This week, potential Republican presidential contender Gov. Bobby Jindal (R-LA) rolled out one of the country’s most regressive tax proposals, a plan that would shift Louisiana’s tax burden away from the wealthy by raising taxes on the bottom 80 percent of state residents. Apparently, the “austerity” measures don’t stop there.

According to New Orleans CBS affiliate WWLTV, Louisiana residents over the age of 21 who are on Medicaid — the public insurance program for disabled and poor Americans — will stop receiving hospice care benefits at the end of this month. That means that low-income Louisianans with terminal illnesses, debilitating disabilities, and chronic long-term medical problems will no longer have access to the essential home and medical care that they need.

And while the cuts are intended to help the state balance its budget, critics point out that it is more likely to increase health care costs by pushing previously-insured Americans with costly medical conditions into private hospitals and emergency rooms where they will not be able to afford their treatments:

The Louisiana Department of Health and Hospitals say the elimination of hospice care for Medicaid patients will mean nearly $3.3 million in savings this year alone. In 2014, it’ll mean $8.3 million in savings.

However, Burns believes the state will end up paying much more with terminally ill patients forced to turn to local hospitals.

“They’ll just go in and out of the hospitals, maybe go to ICUs, and they won’t be able to have their family around them with hospice care,” said Burns. [...]

DHH says there were 5,819 recipients of hospice services through Louisiana Medicaid in the previous fiscal year.

By the Louisiana DHH’s own estimates, the cuts to Medicaid hospice-care beneficiaries are only expected to reduce the state’s projected $900 million budget deficit by 0.92 percent in 2014. These cuts will be imposed on top of the already draconian cutbacks to public education and health care programs that Jindal has in the pipeline.

Battles over Medicaid funding, particularly for those in need of long-term, specialized care, are nothing new. State budget cuts to the Medicaid program have long left disabled and special-needs Americans by the wayside, even in progressive states such as California. But one of the easiest ways for states to address their perennial public health funding issues is for them to participate in Obamacare’s Medicaid expansion, which the federal government will fund for the first several years.

Jindal, however, has refused to participate in the expansion, calling it a “bad idea” that is “expensive for taxpayers.” Ironically, Louisiana already takes in considerably more tax revenue from the federal government than it pays out, and Jindal’s Medicaid cuts — coupled with his refusal to expand Medicaid — will likely exacerbate that dynamic by forcing Americans across the country to subsidize care for Louisianans who have fallen through the safety net.

In a striking example of the intersection between America’s broken health care system and 21st century information technology, doctors and dentists are successfully luring younger Americans between the ages of 20 and 40 into purchasing online coupons for their health care needs, Kaiser Health News reports.

The coupons tend to attract younger patients looking for one-off services that don’t require much follow up. Tellingly, even though many of these Americans already possess private insurance, the online deals are more generous than their benefits:

Health and medical deals make up about 5 to 10 percent of the online coupon industry, according to Unaiz Kabani, data product manager at Yipit, a service that aggregates companies’ daily deals. Groupon, the market leader, had about 115 million subscribers in 2011, which he says are mostly 20- to 40-year-old college-educated women. Living Social says it has about 70 million members.

Health providers often see good results after an initial offer, but the patients who come in for treatment frequently don’t return.

“When you’re looking at a demographic that’s young, where some may have insurance, some many not, they’re more inclined to be episodic,” said James Doulgeris, a health care business and marketing strategist at HCP Associates.

He said coupons are often the cheapest option for healthy people who may not need follow-up appointments. Even for those enrolled in a private insurance plan, the cost of using an online deal or a retail clinic may be less than seeing an in-network physician.

ThinkProgress has previously reported on multiple instances of Americans resorting to desperate measures such as online “crowd funding” — in essence, cyber-begging — in order to pay for their medical care. This is as much a testament to the consumer-assisting potential of the Internet as it is an indictment of America’s increasingly costly health care system.

Although many of the Americans utilizing such deals are doing so out of convenience and don’t suffer from recurring or debilitating health problems, the fact that a fair number of them already have private insurance should serve as a warning sign regarding the pitfalls of inadequate coverage. And the problem only gets worse for those with more extensive medical needs. While Obamacare will assist Americans in purchasing private insurance through its federal subsidies, its “essential health benefits” do not encompass several common — and expensive — treatments such as vision care and dental care for adults.

