Over ten percent of all doctors and nurses on the government’s Medicare and Medicaid blacklist end up on it because they defaulted on government-backed student loans. Medical workers on the blacklist are barred from treating Medicare and Medicaid patients or receiving federal reimbursements for a predesignated time period.

According to a Modern Healthcare analysis of federal records, more than 5,400 of the 51,729 people on the government health entitlement blacklist were placed on it after failing to pay an HHS-backed medical student loan. Given a still-shaky economy, some in the health care sector expect that trend to continue:

[Government data] show that one of the most common reasons for getting barred is failure to repay HHS-backed student loans: 5,417 people are currently kicked out of Medicare for that.

The number of annual exclusions related to student loans has grown steadily in the past decade, peaking at 517 in 2011 before declining again. “That is tied to the economy, and I would expect that to continue to rise,” [said Lynn Gordon, a Chicago-area hospital group partner].

The increasing frequency of default-related blacklisting could prove problematic as the Obama Administration tries to entice more medical students to become primary care and family doctors. Primary care providers and nurse practitioners will be crucial to effective Obamacare implementation, since the health law is expected to drive up demand for medical services as millions of previously uninsured Americans gain coverage.

But the ballooning cost of a medical education could end up being a major barrier to the Administration’s recruitment efforts. According to the Association of American Medical Colleges’ (AAMC) 2012 report on medical school debt, “86 percent of medical school graduates had education debt, with a median amount of $162,000″ in 2011 — a number that has been rising steadily over the years:

AAMC estimates that a borrower with the median $162,000 debt “would have monthly payments ranging from $1,500 to $2,100 after residency.”

That disproportionately affects the very primary care doctors that are integral to health care reform and the U.S. medical system at large. In a 2012 report, consulting firm Merritt Hawkins & Associates found that family practitioners, pediatricians, and psychiatrists are the lowest-paid physician groups in the U.S. with a base pay of $189,000.

While that’s still a lavish salary compared to average U.S. compensation, it pales in comparison to specialist pay — and as the entitlement blacklist numbers underscore, that contributes to a system in which care providers are banned from treating certain patients for purely financial, rather than medical or criminal, reasons.

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(Credit: Morrow County Child Care)

The Obama Administration took a big step on Thursday to ensure that kids in child care are safe. Speaking before a D.C.-area day care, Health and Human Services (HHS) Secretary Kathleen Sebelius announced strict new regulatory rules — the first in 15 years — for child care facilities across the nation.

The newly announced regulations will apply to any child care center or family home that receives federal funding through HHS’s Child Care and Development Fund. Among the expanded rules are universal background checks and fingerprinting for child care workers, mandatory CPR and first aid training for such employees, and “safe sleeping practices” to prevent accidental suffocation deaths. “We frankly can’t wait any longer,” said Sebelius of the regulations.

Administration officials and child safety advocates hope that the requirements will put a dent in the depressingly high number of young children who die as a consequence of negligent care and unsafe practices. For instance, three-month-old baby boy Dane died after a child care worker “put him face-down on a blanket and left him for an hour” — just one example of a child death that the new rules’ safe sleeping component might have prevented.

Federal rules governing these care facilities are currently limited to preventing infectious epidemics and making sure that buildings meet fire safety codes. For the most part, states are left to their own discretion in coming up with more expansive regulations — making the new federal standards particularly significant.

However, the new requirements only apply to the 513,000 child care centers that receive federal money. That means that thousands of other facilities that care for children will still answer to watered-down rules that are left up to the states — and considering how lax some states’ standards are, that’s a big problem.

In a 2010 report, the child safety organization Child Care Aware of America found that nine states scored zero points on their child care safety score sheet. Some of these states, including Iowa, Idaho, and Virginia, require a child care facility to serve seven or more children before requiring state licensing or inspections; eight other states, including Texas, West Virginia, Pennsylvania, Michigan, and South Carolina, do not require a facility inspection or even an on-site visit before issuing a child care license; and Louisiana and New Jersey don’t require any child care facilities to receive a state license at all. “Unfortunately, in too many cases, it takes well-publicized deaths in child-care settings to prompt state action to strengthen their licensing standards to better address children’s safety,” an HHS official told the Washington Post.

