JAMA Forum: Can the Affordable Care Act Proceed Without the Mandate? Should It?

Gail Wilensky, PhD

Gail Wilensky, PhD

The question of whether the Affordable Care Act (ACA) can proceed without the mandate that all US individuals purchase health insurance or pay a penalty if they don’t is just one of several questions the Supreme Court will have to decide by June or whenever it issues its opinion. It depends in part on how the Court looks at the issues that have been brought before it. It is the mandate that is being challenged as being unconstitutional, not the other portions of the bill, as well as whether the ACA’s provision for Medicaid expansion is coercive. Continue reading

JAMA Forum: The Supreme Court Flunks Economics—and That’s Bad News for Patients and Physicians

David Cutler, PhD

David Cutler, PhD

This week, we were treated to the spectacle of the US Supreme Court debating economics. They called it a discussion about the Affordable Care Act (ACA), but it was more economic than legal. They spent an enormous amount of time on markets for health insurance and food (broccoli, to be specific); they spent little time analyzing precedent. Between the 9 justices and the 7 lawyers, there were 16 people who took part in the debate. As best as I can tell, not one of them had any training in economics. Continue reading

Milk Protein Can Escape Detection in Processed Foods

Enzyme-linked immunosorbent assays may be not be able to detect milk protein residue in some processed foods.  Image: Maria Volchetskaya/iStock.com

Enzyme-linked immunosorbent assays may be not be able to detect milk protein residue in some processed foods. Image: Maria Volchetskaya/iStock.com

Milk-protein residue may slip past the standard test used to detect it in processed foods, according to new research. As a result, millions of young children with milk allergy could unknowingly be exposed to milk proteins that will make them sick.

The finding, presented yesterday at a meeting of the American Chemical Society, showed that the standard enzyme-linked immunosorbent assay (ELISA) used by the food industry can’t always pick out milk proteins that have aggregated or changed shape during thermal and non-thermal food processing. Continue reading

Author Insights: Cost Has Small Impact on Children’s Use of Asthma Medication

Anupam B. Jena, MD, PhD, of Massachusetts General Hospital and Harvard Medical School, and his colleagues found that increasing out-of-pocket costs had limited effects on children’s adherence with asthma medication. (Image: David Christopher for the University of Chicago Medicine)

When insurance companies pass a larger share of the costs of asthma medications along to families, children aged 5 years or older use slightly less medication and are hospitalized more frequently, report researchers in this week’s JAMA. But such cost sharing had no significant effect on medication use or hospitalization among children younger than this age threshold.

Few studies have probed the effects of cost sharing on medication use in children. To investigate this issue, Anupam B. Jena, MD, PhD, of Massachusetts General Hospital and Harvard Medical School, and his colleagues conducted a retrospective cohort study of 8834 US children with asthma to analyze the effects of out-of-pocket costs on medication adherence, hospitalization, and emergency department use. They found that the average out-of-pocket cost of a year of asthma medication was about $150. An increase in the out-of-pocket cost for a medication led to reduced medication use among children 5 years old or older but not younger children. The authors noted that this age-related difference might be because younger children are more likely to have more severe asthma or their parents may more tightly control their medication use. Older children whose medications costs were higher also had more hospitalizations but did not make more emergency department visits. Dr Jena discussed the findings with news@JAMA. Continue reading

JAMA Forum: Listening to History in the Making

Andrew Bindman, MD (Image: Ted Grudzinski/AMA)

Andrew Bindman, MD

The revolution will not be televised,” poet-musician Gil Scott Heron famously said, and apparently neither will the US Supreme Court case reviewing whether the Affordable Care Act (ACA) is constitutional.

About a week before the historic proceedings got under way at the Court, Chief Justice John Roberts reported that the Court had rejected requests from members of Congress and news organizations for live, televised coverage of the arguments on the ACA. However, the Court did agree to release audio recordings of the proceedings on the same day. Somewhat unimpressed by this offer, Democratic Senator Richard Durbin of Illinois said that “For that gesture, I guess we can congratulate the United States Supreme Court for entering the radio age.” Continue reading

JAMA Forum: The Other Important Issue Before the Supreme Court—Medicaid Expansion

Aaron Carroll, MD, MS

Aaron Carroll, MD, MS

So much attention has been paid to the individual mandate that relatively few have bothered to focus on the other questions that will be debated tomorrow in front of the Supreme Court. One involves the expansion of Medicaid, and it is absolutely worth some time. Continue reading

JAMA Forum: Dinner Conversations—The Health Care Law and the Supreme Court

Diana Mason, PhD, RN

Diana Mason, PhD, RN

Dinner conversation about the Affordable Care Act (ACA) can turn an otherwise lovely evening with friends into eye-glazing tedium. I feared I had been the catalyst for such a transformation a couple of weeks ago when my husband and I had dinner with a friend, whom I’ll call John. Continue reading