In the wake of the mass shootings at a Connecticut elementary school in December, the American public began engaging in a national conversation about improving the U.S.’s mental health care system to prevent future tragedies. While improving Americans’ access to mental health services is important, some pro-gun advocates like the NRA have used America’s floundering health care system as a convenient scapegoat for violent crimes, despite the fact that people with mental health problems are not statistically inclined towards violence.

It’s true that poor Americans — who are disproportionately affected by mental disorders — shouldn’t struggle to access the mental health services they need, but the existing barriers to that type of health care is just one flaw in a mental health system that may have even bigger problems. New research published in the medical journal JAMA Psychiatry suggests that mental health treatments may not be effective until the U.S. reforms the way they are administered.

According to the study, even though 55 percent of suicidal teenagers had actually received some form of treatment for their depression, that alone was not enough to prevent them from attempting suicide in the absence of comprehensive medical procedures that take disparate mental health issues into account:

Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference.

The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavior problems that can lead to impulsive acts, experts said. According to the Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.

“I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide,” said Dr. David Brent, a professor of psychiatry at the University of Pittsburgh, who was not involved in the study. “We simply do not have empirically validated treatments for recurrent suicidal behavior.”

The lack of holistic treatment to address all areas of mental health — rather than simply focusing on one part of the larger issue — isn’t unique to depression and suicidal teens. Americans with eating disorders often find themselves with spotty benefits and lack comprehensive care due to the complex, wide-ranging physical and mental manifestations of their sickness. Any effort to truly reform America’s mental health system must begin with a basic understanding of the various ways that a patient’s disorder might manifest itself, and how it relates to other aspects of the patient’s medical history.

Many Obamacare provisions are intended to protect Americans from the private insurance industry, such as measures to prevent insurers from denying coverage to Americans with pre-existing conditions and to keep rising insurance premium rates in check. Nevertheless, as the New York Times reports, some of America’s largest insurers are exploiting a lack of stringent oversight in Obamacare to hike their premiums by double-digits anyway.

Insurers like Aetna and Anthem Blue Cross are requesting rate hikes as steep as 26 percent — amounting to hundreds of dollars that Americans will be forced to pay in higher premiums every month — in states such as California and Florida, and there is little that states can currently do to stop them:

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

While Obamacare does require state regulators to review any rate increase request above 10 percent, it does not endow those regulators with any meaningful veto power. Such rate-setting policies are left to states’ discretion, and although 37 states may currently negotiate or reject insurers’ desired hikes, some states with large markets — such as California — do not have this ability.

Large insurers claim that the hikes are necessary in order to keep up with general medical inflation. But since medical inflation has actually been relatively low in recent years, this claim falls flat. Insurers may actually be raising their rates in an attempt to counteract other Obamacare consumer protection measures such as the “80/20 rule” that requires insurance companies to spend at least 80 percent of the premiums they charge on actual care rather than their profits or overhead. In 2014, Obamacare will also end the practice of medical “underwriting” — taking a consumer’s current health into consideration when setting his or her premium rates — so insurance companies may be trying to lock in higher rates on sicker Americans while they still can.

Fortunately, the 80/20 rule — which has already put over $1.5 billion in insurance rebates back in consumers’ pockets — will help ensure that Americans are refunded some of their money if the latest round of rate hikes are excessive. But the only way to ensure that Americans are not held hostage to the whims of private insurers is to expand state regulators’ ability to negotiate and control premium rates.

And lawmakers are quite aware of the discrepancy. Three years ago, Sen. Dianne Feinstein (D-CA) introduced the Health Insurance Rate Authority Act of 2010 in an effort to give regulators more control over insurance rate hikes, but the bill died in committee. President Obama has also called for greater federal oversight of insurance rates.

In a case that encompasses illegal drug promotion, corporate kickbacks to doctors, and pre-meditated Medicare fraud, Los Angeles Times reports that biotech and pharmaceutical conglomerate Amgen will be fined $762 million after pleading guilty to allegations of improper drug marketing.