While child care advocates are encouraged by the new federal rules, many still acknowledge that real reform requires congressional action, as well as more funding for the federal Child Care and Development Fund. The Fund was last reauthorized by Congress in 1996.

Last Friday, the U.S. Department of Health and Human Services (HHS) announced that it would allow states to pursue waivers letting them privatize their Medicaid expansions under Obamacare — an idea that took root with a deal worked out by Arkansas Gov. Mike Beebe (D) and the Obama HHS last month. Commentators and policy-makers heralded it as a “game-changer” for the reform law, as it could influence red states — many of which have high poverty levels and massive uninsurance rates — to extend coverage to poor people and help facilitate a major Obamacare provision.

But as Medicaid policy expert and George Washington University professor Sarah Rosenbaum smartly pointed out to the Washington Post’s Sarah Kliff in March, using federal dollars to put Medicaid-eligible populations into privately-contracted plans isn’t a novel concept at all — to the contrary, states have actually been doing it for decades through their increasing use of Medicaid managed care (MMC) arrangements. These arrangements contract beneficiaries’ care out to private insurers and providers, and a full “two-thirds of Medicaid enrollees now receive most or all of their benefits in managed care.”

Republicans have historically been strong proponents of MMC, touting its potential to cut costs while protecting poor Americans’ benefits. But with HHS’s new offer to institute a wide-scale version of this program now on the table, several notable Republicans are balking at the idea — including some who have pushed for similar measures themselves in the recent past:

1. TEXAS GOV. RICK PERRY. The 2012 presidential aspirant has been on an anti-Medicaid bender of sorts lately, declaring that “Texas will not be held hostage by the Obama administration’s attempt to force us into the fool’s errand of adding more than a million Texans to a broken system.” Yet, during his presidential run in late 2011, Perry struck a massive deal with federal officials allowing him to move close to a million Medicaid beneficiaries into managed care. Perry heralded the move in a press release, saying, “By approving Texas’ Healthcare Transformation and Quality Improvement Program Waiver, state and local officials can provide more efficient and effective care, and implement locally-tailored health solutions.” Apparently, Perry doesn’t view the Obama Administration’s offer on privatized Medicaid to be a similar opportunity for implementing “locally-tailored” solutions.

2. LOUISIANA GOV. BOBBY JINDAL. One of Obamacare’s most ardent critics, Jindal has steadfastly refused to expand Medicaid in his low-income state, saying that “Medicaid still operates under a 1960s model of medicine with inflexible, one-size-fits-all benefits and little consumer engagement and responsibility.” So far, he has stuck by that decision despite the urging of local lawmakers and his own state’s hospital chains. But back in 2011, Jindal aggressively — and successfully — pushed through an expansion of Louisiana’s MMC program, shifting 900,000 Medicaid and CHIP beneficiaries onto private, managed care. The measure was actually Jindal’s number one health care-related priority for 2012, and his administration publicly sold it “as a way to save taxpayer money and provide better care through coordination among doctors, hospitals and other medical professionals.”

3. MISSISSIPPI GOV. PHIL BRYANT. In an interview with Kaiser Health News, the Mississippi governor said, “I would rather pay extra to Blue Cross [to help cover uncompensated costs for the uninsured], rather than have to raise taxes to pay for additional Medicaid recipients” — a tacit endorsement of a managed care scheme. In fact, in 2012, Bryant signed a bill allowing Mississippi’s Medicaid division to increase the proportion of beneficiaries who could be placed onto managed care programs from 15 percent to 45 percent of the aggregate pool. Bryant has attributed his opposition to Medicaid expansion to his view that the program disincentivizes people “to find a better job, or to go back to school, or to get [into] a workforce training program.”

