A Senate Republican has seized on the growing controversy surround the IRS scandal to introduce a bill that would effectively repeal a huge chunk of the Affordable Care Act and significantly increase health care costs for millions of Americans.

Sen. Dean Heller’s (R-NV) “IRS Accountability Act” would prohibit “the IRS from receiving any ObamaCare funding that would otherwise be used for implementing the massive healthcare law,” preventing the agency from enforcing the law’s individual health care mandate, determining eligibility for affordability credits, and collecting taxes to help pay for the coverage expansion.

“Nevadans are already concerned about ObamaCare, so the fact that Congress could hand over even more power to an agency under intense scrutiny to enforce the health care law is deeply concerning,” Heller said in a statement. “The ‘IRS Accountability Act’ suspends funding for new ObamaCare IRS agents because right now we can’t trust the IRS to do its job.”

By 2014, the health care law will require the agency to assess fines on individuals who can afford to purchase health care coverage, but choose not to, and distribute tax subsidies for families who make no more than four times above the federal poverty line, approximately $94,200 for a family of four. Should Heller’s bill become law, the government wouldn’t be able to collect the penalties or pay out subsidies. It would also struggle to capture revenues from fees on medical devises, health care insurers and high-cost plans.

The penalty for going uninsured — which will be gradually phased in from 2014 to 2016 and then increase annually by the cost-of-living adjustment — is designed to encourage young and healthy people to buy coverage and spread the cost and risk of coverage across a wider population, thus lowering premiums. Though it’s unclear how many fewer people would purchase insurance if they were not penalized for not doing so, a 2012 study from the Urban Institute indicated that without a mandate, “nongroup premiums overall would increase by roughly 10 percent with high exchange participation and by 25 percent with low participation.”

Heller’s office did not respond to requests for comment.

On Tuesday, to celebrate Nurses Week, Rep. Carolyn McCarthy (D-NY) will introduce legislation for a startling problem in America’s public schools: A serious shortage of access to school nurses.

A 2007 study (PDF) by the National Association of School Nurses found that “45 percent of public schools have a school nurse all day, every day, with another 30 percent working part time in one or more schools.” It’s likely those numbers have only worsened as schools deal with drastic budget cuts, though no newer studies are available.

In total, one quarter of schools completely lack a school nurse. At the local level, such a lack of access to care can have dangerous consequences: In Michigan — where it’s estimated that there are 180 public school nurses for 1.5 million children from K-12 — other teachers become responsible for giving insulin shots or even “rectal anti-seizure medicines.”

McCarthy’s bill, the Student to School Nurse Ratio Improvement Act of 2013, would create new funding for public school nurses. But it might also help to shed light on why it’s so important to have nurses in the first place; it would also require the Department of Education to study how access to nurse care impacts students’ academic performance.

Medicaid gets a bad rap from a lot of conservatives for poor access to health care and poor health outcomes. It’s one of the main arguments in favor of schemes to cut Medicaid funding and block grant it to the states, on the grounds it will promote efficiency and innovation in the program.

But a new study in the Journal of General Internal Medicine found that when you compare the proper groups, Medicaid actually does a better job delivering access and affordable coverage than either private coverage or Medicare.

As Aaron Carrol summed up at the Incidental Economist, the study focused on the underinsured — that is, people on insurance plans that just aren’t very good — rather than those who have no insurance. More importantly, it only looked at people at or below 125 percent of the poverty line. That’s important because the problem with the studies showing Medicaid delivering inferior results to private coverage is that it’s difficult for their comparisons to avoid the apples-to-oranges problem. Medicaid is meant for poorer Americans — you have to be below a certain income threshold to qualify for it — but private coverage is available to the poor and well-off alike. It’s a matter of basic economic logic that the private plans only the well-off can afford will will provide much better access and quality care then the plans the poor can afford as well. Products poor people can afford tend to be poor products.

