Administration under pressure to appoint Obamacare CEO

FILE – In this Sept. 27, 2013, file photo, MNsure insurance exchange representatives Carlos Villanueva, left, and Emily Joyce prepare for the Oct. 1 open enrollment debut at the center in St. Paul, Minn. (AP Photo/Jim Mone, File)

(Reuters) – The White House is coming under pressure from some of its closest allies on healthcare reform to name a chief executive to run its federal health insurance marketplace and allay the concerns of insurers after the rocky rollout of Obamacare.

Advocates have been quietly pushing the idea of a CEO who would set marketplace rules, coordinate with insurers and state regulators on the health plans offered for sale, supervise enrollment campaigns and oversee technology, according to several sources familiar with discussions between advocates and the Obama administration.

Supporters of the idea say it could help regain the trust of insurers and others whose confidence in the healthcare overhaul has been shaken by the technological woes that crippled the federal HealthCare.gov insurance shopping website and the flurry of sometimes-confusing administration rule changes that followed.

The advocates include former White House adviser Ezekiel Emanuel, the brother of President Barack Obama’s former chief of staff Rahm Emanuel, and the Center for American Progress, the Washington think tank founded by John Podesta, the president’s newly appointed senior counselor.

The White House is not embracing the idea of creating a CEO, administration officials said.

“This isn’t happening. It’s not being considered,” a senior administration official told Reuters.

Some healthcare reform allies say the complexity of the federal marketplace requires a CEO-type figure with clear authority and knowledge of how insurance markets work.

Obama’s healthcare overhaul aims to provide health coverage to millions of uninsured or under-insured Americans by offering private insurance at federally subsidized rates through new online health insurance marketplaces in all 50 states and in Washington, D.C.

Only 14 states opted to create and operate their own exchanges, leaving the Obama administration to operate a federal marketplace for the remaining 36 states that can be accessed through HealthCare.gov.

The marketplace is now officially the responsibility of the U.S. Centers for Medicare and Medicaid Services (CMS) and its administrator, Marilyn Tavenner. Healthcare experts say there is no specific official dedicated to running the operation.

A CMS spokesman said exchange functions overlap across different groups within the agency’s Center for Consumer Information and Insurance Oversight.

The lack of a clear decision-making hierarchy was identified as a liability months before the disastrous October 1 launch of HealthCare.gov by the consulting firm McKinsey & Co.

Obama adviser Jeffrey Zients, who rescued the website from crippling technical glitches last month, also identified the lack of effective management as a problem.

POTENTIAL CEO CANDIDATES

Former Microsoft executive Kurt DelBene has replaced Zients as website manager, at least through the first half of 2014.

“We’re fortunate that Kurt DelBene is now part of the administration – there’s no one better able to help us keep moving forward to make affordable, quality health insurance available to as many Americans as possible,” Obama healthcare adviser Phil Schiliro said in a statement to Reuters.

The White House appears, for now, to be concentrating on ironing out the remaining glitches in HealthCare.gov to ensure millions more people are able to sign up for coverage in 2014. Good enrollment numbers are seen by both critics and supporters of Obamacare as a key measure of the program’s success.

“So my sense is that they’re not thinking about appointing a CEO in the short term,” said Topher Spiro, a healthcare analyst with the Center for American Progress.

The CEO proposal calls for removing day-to-day control of the marketplace from the CMS bureaucracy and placing it under a leadership structure like those used in some of the more successful state-run marketplaces, including California.

The new team would be managed by a CEO, or an executive director, who would run the marketplace like a business and answer directly to the White House, sources familiar with the discussions say.

They point to insurance industry and healthcare veterans as potential candidates, including former Aetna CEO Ronald Williams, former Kaiser Permanente CEO George Halvorson and Jon Kingsdale, who ran the Massachusetts health exchange established under former Governor Mitt Romney’s 2006 healthcare reforms. None of the three was available for comment.

Healthcare experts say the idea should have been taken up by the administration years ago.

“It’s the right thing to do. It’s just two years late,” said Mike Leavitt, the Republican former Utah governor who oversaw the rollout of the prescription drug program known as Medicare Part D as U.S. health and human services secretary under President George W. Bush.

“The administration is confronted by a series of problems they cannot solve on their own. They do not possess internally the competencies or the exposure or the information,” he told Reuters.

