Missourinet reports that state Sen. David Pearce (R-Warrensburg) has introduced a bill into committee that would “mandate health insurance coverage for Missourians with eating disorders that would cover the diagnosis and treatment of the eating disorder as well as residential, medical, and psychiatric treatment.”

While Pearce’s proposal is capped at $30,000 per beneficiary — to be paid for out of the state’s general fund — it still represents one of the most comprehensive approaches to addressing a public health concern that often goes ignored:

Pearce says funding for the coverage would stem from the state’s heath plan. “The funding, I would assume would come from general revenue. A lot of this would be done by the Missouri consolidated health plan,” he said. “So a lot of that could be taken from existing information, statistics, that the state already has.”

Pearce says that by having this coverage, it can ward off the possibility of long-term hospital stays, or even death, by posing the questions, how much money can be saved in the long run and how many lives can be saved? “Eating disorders is treatable if it’s caught early,” he said. “And how we can save lives and improve the lives of folks, and yet, if we don’t catch it early eating disorders has the number one fatality of all mental illnesses.”

Pearce rightfully calls eating disorders what they are — mental illnesses — but it’s a bit more complicated than that. Eating disorders are extraordinarily complex conditions to treat, as effective regimens address the intertwining physical and mental components of the disease. That’s easier said than done in a health care system that does not assume parity between mental services and more “traditional” treatments. And while Obamacare will require insurance plans to offer some form of mental health coverage as one of its “essential health benefits,” states still have most of the discretion when it comes to determining how generous those benefits will be.

That’s also what makes Pearce’s bill important. Lack of adequate funding for comprehensive eating disorder coverage prevents nine out of ten Americans suffering from the condition from receiving treatment — $30,000 in comprehensive benefits could significantly shift that dynamic in Missouri.

Florida Gov. Rick Scott (R), a former hospital CEO and ardent Obamacare critic, announced at a press conference Wednesday evening that he will accept Obamacare funding in order to expand his state’s Medicaid program for low-income Americans. The move comes after Scott secured a waiver to privatize the public insurance program.

The decision represents a marked departure from Scott’s previously held stance. Scott didn’t just initially oppose taking part in the expansion — which the Supreme Court ruled to be optional last summer — he knowingly cited wildly inaccurate figures to inflate the program’s cost to the state by 2500 percent in an effort to discredit it. He eventually dropped his estimate for the expansion by $23 billion in the face of intense media scrutiny. The federal government will pay the lion’s share of funding for states that expand Medicaid, including fully funding expansions for the first three years.

Participating in the expansion will provide medical and financial security to about one million low-income Americans in Florida, a state that has one of the nation’s highest uninsurance rates. But some public health officials worry that Scott’s concurrent decision to privatize the state’s Medicaid program could leave poor Americans by the wayside. An initial pilot program for the privatization in five Florida counties was rife with collusive practices, dropped coverage, and profit-making at the expense of Floridians’ health — but Florida lawmakers claim that they have fixed the problems, citing “increased oversight and more stringent penalties, including fining providers up to $500,000 if they drop out.”

Scott’s decision comes after intense lobbying by Florida’s hospitals, who would benefit greatly from treating low-income Floridians with actual insurance as it would substantially lower their uncompensated care costs. “If Florida doesn’t expand Medicaid, we’re going to have the money taken out of one pocket, we just won’t get it put back in the other,” said Tommy Inzina, chief administrative officer at BayCare Health System.

But regardless of Scott’s motives, his actions could serve as a model for the 10 remaining GOP governors who have still not announced whether or not they will take part in Obamacare’s Medicaid expansion. To date, six other Republican governors — in Arizona, Michigan, New Mexico, North Dakota, Ohio, and Nevada — have decided to expand their Medicaid programs. Wisconsin’s Scott Walker recently announced his own alternative plan that, while better than nothing, will substantially limit the number of services and benefits that low-income Wisconsinites have access to.