That’s why safety net programs like Medicaid, which provide people more assistance than they could afford in a pure free market world, are so important. And why, when the proper apples-to-apples comparison is made between poor people on private insurance and poor people on Medicaid, the latter’s performance improves remarkably:

For the purposes of this study, underinsurance was defined as (1) having out-of-pocket expenses that were more than 5% of household income, (2) delaying or failing to get needed medical care because of cost, or (3) delaying or failing to get needed medications because of cost. This study specifically looked at adults who had full-year continuous coverage in some form, but had an income less than 125% of the poverty line. They specifically wanted to know how many of those people were still underinsured.

They found that more than a third of these adults were underinsured. What’s more is what kind of insurance left people underinsured. More than 65% of those people on Medicare were underinsured. More than 37% of people with private insurance were underinsured. But only 26% of people on Medicaid were underinsured. People who were underinsured were more likely to be White, in poor health, and unemployed. Even after adjusting for these factors, those on Medicaid were significantly less likely to be underinsured than those on private insurance (odds ratio 0.22).

The gap between Medicaid and Medicare, meanwhile, is most likely due to Medicare’s higher co-pays and other forms of cost-sharing. While this generally won’t be a problem for seniors in the middle class and up, it can be difficult for poor seniors to meet their share of the costs.

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Last month’s bombings at the Boston Marathon left three people dead and about 260 people injured, including about 25 victims who had to get limbs amputated. Initial estimates suggested that the total medical costs of treating the survivors could exceed $9 million. Luckily, in order to help ensure that the survivors can afford their treatment, insurance companies and hospital administrators have announced they will help out by waiving most of the medical costs for them.

And now, the bombing victims with particularly serious injuries may also get some relief for their artificial prosthetics — which aren’t necessarily completely covered by insurance. The American Orthotic and Prosthetic Association, a trade group that represents companies that make artificial limbs, has promised to provide some prosthetics free of cost to the people who underwent amputations after the bombings:

The association’s offer, announced on a conference call with reporters under the name Coalition to Walk and Run Again, will only cover a portion of the expected costs for amputees. Victims who lost both legs face estimated medical bills of $450,000 over the next five years, said Tom Fise, executive director of the association, citing a Department of Defense and Veterans Affairs study.

The association estimates that at least half the Boston Marathon amputees lack enough insurance to cover their prosthetic costs as some policies provide as little as $1,000 per device or only provide one artificial limb. Many prosthetics need replacing every five to seven years.

“The last thing that someone should have to worry about when they lose … a leg is to have adequate insurance coverage for a prosthetic device,” said Kendra Calhoun, president of the Amputee Coalition, an organization supporting the estimated 2 million amputees in the United States.

Since the attacks at the Boston Marathon, support has poured in for the victims, many of whom had their lower extremities blown off by the explosions. The One Fund, a relief group established by Massachusetts Gov. Deval Patrick and Boston Mayor Tom Menino, has collected about $27 million in donations that it plans to distribute to the survivors and their families. Upcoming marathons in other cities are planning to organize donations for the One Fund. There are also several other celebrity-backed general funds soliciting aid for the victims, as well as individual efforts to raise money for particular survivors with serious injuries.

This past week, Congress approved a measure to restore funding to the Federal Aviation Administration (FAA) after sequester cuts to the national transportation agency disrupted airline travel across the country — but they haven’t taken similar steps to provide relief for other programs that are struggling as a result of sequestration. Now, employees at cancer clinics are sharply criticizing that move, pointing out that lawmakers should have prioritized their funding before working to alleviate airport delays.

After automatic budget cuts slashed their funding, cancer clinics have been forced to delay chemotherapy treatment for their patients. Some clinics may actually have to close their doors altogether if the sequester cuts are not reversed. As several cancer doctors told the Hill, they suspect they may not have been at the top at Congress’ list because reduced access to chemotherapy doesn’t personally inconvenience lawmakers in the same way that airport delays do:

“I would invite anyone in Washington to come look my patients in the eye and tell them that waiting for a flight is a bigger problem than traveling farther and waiting longer for chemotherapy,” said William Nibley, a doctor at Utah Cancer Specialists in Salt Lake City. [...]

