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Remaking Health Care

This blog explores how health reform is changing the ways in which we pay for and deliver health care in the U.S. On any given week, that could mean a look at how Republican plans to repeal Obamacare could reshape the individual insurance market, how the safety net system is adapting to new financial pressures, or whether Trumpcare will affect the trend of doctors and hospitals merging into ever-larger entities. We also explore health care costs and whether Obamacare or its successor plans can live up the promise to rein them in. Throughout, we keep watch on how the goals of health reform intersect with the shaping power of markets and human behavior. Contributors include veteran health journalist Trudy Lieberman, David Lansky, executive director of the Pacific Business Group on Health, and independent health journalist Kellie SchmittRyan White, content editor of Center for Health Journalism Digital, serves as the blog's principal editor. 

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For one mental health counselor in Washington state, Obamacare has improved mental health care for many of her clients. With some providers seeing an uptick in newly insured clients, more adults and children are getting long-needed care.

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Obamacare's enrollment period largely overlaps with the holidays, when potential enrollees' budgets and mental resources are stretched. So why not schedule enrollment season after the holidays, when tax refunds could give low-income consumers an extra nudge?

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News reports on health reform tend to focus on patients and consumers. But how are doctors faring? Some voice complaints of administrative kinks, reimbursement struggles, and coverage confusion. But not all of these problems are new, and some docs emphasize the gains being made.

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New data show that tax credits have dramatically lowered premiums for those on Obamacare plans. But for employees stuck with high-deductible plans, big out-of-pocket costs can drain bank accounts and incentivize going without care.

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Telehealth has the potential to lessen physician shortages in rural areas and deliver care to those unable to travel. Proponents hail its efficiency. Why then has it been so hard to harness new technologies to expand care to areas and groups in desperate need?

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A recent report finds California's safety-net hospitals could face huge funding shortfalls by decade's end, as federal payments for uncompensated care are cut. Meanwhile, rising medical costs and the remaining uninsured will put added pressures on the system's solvency.

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By ensuring care for inmates after release, the Medicaid expansion could improve health and lower recidivism. But efforts to enroll inmates face many challenges, from a lack of basic infrastructure to poor coordination between health, corrections and social services departments.

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A May report found a modest increase in Medi-Cal spending could give about 700,000 undocumented Californians access to care. Meanwhile, in the Salinas Valley, some say an employer-sponsored trust could provide essential care to farmworkers.

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After Obamacare's passage, California expanded its Medicaid benefits to allow those with mild to moderate mental health problems to receive care. But as the state's Medicaid numbers surge, some say there aren't enough providers to meet the rising demand.

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In response to the growing shortage of primary care doctors, some advocate for expanding the roles of nurse practitioners to expand access and lower costs. But the suggestion has met with pushback from some physician groups.

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