During his remarks on sweeping gun safety proposals today, President Obama sought to dispel any notions of gun lobby favoritism in Obamacare — addressing some concerns over a little-known Obamacare provision entitled the “Protection of Second Amendment Gun Rights” that was quietly inserted into the health care law at the request of pro-gun, NRA-backed Sen. Harry Reid (D-NV).

That measure seemingly gives gun owners special privileges by preventing wellness and better-living programs from requiring Americans to disclose information about their possible gun ownership, as well as prohibiting insurers from considering gun ownership when determining premium rates. As the President unveiled his gun safety proposals on Wednesday, he didn’t address those two points. But a fact sheet released to reporters does assert that the Department of Health and Human Services (HHS) will clarify that Obamacare doesn’t prohibit medical professionals from openly discussing gun ownership with their patients:

Protect the rights of health care providers to talk to their patients about gun safety: Doctors and other health care providers also need to be able to ask about firearms in their patients’ homes and safe storage of those firearms, especially if their patients show signs of certain mental illnesses or if they have a young child or mentally ill family member at home. Some have incorrectly claimed that language in the Affordable Care Act prohibits doctors from asking their patients about guns and gun safety. Medical groups also continue to fight against state laws attempting to ban doctors from asking these questions. The Administration will issue guidance clarifying that the Affordable Care Act does not prohibit or otherwise regulate communication between doctors and patients, including about firearms.

Public health officials overwhelmingly consider gun injuries and fatalities to be a public health concern. The Centers for Disease Control (CDC) estimate that gun violence costs $5.6 billion in annual medical bills, and up to $100 billion annually when also considering lost productivity from gun injuries and deaths.

Health and Human Services (HHS) Secretary Kathleen Sebelius announced on Monday that, for now, states will not be able to receive full federal funding if they choose to implement partial Medicaid expansions. States will need to fully expand the program to be eligible for the matching funds under Obamacare that will offset the cost of the program.

Although the Supreme Court upheld the bulk of the landmark health reform law last summer, Obamacare’s proposed Medicaid expansion was scaled back when the court ruled that states should be able to decide whether or not to expand their programs. Since then, GOP governors have been digging in their heels against reform, refusing to expand their states’ Medicaid pools to extend affordable insurance to millions of low-income Americans. That’s led lawmakers in several GOP-run states, such as Texas and Louisiana, to toy with the idea of partially expanding Medicaid in individual counties as a way of overcoming their governors’ continued obstruction.

But Sebelius has confirmed that pursuing that option will make states ineligible for the matching funds that the federal government will offer to the states that choose to fully expand Medicaid:

[W]e explain how Exchanges and Medicaid administrative costs will be funded and how we will continue exploring opportunities to provide States additional support for the administrative costs of eligibility changes. We clarify in our new guidance that states have the flexibility in Medicaid and the Children’s Health Insurance Program to provide premium assistance for Exchange plans as well as to adopt “bridge plans” that offer coverage through both Medicaid and Exchanges – keeping individuals and families together when they cross the line between Exchanges and Medicaid. And, while the law does not create an option for enhanced match for a partial or phased-in Medicaid expansion to 133 percent of poverty, we will consider waivers at the regular matching rate now and, in 2017 when the 100 percent federal funding for the expansion group is slightly reduced, broad-based State Innovation Waivers.

We hope states will take advantage of the substantial resources available to help them insure more of their residents. As an independent report highlighted, “Accounting for factors that reduce costs, states as a whole are likely to see net savings from the Medicaid expansion.”

In fact, several independent reports have highlighted the cost-cutting potential of Obamacare’s Medicaid expansion.

Without full federal matching funds for partial expansions, the stakes have been raised for recalcitrant GOP governors and legislatures, who control the state governments of seven out of the ten least-insured cities in America.