“Unfortunately, this doesn’t (hit) home directly to members, as traveling does,” said Ted Okon, executive director of the Community Oncology Alliance, which is aggressively lobbying Congress to soften the cuts to cancer clinics.

Okon said he has sympathy for the FAA employees who were furloughed — the FAA is one of a slew of federal agencies that docked employees’ hours and pay as a result of the sequester. He does not begrudge furloughed FAA workers their fix, but he said Congress needs to move quickly on cancer care, too.

Earlier this month, Rep. Renee Ellmers (R-NC) proposed restoring some funding for cancer clinics after realizing the “unintended consequences” of sequestration. Unlike the measure to address airport delays, Ellmers’ legislation has not yet seen any movement in Congress. She told the Hill that she hopes it will soon be “expedited in the same way that the FAA bill was this week.”

Ellmers isn’t the only Republican who is beginning to acknowledge the potentially disastrous effects of sequestration, and the other funding priorities that should likely take precedent over air travel. On Meet the Press this morning, Sen. John McCain (R-AZ) suggested that Congress has “our priorities a little bit skewed here.”

“With all due respect to my friends, it’s a little bit hypocritical that, on the same day when all of the focus was on the delays we have in getting through airports, the chief of staff of the U.S. army was saying that if we don’t reverse this we will be unable to defend the nation and it will take us 10 to 15 years to recover,” McCain said. “Look, I’m for giving the FAA flexibility, but I also want to give the military flexibility and I don’t want the sequestration cuts to be as deep as they are in our national defense.”

In his most recent weekly address, President Obama also suggested that the swift action on the FAA’s funding was largely due to the fact that lawmakers were directly impacted by airport delays, even though there are more pressing budget priorities at hand following the automatic sequester cuts. “I hope Members of Congress will find the same sense of urgency and bipartisan cooperation to help the families still in the crosshairs of these cuts,” Obama said. “They may not feel the pain felt by kids kicked off Head Start, or the 750,000 Americans projected to lose their jobs because of these cuts, or the long-term unemployed who will be further hurt by them. But that pain is real.”

This Friday, House Republican Tim Murphy is holding a hearing on whether the Health Insurance Portability and Accountability Act (HIPAA) “helps or hinders patient care and public safety” in the context of mentally ill patients. The hearing, a followup to his hearing last month in which he reiterated false claims about mental illness and violence, will notably not include a single mentally ill witness. Why not? Because, according to Tim Murphy, mentally ill people are not “competent” to testify about how a relaxation of HIPAA rules would affect their own lives.

Instead, the hearing will revolve around family members, psychiatric professionals, and public health representatives, making decisions with potentially very serious implications about medical privacy for mentally ill people.  This event is occurring in a larger context of national panic about mental health and violence — with few public figures brave enough to stand against the tide, as Al Franken recently did, and warn against continued stereotyping and stigma of mentally ill people.

Rep. Murphy’s claim is that HIPAA “may interfere with the timely and continuous flow of health information between health care providers, patients, and families, thereby impeding patient care, and in some cases, public safety.” In other words: mentally health patients shouldn’t receive patient confidentiality, because mentally ill people are violent, and it’s in the best interest of society overall to lift privacy restrictions that limit the disclosure of their health information. This is part of a larger attack on HIPAA rights for mentally ill people with potentially grave implications that’s wrongheaded from a number of perspectives.

Despite the public perception that mentally ill people are violent and dangerous — one fostered by dangerous pop culture depictions, scaremongering media, and public comments by politicians and other leaders — it’s just not the reality. In fact, the link between mental illness and violence goes the other way round; mentally ill people are far more likely to be the victims than the perpetrators of violence. They also experience sexual assault, financial exploitation, and discrimination at very high rates because they’re viewed as easy victims. Of those who do commit violence, the vast majority engage in acts of self-harm like suicide, not violence against others.

