid to 133 percent of the federal poverty line is 5 to 1; more than $5 will come into Arizona from the Federal government for every dollar Arizona expends. You can’t beat that return on investment.”

The study points out that by expanding Medicaid and qualifying for higher federal matching funds over the first four years of its implementation, Arizona could save $1.2 billion from the state’s general fund. Although the state would be expending more money to cover additional low-income residents, the influx of federal funds would exceed that expense. The study’s authors also used economic software to simulate the effects of three options for the state — accepting the Medicaid expansion, rejecting the expansion to continue the state’s current Medicaid policies, and continuing an amended state Medicaid policy that Arizona enacted in the midst of a recent budget crisis — and found that expanding Medicaid would impact other sectors of the state’s economy and help the state add thousands of new jobs.

Other researchers have also documented the potential cost-saving effects of expanding Medicaid in Nebraska, Oklahoma, and Arkansas. Hospital officials have also spoken out in favor of the proposed expansion, saying their hospitals could stand to lose millions if governors choose to reject the Medicaid expansion. However, despite the potential positive results in store for states that choose to expand the Medicaid program under Obamacare, some GOP governors continue to stand in the way. Republican governors in states including Florida, Mississippi, Texas, Wisconsin, South Carolina, and Louisiana have pledged to refuse the Medicaid expansion. Brewer has not publicly taken a position yet, saying she will wait to decide until after the November election.

A new study from Families USA compares both Mitt Romney’s Massachusetts health reform law and proposed health care plans as a presidential candidate with President Obama’s health care reform. The report finds that on both a national and state-by-state level, Romney’s proposed reforms would lead to a substanitally higher uninsurance rate and considerably less financial support for American families trying to access health coverage than Obamacare would. A key element of the study notes that Romney’s plan uses tax deductions (relief on the amount of taxable income workers have to claim) as opposed to Obamacare’s tax credits (an actual reduction in the total taxes workers pay) as its method of premium support, thus reaching fewer Americans and providing them with less subsidies.

As the following chart from the report demonstrates, Romney’s proposals would provide working families little more than half the subsidies that Obamacare does, and by 2022 Romney’s plan would lead to a net 50 million more uninsured Americans than Obamacare would:

Earlier this month, Missouri legislators overrode Gov. Jay Nixon’s (D) veto to approve a bill that allow employers or health insurance providers to stop offering coverage for contraception, abortion, or sterilization if doing so violated their religious or moral convictions.

But before lawmakers passed the new law to push back against Obamacare, the state already had a decade-old law that “allows insurers to offer policies without contraception coverage to people or employers who say it violates their moral or religious beliefs,” according to the Associated Press.

Now, under the original contraception provision, the Missouri state department of insurance has issued a $1.5 million fine to insurance provider Aetna for failing to let employers opt out of contraception coverage. Additionally, Aetna provided insurance policies that covered abortion without an additional premium — in violation of a 1983 state law preventing abortion coverage in basic coverage. One official said Missouri’s settlement with Aetna is a reminder of the state’s current, restrictive laws:

“This settlement should be a reminder to all health benefit plans covering Missourians, that state law has stringent requirements honoring the religious and moral beliefs of insurance customers,” Missouri insurance director John Huff. “We will be enforcing Missouri’s decade-old contraception coverage law, as well as the new law on the subject, anywhere we see violations.” [...]

Under that newly enacted law, individuals, employers and insurers can cite religious or moral exemptions from mandatory insurance coverage for abortion, contraception and sterilization. It also changes a “may” to a “shall” when describing an insurer’s duty to provide policies without contraception coverage for those who request it.

It’s unclear what will happen to Missouri’s laws about contraception coverage because federal law invalidates them. The measures directly contradict with Obamacare’s regulation, which mandates that insurance plans cover contraception at no additional cost. The exemptions for religious organizations and accommodations for nonprofit religiously affiliated organizations do not include employers’ personal moral and religious views, making the Missouri regulations invalid under the Affordable Care Act. Under the Constitution, federal law “shall be the supreme law of the land,” and Missouri lawmakers cannot change that with a new or existing law to restrict women’s access to birth control.