Since Friday is the one-year anniversary of the Department of Health and Human Services’ decision to overrule the FDA’s recommendations on emergency contraception — choosing to restrict access to Plan B for those under the age of 17 even though the FDA confirms it’s safe for women of all ages to use — health advocates are marking it as Emergency Contraception Day of Action to pressure the Obama administration to reverse its policy. The Center for American Progress has released an infographic to highlight why the age restriction on Plan B is a harmful policy that prevents young people from accessing the contraceptive methods they need:

Despite widespread information about the scientific nature of emergency contraception, it is simply a strong dose of birth control that does not actually induce abortions.

Friday marks exactly one year since the Health and Human Services Department overruled the FDA to restrict access to emergency contraception for women under the age of 17, disregarding the FDA’s recommendation that Plan B — which medical research shows is actually safer than aspirin — should be available to women of all ages. When HHS Secretary Kathleen Sebelius rejected the FDA’s guidelines on emergency contraception last year, some Democratic lawmakers suggested that decision was politically motivated rather than scientifically based.

Now, with the presidential election behind them, women’s health advocates are renewing their pressure on the Obama administration to reverse that policy:

“We are asking Secretary Sebelius to go back and take another look at the science, the medical evidence … and see if there’s a way to come to agreement to make this product more easily available to the women who need it,” says Kirsten Moore, president and CEO of the Reproductive Health Technologies Project. [...]

Moreover, Moore says, she thinks the election shows that there would be no political price to be paid by the administration for making what advocates say is the science-based decision.

“If there was concern that doing the right thing by emergency contraception was going to get people into trouble,” she says, “I think that question’s been asked and answered politically.”

Under the current federal guidelines, women younger than 17 years old must obtain a prescription from their doctor before being able to purchase Plan B. And the age restrictions have further complicated the stigma around emergency contraception, so even those over the age of 17 run into roadblocks when they attempt to legally purchase Plan B over the counter. Pharmacists often falsely tell women they may not purchase emergency contraception without a prescription, or incorrectly deny Plan B to men, or simply refuse to dispense emergency contraception for their own personal reasons.

The American Academy of Pediatrics has criticized the Obama administration’s age restrictions for posing a significant hurdle to the young women who need access to emergency contraception in a timely manner, especially since Plan B is the most effective when it’s taken within 24 hours of sexual contact. And the American College of Obstetricians and Gynecologists recently recommended that all forms of birth control should be easily accessible over the counter, since women more regularly take effective forms of birth control when they don’t face any roadblocks to accessing them.

Kirsten Moore also believes the voters who reelected President Obama sent a strong message to his administration about their position on these issues — and Obama now has an obligation to follow through for them. “The voters said very clearly this past November that when it comes to women’s health, they think that prevention is a good thing; providing contraception is a good thing; reducing barriers to access, whether it be cost, is a good thing,” she explained to NPR. “And they supported a candidate who clearly made that a part of his message.”

The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) released a slew of important new Obamacare rules and regulations today, continuing a widely expected post-election effort to successfully implement President Obama’s landmark health care reform law by 2014.

In a call with reporters, CMS and HHS outlined the new proposed rules, which instruct insurers, providers, and governmental institutions on how they must proceed in implementing Obamacare measures — ranging from a ban on discriminating against Americans with pre-existing medical conditions to public wellness initiatives such as coverage for employees’ gym use. Here are the three most important things you need to know about the new rules:

1) Insurers will be prohibited from discriminating against Americans with pre-existing conditions. Long considered one of the health insurance industry’s most odious practices, refusing to extend coverage to Americans suffering from a pre-existing medical condition will soon be a thing of the past. The first of CMS’s proposed rules mandates that insurance companies will need to base their premium rates solely on an individual’s age, family size, geography, and history of tobacco use — preventing discrimination against Americans for any other reason, such as their gender or their chronic illnesses. The rule will also set strict limits on how much insurers can vary the premiums they charge Americans based on these factors, marking an end to gender rating practices that charged women more than men for the same medical services. This will be a boon to the over 120 million Americans who suffer from a pre-existing condition in one form or another.