During an interview with Fox News host Greta Van Susteren on Wednesday night, Republican National Committee (RNC) Chairman Reince Priebus made a rather bold prediction about President Obama’s second term, asserting that the president’s “brand” would suffer over the next four years as Americans come to grips with what Priebus paints as the dire consequences of health care reform.

Priebus was reacting to a just-released Congressional Budget Office (CBO) report with updated projections on the federal budget and Americans’ insurance coverage under Obamacare. The report reassessed the number of Americans who will no longer receive employer-sponsored health insurance as the health law takes effect, increasing it from 4 million to 7 million Americans. This led Priebus to forecast a slippery slope in which more and more Americans lose their health coverage, indelibly tainting Obamacare’s — and President Obama’s — public image:

PRIEBUS: I think over time people are going to see, over the next four years, that this is not going to be a new story, this is going to be — next year — another story is going to come out and instead of seven million people dropped off the health care rolls, you’ll find it’s going to be 14 million… And more people aren’t going to be able to keep the insurance that they were promised. Businesses are out there saying, wait a second, this is too expensive and so we’re not going to provide this to our employees, so what we’re going to do is drop the insurance, pay the fine and it’s cheaper, and people are going to be left out in the cold. We knew this was going to happen, and we said it’s going to happen, and I think over time the Obama brand — the next four years — the reality of what the truth is going to be under his signature program, which was Obamacare, is going to go down in flames and people aren’t going to like it.

Watch it:

But there isn’t actually any evidence supporting Priebus’s claim that the number of Americans losing employer-sponsored insurance will somehow double next year. As Wonkblog’s Sarah Kliff explained on Wednesday, the reason the CBO increased its projections of Americans who would lose employer-provided coverage is due to the recent “fiscal cliff” deal that set low income tax rates on those making less than $450,000. As Kliff noted, “providing health insurance as a tax-free form of income becomes less attractive when marginal tax rates are lower — and when a publicly-subsidized option becomes available.” Ironically, this problem would have been exacerbated even further if GOP leaders like Priebus and House Speaker John Boehner (R-OH) had gotten their way and codified lower tax rates for millionaires and billionaires.

And it’s misleading to equate Americans losing their employer-sponsored insurance with Americans losing any form of insurance — particularly since Americans who lose employer-sponsored coverage can still receive federal subsidies to help them purchase private insurance on the individual marketplace. Predictions of how many employers will drop coverage may also be overblown, as studies have shown that Obamacare only modestly increases large businesses’ health care costs while actually lowering costs for small businesses.

As part-time workers, the poor, and Americans with pre-existing and costly medical conditions learn more about the law’s substantial benefits for them, support for repealing Obamacare has plunged to an all-time low. In the meantime, however, it appears that reform critics will continue their misleading smear campaigns against the health care overhaul.

Two separate reports by the Centers for Medicare and Medicaid Services (CMS) and Health Affairs builds upon earlier research to conclude that private insurance plans under the Medicare Advantage program drive up Medicare spending. Ultimately, those private plans raise health care costs by encouraging seniors to cherry pick their health plans respective to their health, Kaiser Health News reports.

Private insurance plans under Medicare Advantage are often able to attract healthier Medicare beneficiaries by offering cheap — but bare-bones — health plans. When those healthier seniors encounter a medical problem that’s too extensive for their private coverage, they switch over to the more generous traditional Medicare program in order to take advantage of its more expansive benefits. That in turn, raises spending in the traditional Medicare pool:

A study released Thursday, by Gerald Riley, a researcher at the Centers for Medicare & Medicaid Services (CMS), adds to those concerns. The study looked at more than 240,000 people who dropped out of Medicare Advantage plans in 2007, and compared them with beneficiaries who remained in traditional Medicare the entire time. In the six months after leaving the private plans, the former Medicare Advantage patients used an average of $1,021 in medical services each month, while the patients in the control group cost Medicare $710 a month, the study found.