The vast majority of violent crimes are perpetrated by people without mental health conditions. And, in unsurprising news, the largest factors involved in a violent crime that does involve a mentally ill person are lack of access to treatment (a perennial problem in the US) and drugs, which some patients may turn to for self-medication when they cannot get care through other means.

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Our guest blogger is s.e. smith, a writer and editor based in Northern California with a journalistic focus on social issues, particularly gender, prison reform, disability rights, environmental justice, queerness, and class.

At this point, it appears that all of the nearly 200 people who were treated for injuries in the aftermath of the Boston Marathon bombings will survive. As the New Yorker points out, this is no small accomplishment for the city’s medical professionals — particularly since explosions resulting from domestic terrorist attacks are typically about three times deadlier than explosions that occur in the midst of warfare, because civilians don’t have specialized equipment, training, or armor.

That wasn’t the case this week in Boston, even though over the explosions left about dozen people in critical condition and at least 10 people in need of amputations. That’s probably partly because the city has an especially large hospital system, which means that first responders and medical teams were well-equipped with the resources they needed to spring into action after this type of tragedy. It’s also, as Mother Jones details, a result of the lessons that doctors have learned from the past decade of modern warfare in Iraq and Afghanistan:

Those wars in effect served as field trials for doctors developing a new set of best practices for dealing with traumatic lower-body wounds, helping to dramatically lower mortality rates for injuries that were once virtual death sentences.

Military hospitals “can’t do prospective research, but they can record a tremendous amount of experience and give that back to civilian research,” said Dr. Carl Hauser, a trauma surgeon at Boston’s Beth Israel Deaconess Medical Center. “This particular incident here was very much one where they had helped us.” [...]

“Learning how to care for these wounds, how much work has to be done, how much tissue you need to remove, how much to leave behind — that’s something that is almost impossible to recreate in a civilian training environment,” [Donald Jenkins, director of the trauma center at the Mayo Clinic in Rochester, Minn., and a 24-year Air Force veteran] says. “We all learned to do this when we went to the war. And those of us who learned early passed it on, literally, surgeon to surgeon, as they exchanged positions in the war…Now we have scores, hundreds of surgeons who have been through that and know how to do this.”

Perhaps most notably, military doctors have learned how to more effectively stem the flow of blood. They re-popularized the use of tourniquets — which were discouraged at the beginning of the Afghanistan War because too many people were misusing them — after finding that a correctly-applied tourniquet can reduce mortality rates by a staggering 80 percent. They also discovered a better way of doing blood transfusions that resulted in much less blood loss and therefore fewer deaths. Now, those tactics have become standard procedures for the United States’ trauma teams responding to crises here at home.

“As an orthopedic surgeon, we see patients like this, with mangled extremities, but we don’t see 16 of them at the same time, and we don’t see patients from blast injuries,” Dr. Peter Burke, the trauma surgery chief at Boston Medical Center, told the New York Times in reference to the bombing’s aftermath. Fortunately, that didn’t prevent Boston’s medical staff from ultimately saving each one of those lives.

Direct-care health aides — the people who care for elderly Americans by helping them bathe, dress, and eat — represent the nation’s fastest-growing occupation. Nevertheless, as the Baby Boomer generation of Americans are about to enter old age, this health care sector is facing a serious labor shortage. That’s largely due to the fact that those positions don’t pay much more than minimum wage, even though they’re incredibly demanding jobs.

The Wall Street Journal reports that nursing homes and in-home health care agencies are already struggling to find direct-care workers, and advertisements for open positions in the field jumped by 120 percent over the past year. That’s partly because a fifth of this workforce is over the age of 55 and beginning to retire, but it’s also because it’s difficult to retain employees who are willing to work in difficult conditions for low wages:

Nursing aides, mostly women, do some of the toughest work in nursing homes — hoisting residents out of bed and changing their diapers. They are among the residents’ closest companions, spending more time with them than relatives typically do, and are often first to spot a turn for the worse that requires medical attention. Their rate of occupational injury, usually related to back or muscle strains, is higher than construction and factory workers. Aides are sometimes kicked, bitten or spat upon by residents suffering from dementia.