2) State exchanges will establish a standard of “essential health benefits” that every plan will be required to cover. Obamacare will require the plans offered under state-wide health insurance exchanges in 2014 to clear federal benchmarks across ten “essential health benefit” categories, including access to maternal care, mental health services, preventative health care, and prescription drug coverage. These assured benefits — which are supposed to reflect the level of coverage offered by a typical employer-sponsored plan — will help correct for spotty coverage that does not actually meet Americans’ medical needs. CMS’s proposed rule requires state exchanges to offer to the same level of coverage as a statewide benchmark health plan of the state’s choosing. If a state’s chosen benchmark plan does not cover all of Obamacare’s required benefit categories — for instance, by not offering mental health services — then the federal government will intervene and supplement that plan so that it does meet the health law’s coverage requirements. The rule also creates standards for prescription drug coverage so that such coverage actually meets Americans’ health care needs and prohibits health plans from designing their benefits in a way that discriminates against certain groups of Americans.

3) Wellness programs will help promote public health and curb health care costs. The last of the three proposed rules is joint guidance from HHS, the Treasury, and the Department of Labor regarding sponsorship of workplace wellness programs. Obamacare encourages preventative health initiatives and a transition from “sick care” to actual “health care” in an effort to both improve Americans’ quality of life and lower national health spending. Under the proposed rule, employers are encouraged to continue both participatory and health-contingent wellness programs — such as subsidizing the cost of employees’ fitness center memberships or enrolling employees in tobacco-cessation programs — in exchange for federal rewards.

These rules will give states more clarity as they move forward in implementing the Affordable Care Act. Although many Obamacare details must still be worked out — particularly regarding the statewide insurance exchanges — the reform law has made enormous strides in the last year that will result in a fairer, more accessible, and more affordable American health care system that is a marked improvement over the pre-Obamacare era. “It’s important to remember what this market looked like back in 2009… We were definitely headed in the wrong direction,” HHS Secretary Kathleen Sebelius said on the conference call.

During the Republican Governors Association conference last night, Maine’s Gov. Paul LePage (R) told reporters he’s “not lifting a finger” to institute a health insurance exchange for his state. In his official letter to the federal government, LePage explains that’s because he doesn’t want Maine to be “complicit in the degradation of our nation’s premier health care system.”

Maine was well on its way to implementing Obamacare before the 2010 election cycle gave the GOP control over the state legislature and governor’s office. But LePage has now confirmed that Maine will join the other Republican-controlled states that continue to resist Obamacare — even in the wake of the Supreme Court upholding the law and President Obama’s recent reelection:

On Wednesday, Gov. LePage signed the letter along with 20 other Republican governors that was sent to the Obama administration requesting more time and guidance.

On Thursday, however, LePage sent a letter to Health and Human Services Secretary Kathleen Sebelius saying the state would not create a state-run exchange and saying the health reform law “is a stepping stone to a single-payer system. Maine will not be complicit in the degradation of our nation’s premier health care system.”

Yesterday, Health and Human Services (HHS) Secretary Kathleen Sebelius extended the deadline for states to inform HHS whether they intend to establish their own statewide exchange, in an attempt to offer the 20 Republican governors the time they requested. If states like Maine choose not to set up an exchange, the federal government will step in and do it for them. And the Portland Press Herald reports that Maine lawmakers from both sides of the aisle are now bemoaning the wasted opportunity to build an insurance marketplace that specifically fits Maine’s needs, since LePage’s refusal to implement an exchange ensures that those decisions will now simply be turned over to the federal government.

As opposed to LePage’s assertion that health care reform would “degrade” what is already a “premier health care system,” six out seven doctors agree that the United States’ current health system isn’t working, largely because of the country’s high rates of uninsurance. Setting up state exchanges and expanding state-run Medicaid programs under Obamacare would help work toward expanding health insurance to the Americans who are currently uninsured.