Another study in the December issue of the journal Health Affairs found that people “disenrolling were much more likely than other beneficiaries to report health declines.” Those researchers, led by J. Michael McWilliams, a Harvard Medical School professor, surmised that beneficiaries who developed serious ailments might leave the plans to get unfettered access to physicians and treatments through traditional Medicare, but neither that study nor Riley’s determined what motivated the changes. [...]

McWilliams’ study, along with other analyses in the same issue of Health Affairs, found that generally, Medicare has succeeded in reducing cherry-picking by Medicare Advantage plans by changes in how the program worked, including restrictions in the time periods that people could switch from a private plan back to traditional Medicare. In 2006, Medicare tried to crack down on switches by limiting them to once a year rather than monthly.

While the Health Affairs study notes that there have been some protective measures instituted to prevent this cherry-picking, it still occurs in considerable volume. The findings underscore the reality that adverse selection remains a costly problem in private insurance markets.

While some critics might claim that reductions to Medicare Advantage payments under Obamacare could encourage seniors to continue disenrolling from private Medicare Advantage plans, that hasn’t borne out in reality. In fact, since Obamacare’s cuts to overpayments in Medicare Advantage began to be phased in, enrollment in the program is up while premiums are down.

Furthermore, increased enrollment into traditional Medicare might actually be a desirable outcome — the traditional Medicare program costs less per capita than the private Advantage program. And as these recent studies show, Advantage plans tend to fall short — and cost more — once beneficiaries get sick. As Center for Medicare Advocacy executive director Judith Stein put it, “Private Medicare Advantage plans work for people when they are relatively well, but fall short of traditional Medicare when they are sick or disabled.”

The vast majority of part-time workers in the U.S. don’t have employer-based health insurance, according to a new study from the ADP Research Institute — an issue the health care reform law will help address once it is fully in effect.

The majority of Americans access health insurance through their jobs. But the results from ADP’s study highlight the fact that the current employer-based model often leaves low-wage workers, and particularly those who work fewer than 40 hours a week, in a coverage gap. Only a small percentage of part-time employees are offered health insurance through work, and many of them can’t afford to pay into those plans — but they also typically can’t afford to purchase insurance plans on their own, either.

Fortunately, several Obamacare provisions — including extending Medicaid coverage to additional low-income Americans, providing Americans with subsidies to help them purchase health care on state-based insurance markets, and requiring employers with more than 50 workers to provide health insurance — will start to eliminate some of those coverage gaps and help part-time workers better afford health coverage:

The ADP Research Institute analyzed data from about 300 large employers covering 2 million workers and dependents. Among the employers studied, 23 percent of their workers are part-time but only 8 percent get company-sponsored health benefits. Just 15 percent of part-time workers are even offered health insurance.

Cost is the main reason part-time workers don’t enroll in company health plans when they’re available, especially among those who earn less than $30,000 a year, said Tim Clifford, the president of ADP Benefit Services. That group is due to receive the largest financial assistance under health care reform.

“Part-time coverage has always been pretty low,” Clifford said. “There’s no question that the law will extend coverage to millions of Americans,” he said. But it also will create some disruption within the realm of employer-sponsored health benefits as companies decide whether to open their insurance plans to more workers or devise strategies to avoid Obamacare’s new rules and costs, he said.

ADP’s study builds upon previous research that confirms the health care reform law will help low-wage workers afford the health coverage they need. Particularly in recent years, as health care costs have been skyrocketing while workers’ wages are stagnating, increasing numbers of Americans worry about being able to access and afford insurance coverage.

But as Clifford noted, that hasn’t stopped several extremely profitable companies from trying to get around Obamacare and continue denying their workers basic health benefits. The restaurant industry, which often employs low-wage and part-time workers, has been particularly resistant to Obamacare’s regulation that requires businesses to ensure their employees will be able to afford health care.