Kassie Westmoreland, a former Amgen employee and a whistleblower in the suit, was one of several people to charge that Amgen promoted the anemia-treatment drug Aranesp for off-label use and overfilled doctors’ promotional samples of the drug. In a brazen twist, Westmoreland also claims that the company orchestrated a collusive scheme to allow doctors to fraudulently profit off of their patients’ drug benefits:

[Westmoreland's] suit charged that Amgen overfilled vials of Aranesp to supply doctors with extra medicine at no charge. She alleged the company then encouraged doctors to bill Medicare and private insurers for this surplus amount, reaping them extra profit. Amgen pursued this strategy to take business away from Procrit, a popular anemia drug sold by Johnson & Johnson, according to the suit.

The Westmoreland case cited internal spreadsheets used by Amgen sales representatives to allegedly show doctors how much more money they could make from the overfills.

“Amgen provided extra product in the Aranesp vials as a liquid kickback that doctors could then cash in with federal and state governments through Medicare and Medicaid reimbursements,” said Charles Kester, a Calabasas attorney who represents Westmoreland along with law firms in Boston and Washington, D.C. “Amgen is being held to account in a serious way for its choices to market this drug unlawfully.”

Amgen’s penalties highlight the fact that most federal health care settlements stem from Medicare fraud and pharmaceutical misconduct. While doctors can prescribe drugs for off-label use, it is illegal for pharmaceutical companies to advertise drugs for purposes other than what the Food and Drug Administration (FDA) has approved. But settlements of this kind — and the government’s ability to crack down on drug makers’ practices that may threaten public health — could soon be a thing of the past.

A recent appellate court ruling in favor of the pharmaceutical industries’ right to promote their products as they see fit has set the stage for a Supreme Court showdown over drug makers’ First Amendment rights — and opens up big questions about how stringently the FDA can regulate Big Pharma.

One of Obamacare’s major approaches to tackling skyrocketing health care costs is by encouraging a healthier citizenry through a combination of healthy-living incentives to doctors and patients and free preventative care services for Americans. Smoking cessation efforts have been a major part of those preventative efforts — and with good reason, since cardiovascular disease is the number one cause of death in America, and localities that engage in aggressive anti-smoking efforts tend to see a substantial return on their investment.

But a recent study by the public health advocacy group Tobacco Free Kids finds that there is a large amount of confusion over the rules governing smoking cessation in qualifying health plans, as Kaiser Health News reports:

[W]hen researchers at Georgetown University’s Health Policy Institute examined 39 health plans in six states, they found that coverage for smoking cessation was often confusing. Many contracts didn’t clearly state that the coverage was available, didn’t cover recommended treatments and/or didn’t provide it without cost-sharing.

“The study points out the need for the Department of Health and Human Services to provide much more specific guidelines,” Myers says.

Insurers offer a different perspective. “The final rules [for preventive services] recognized that there wasn’t necessarily a one-size-fits-all approach,” says Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group. “So we would expect to see variation around the methods that plans are using.” In addition, she said AHIP’s own survey of plans found that nearly all offer some type of intervention for tobacco users.

It isn’t surprising that AHIP is content with the current fragmented coverage. Covering smoking cessation programs as preventative care, without charging Americans a co-pay, ultimately translates into higher costs for the insurance companies that AHIP represents. Fortunately, though, the health care reform law is less interested in guarding insurers’ profits and more interested in reducing Americans’ medical costs by encouraging them to improve their health. So better guidelines should naturally follow.

Especially considering the fact that recent Obamacare rules also allow insurance companies — to an extent — to charge American smokers higher premiums than non-smokers, it would be unfair to Americans if the federal government did not offer clearer guidelines on the preventative services that smokers will receive in return for their health care payments.

The designation of anti-smoking programs as freely available preventative services has also been extended to the seniors on Medicare.

During his address in the wake of last Friday’s tragedy at Sandy Hook Elementary School, President Obama lamented that the children who survived the shooting have had their innocence “torn away from them too early.” As this latest tragedy has highlighted America’s underfunded and inadequate mental health system, some do wonder if the trauma from the shooting will leave those survivors with long-term mental and emotional health problems.

But according to the New York Times, even young children are mentally resilient, and the available empirical data suggests that the survivors of Sandy Hook will be emotionally stable in the end:

“Most kids, even of this age, are resilient,” said Dr. Glenn Saxe, chairman of child and adolescent psychiatry at NYU Langone Medical Center. “The data shows that the majority of people after a trauma, including a school assault, will end up doing O.K.”