Such demands lead to high labor turnover. Between 43% and 75% of nursing aides turn over each year, various studies have found. That compares with a 28% rate for all health-care and social-assistance jobs in 2012, according to U.S. government data. [...]

Low pay doesn’t help. The median hourly wage for nursing aides is $11.74, according to the U.S. Labor Department, compared with $16.71 per hour for all occupations.

“These people are the actual backbone of nursing-home care,” says Lew Little, chief executive officer of Harden Healthcare LLC, Austin, Texas. Hourly pay for nursing aides at some of Harden’s nursing homes in Texas starts at $8.25, or $1 above the minimum wage.

There were about 40 million Americans over the age of 65 in 2010. As the Baby Boomers age, that number is projected to reach 73 million by 2030. The U.S. government estimates that growing elderly population will require five million direct-care workers in 2020 — nearly 50 percent more than the current workforce.

Direct-care health workers are essential foot soldiers in carrying out many of the reforms included in Obamacare, as the health law works to reduce medical costs by coordinating care more efficiently. The Obama Administration has pushed to increase labor protections for health aides — who often don’t receive adequate benefits, thanks to a federal loophole that classifies in-home health workers in the same “companion” category as babysitters — but Republican lawmakers and business groups have criticized the effort.

The New York state Attorney General’s office has launched an investigation into Correctional Medical Care (CMC) Inc., a private health care contractor that has become the Empire State’s largest provider of medical services to county jails. The investigation comes in the wake of nine inmate deaths at several different jails between 2009 and 2011 that have all been linked to negligent or inadequate care provided by CMC.

A report by the Commission of Correction’s Medical Review Board highlighted inadequacies in the care provided by CMC, including poor communication, negligence, and failure to live up to its own stated standards of medical care:

The Medical Review Board has blamed CMC for failing to follow its own drug withdrawal and detoxification policies, for ignoring signs of mental illness and for failing to treat some illnesses, the Press and Sun-Bulletin reported. The board recommended county-level inquiries to decide if CMC is to continue to provide services at the Broome, Tioga and Dutchess county jails.

CMC has provide medical services at the Broome County jail since 2006 under contracts worth more than $18 million through the end of 2013. Sheriff David Harder told the newspaper he was satisfied with CMC’s track record and noted few inmate complaints.

The state review board report said CMC failed to follow its own intoxication and withdrawal policy after Alvin Rios was booked into jail following his July 2011 arrest for criminal possession of a controlled substance. The doctor said he wasn’t made aware of Rios’ condition. The report said Rios was left in a “life-threatening status without appropriate medical attention” and died of a heart problem.

Other inmate deaths included 26-year-old Justin McCue, who hanged himself after his mental health services were halted; Maria Viera, who died of a heart inflammation after CMC failed to provide her with proper detoxification procedures; and a number of suicides that stemmed from a combination of improper mental health evaluations and insufficient medication.

A comprehensive 2009 study published in the American Journal of Public Health found that New York’s use of private health contractors has directly corresponded with the state’s ballooning prison population — and those concurrent trends have the potential to exacerbate each other. That’s because higher incarceration rates have led to exploding demand for cheap medical services, which in turn promotes profit-driven behavior from health care companies, since they actually have a financial incentive to see more Americans put in jail. In New York, that dynamic has resulted in the growth of “for-profit corporation[s] providing cost wary, yet expensive and inconsistent care” in a state that spends three and a half times more money on prisons than it does on education.

The CMC investigation underscores the serious problems stemming from a combination of exploding prison populations, states’ increasing use of for-profit health care contractors, and budget cuts to safety net programs. And this isn’t the first time that this issue has been in the news recently. California Gov. Jerry Brown is also currently under fire for turning a blind eye to his state’s lackluster prison health care.