By January of next year, Obamacare will require Americans to have insurance coverage, either through their employer or through one of the health law’s statewide insurance marketplaces. In order to make that coverage affordable, the law provides progressive insurance subsidies in the form of tax credits for Americans buying coverage on the marketplaces and fines companies that don’t cover their workers. But an existing loophole in the law may leave some American families in a coverage gap — and Congress may not be able to agree on a solution to fix the glitch.

The families in question would be unable to afford family health plan premiums through their employer, while also ineligible to qualify for the subsidies to help them buy an alternative plan on an Obamacare exchange. As Modern Healthcare explains, the loophole has to do with the definition of what is considered “affordable” coverage under the law, which is directly related to the federal subsidies that a family is eligible to receive:

Congress said affordable coverage can’t cost more than 9.5 percent of family income. People with coverage the law considers affordable cannot get subsidies to go into the new insurance markets. The purpose of that restriction was to prevent a stampede away from employer coverage.

Congress went on to say that what counts as affordable is keyed to the cost of self-only coverage offered to an individual worker, not his or her family. A typical workplace plan costs about $5,600 for an individual worker. But the cost of family coverage is nearly three times higher, about $15,700, according to the Kaiser Family Foundation.

So if the employer isn’t willing to chip in for family premiums — as most big companies already do — some families will be out of luck. They may not be able to afford the full premium on their own, and they’d be locked out of the subsidies in the health care overhaul law.

Ron Pollack, the executive director of the health care advocacy group Families USA, told Modern Healthcare, “This is a very significant problem, and we have urged that it be fixed. It is clear that the only way this can be fixed is through legislation and not the regulatory process.”

Unfortunately, that doesn’t bode well for the American families who fall inside of this coverage gap. While Obama Administration officials have called for a fix, the GOP-controlled House of Representatives has been staunch in its refusal to do anything with Obamacare other than obstruct its funding sources. Some Republicans have gone even further than that, attempting to strip away the law’s federal insurance subsidies to Americans in states that choose not to implement their own exchanges, claiming that a semantic technicality in Obamacare forbids assisting Americans in such states from buying coverage — a move that the Administration has vehemently rejected, since it would financially devastate Americans in half of the country.

The IRS has instituted certain regulations in an attempt to mollify the impact of the loophole on American families, ruling that families that fall into that coverage hole will not be subject to the law’s penalty for not purchasing insurance. All in all, very few Americans will actually be subject to the individual insurance mandate penalty, and 80 percent of those who will have incomes higher than the federal poverty level. Still, that may end up being small comfort for the Americans whose employers choose not to pitch in for family health plans.

More than a decade after the 9/11 terrorist attacks, 15 first responders were the first to receive health payouts on Tuesday as part of a federal compensation fund for victims.

The awards will help victims and their families face the unexpected healthcare costs, lost wages, and suffering that resulted from the exposure to toxic fumes, dust and smoke at Ground Zero. And as of last year, 50 types of cancer that may be linked to Ground Zero exposure are finally eligible for coverage as well.

Thousands have suffered from respiratory illnesses and other diseases since assisting in the aftermath of the 9/11 attacks, and the death toll for emergency responders has exceeded 1,000.

Because of the sheer number affected, the fund “could in theory, according to an actuarial calculation, have to pay $8.5 billion, far more than it can afford.” In 2010, Republicans temporarily blocked the plan in the Senate, and effectively cut down the health coverage able to be provided over the fund’s five-year period.

Last week, Louisiana’s poor and terminally ill residents won a surprising victory when Gov. Bobby Jindal (R) announced that his state would not stop providing hospice care to its Medicaid beneficiaries. Unfortunately, that’s about the only piece of good news for low-income Louisianans’ health coverage, as the state is still set to implement massive cuts for Medicaid programs that “provide behavioral health services for at-risk children, offer case management visits for low-income HIV patients and pay for at-home visits by nurses who teach poor, first-time mothers how to care for their newborns” this Friday.