In a 2007 Duke University study that psychiatrists say is nationally representative, only 13 percent of people who had experienced a traumatic event before age 16 developed symptoms associated with post-traumatic stress disorder, and less than 1 percent developed “full-blown” PTSD. Over all, more than two-thirds of the 1,420 children surveyed reported experiencing some kind of trauma.

“Like recovering from surgery, you could end up with a scar, and depending on the surgery it could be a big one,” said Dr. Don Bechtold, medical director of the Jefferson Center for Mental Health in Wheat Ridge, Colo. “People get better — the extent of what ‘better’ means is relative.”

It is difficult to predict exactly how such trauma might manifest itself in shooting survivors’ mental health, but it is possible to improve the mental health treatment available to them. Mental health services have been the target of budget and benefit cuts year after year in America — particularly during the recession — leading many Americans to resort to the public education or penal systems to access those services. Furthermore, studies estimate that a full 70 percent of children who need mental health care do not receive it.

Since last Friday’s mass shooting at Sandy Hook Elementary School in Newtown, CT, the media coverage has largely concentrated on gun control policies and America’s ongoing inability to address mental health issues. While the image of twenty dead children makes the effects of gun violence vividly tangible, it doesn’t reveal the full extent of the costs of what some might argue has become an American epidemic.

According to a Centers for Disease Control (CDC) study, nonfatal gun injuries and gun-related deaths cost the United States $5.6 billion in medical spending every year, and an additional $64.6 billion when accounting for the lost productivity that stems from gun-related violence:

Worse still, victims of gun violence tend to be concentrated in urban and inner-city regions — the types of Americans who are less likely to be employed or have health insurance, and more likely to pass the cost of their care onto other Americans by relying on emergency room services.

Although the number of gun-related deaths has been lowered thanks to breakthroughs in medical technology, the actual incidence of gun-related violence has actually been increasing.

Michigan’s Gov. Rick Snyder (R) has incited a political firestorm over the controversial anti-union “right-to-work” law that he signed this week. That bill has significant implications for labor rights, particularly for Michigan’s middle class, and may threaten the health care benefits that union workers receive through their collective bargaining abilities.

According to the Employee Benefit Research Institute (EBRI), union workers have much better access to health insurance than their non-union counterparts. In 2005, a full 86 percent of unionized workers had access to health insurance, compared to 59.5 percent of non-union workers:

The report goes on to say that while non-union workers enjoy more health coverage as dependents, unionized workers have a significantly lower uninsurance rate as a consequence of their ability to negotiate with employers. That bargaining power is pretty significant in an era in which employers increasingly try to push the cost of essential benefits such as health care onto their workers. For some context, the Kaiser Family Foundation estimates that Michigan adults have an uninsurance rate of 18 percent.

In fact, a Center for American Progress report estimated that if the states that don’t currently have right-to-work laws lowered their benefit levels to those in anti-union states, 2 million fewer workers would receive health insurance benefits.

Adding to the ongoing indictment of unfair cost-sharing in employer-sponsored health insurance, a new study from the Commonwealth Fund finds that employees’ contributions to health plans has skyrocketed — even though wages haven’t.

According to the report, workers in every single state have seen their health care contributions to family health plans increase by 74 percent since 2003, while the average premiums for such plans have risen by 62 percent in the same time period. At the same time, the number of workers forced to pay deductibles on their coverage has appreciated significantly, and the average workers’ deductible has doubled — all while wages saw a meager 10 percent increase over the last eight years:

Saddled with the rising cost of health care, employers have increasingly resorted to pushing their coverage costs onto workers through asymmetric cost-sharing and a growing reliance on risky, inefficient high-deductible insurance plans. The Commonwealth Fund’s report confirms earlier findings that worker contributions to premiums have been increasing at a faster rate than general premium inflation, despite the fact that corporate profits remain at an all-time high and workers’ wages have sunk to an all-time low.

And although Obamacare will actually reduce health care costs for small employers — while increasing larger employers’ costs only marginally — that hasn’t stopped some businesses from trying to frame the landmark health care law as a fiscal burden, and facing public backlash after threatening to cut their employees’ hours and wages.