While Jindal administration officials argue that the cuts could be mitigated by Medicare and private managed care programs, the reality is that many of these specialty services are simply unavailable — or unaffordable — outside of Medicaid:

Health and Hospitals Secretary Bruce Greenstein said he targeted programs that were duplicative, costly and optional under the state’s participation in the state-federal Medicaid program.

Greenstein said in many instances, people can get the care they’re losing through other government-funded programs. But he acknowledged that won’t happen in every case, meaning some people will simply lose the services or receive reduced services. [...]

Jan Moller heads the Louisiana Budget Project, which advocates for low- to moderate-income families. Moller said he’s most distressed by the cut to the Nurse-Family Partnership Program.

The health department is eliminating the portion of the program that offers at-home visits to low-income women who are pregnant with their first child. Registered nurses visit the women early in their pregnancy and until their children’s second birthday, offering advice on preventive health care, diet and nutrition, smoking cessation and other child developmental issues. [...]

“What the Nurse-Family Partnership does goes above and beyond what a good obstetrician does,” Moller said. “It’s really about teaching life-skills to at-risk moms to make them better parents and make them better able to care for their children, and it’s been proven to work.”

Speech therapy programs for low-income children are also on the chopping block. The cuts — as well as Jindal’s proposals to raise taxes on the poor while slashing public education and other health care funding — are meant to plug a midyear budget deficit. But they are more likely to raise health care costs and poverty levels in a state that already ranks among America’s least-insured and poorest locales by pushing people poor people into finding services that they will no longer be able to afford.

While Jindal has spoken at length on the Republican Party’s existential need to stop being “the stupid party,” the “austerity” policies that he has pursued for his state are some of the most regressive in the entire country.

Over 50 San Francisco-based restaurant owners are under fire for prioritizing their own profits over their workers’ health care coverage. A city-wide investigation revealed that, after the restaurant industry collected a total of $14 million in worker health care surcharges in 2011, just a third of that money actually went toward providing low-wage workers with insurance.

Under a city-wide requirement, businesses in San Francisco are supposed to set aside some extra money — about $2 dollars an hour for each worker — to help their employees afford their insurance costs. When the rule first went into effect in 2008, some restaurant owners avoided raising the prices on their menu by tacking a surcharge onto the bottom of their bills and explaining to their customers that the fee would help fund workers’ health care.

But according to San Francisco Supervisor David Campos and Assemblyman Tom Ammiano, who helped conduct the investigation into the restaurant owners’ practices, those customers were being deceived. “I can’t say all of them, but for some of these restaurants it was a marketing ploy,” Campos said. And that marketing ploy came at the direct expense of their workers, some of whom didn’t have health insurance at all:

In some cases, not only did the surcharge money go back into owners’ pockets, but employees were denied health care altogether, Ammiano and Campos said.

The inconsistencies were caught after the health law was amended in 2011, requiring city audits of the surcharges. Last year, 3,652 restaurants turned in their paperwork to the labor office, which found oddities in the accounting. The documentation was then turned over to the city attorney for a full-fledged investigation. [...]

For Campos, it’s a consumer-trust issue. “These diners thought they were paying for workers’ health care. Instead these owners were gaming the system,” he said.

Low-wage workers like the employees in San Francisco’s restaurant industry typically don’t have access to health insurance — in fact, more than half of low-wage workers at small firms were uninsured in 2010. And workers’ health care costs are continuing to rise while their wages are stagnating, so it’s nearly impossible for them to afford their own insurance on the private market if their employers choose to deny them health coverage.

Obamacare will help address some of these issues in a similar way as San Francisco began doing in 2008. Starting in 2014, the health reform law will help ensure that employers can’t deny their workers health care simply to protect their own profits, and require businesses with more than 50 employees to offer basic health benefits. Nonetheless, profitable members of the restaurant industry like Olive Garden, Taco Bell, and Wendy’s are already using Obamacare as a convenient excuse to keep perpetrating their anti-worker labor practices and avoid giving their workers any benefits.