Emanuel, one of the administration’s longest-standing allies on healthcare reform, recommended a marketplace CEO in an October 22 Op-Ed article in the New York Times, calling it one of five things the White House could do to fix Obamacare.

“The candidate should have management experience, knowledge of how both the government and health insurance industry work, and at least some familiarity with IT (information technology) systems. Obviously this is a tall order, but there are such people. And the administration needs to hire one immediately,” he wrote.

The administration has adopted Emanuel’s four other recommendations: better window-shopping features for HealthCare.gov; a concerted effort to win back public trust; a focus on the customer shopping experience; and a public outreach campaign to engage young adults.

(Reporting by David Morgan in Washington; Editing by Karey Van Hall, Michele Gershberg, Ross Colvin and Will Dunham)

After Heart Surgery, Physical Inactivity Linked With Depression Risk

Posted: 12/29/2013 10:02 am EST

If you’ve just undergone heart surgery, the best thing you can do for your mental health may be to get moving.

A new study in the Canadian Journal of Cardiology shows an association between physical inactivity after cardiac surgery and increased likelihood of developing depression — a known risk factor for heart complications.

However, the researchers from the University of Manitoba and St. Boniface General Hospital were quick to note that the study only showed an association between depression and physical inactivity after cardiac surgery — it did not say whether inactivity led to depression, or if depression then spurred inactivity.

The new study is based on data from 436 patients who were undergoing cardiac surgery. Their depression levels and physical activity were analyzed before their surgery, right after they were discharged from the hospital, and three months and six months after their surgeries.

Researchers found that 23 percent of the patients were depressed before the surgery, 37 percent were depressed right after being discharged, 21 percent were depressed three months out from the surgery and 23 percent were depressed six months out from the surgery.

Being physically inactive before the surgery was associated with a doubled risk of depressive symptoms before undergoing surgery, researchers found. In addition, being physically inactive was associated with experiencing depression symptoms six months after receiving the surgery.

Researchers also found that more than half — 58 percent — of people who were considered “at risk” for depression before undergoing the surgery went on to develop clinical depression after the surgery. Meanwhile, just 28 percent of people who were considered “depression naive” before the surgery went on to develop clinical depression.

Stressful events were also found to be associated with development of depression post-surgery, researchers said.

In addition, people who were not depressed before undergoing surgery but who went on to develop depressive symptoms three to six months after surgery, were more likely to decrease physical activity compared with people who did not go on to develop depression.

Tonya Lewis Lee Talks Balancing Motherhood, Healthy Living & New Film

What the Dying Want Us to Know About Living

Health

Death teaches us not to rush past the things we’ll wish we had more of at the very end of life

by Alexandra Rosas Sunday, August 25, 2013

Twenty-five years ago, I held my grandmother’s hand as she passed away. Two and half weeks ago, it was my mother’s hand that I held as she left our world.
I was there for the last days of life with both my mother and grandmother, and in our time together, they spoke of things with a sadness and urgency that they never had before.
There’s an old photo I have of my mother, which I’ve always loved. In it, she’s a young, sharply dressed working woman in South America, and you can feel the determination in her stride. I showed her this photo just a few weeks ago, and you could’ve heard the pride in my voice as I asked if she remembered where she was going on the day it was taken.
“I have always hated that picture,” she said, which startled me. “I was always in a hurry. Hurrying. Always. For what?” She took a deep breath, and gently said it one more time, “Always in a hurry ….”
What left me astonished and teary-eyed was not the surprise of her hating the picture, but that these words were exactly the ones my grandmother had spoken to me on the morning of her own passing. I had been sitting vigil at her bedside and she was growing weaker with each day in the hospital. Stroking her hand, I spoke softly to her, “Abuela. Abuela, do you hear me? Remember when you would take us to the grocery store across the street from our house at the start of every summer, and you began our first day of vacation with a popsicle?”

Smiling, with her eyes still closed, she quietly answered, “I would tell you all to hurry, make your flavor choices, and to hurry. There was much to do. I would let you take your time choosing now, if I could. Things could have waited.”

What the dying want us to do — and wish for us to know — is to regard our lives as precious moments making up our days. They want us to focus less on the big picture of building a large body of evidence that proves our accomplishments, and more on the true wonders in our life — the kind where we find unexpected beauty that will be remembered with a wistful smile.

Like walking with your child alongside you, going somewhere without purpose. Or waiting patiently while five- and six-year-old children choose, change their minds, choose, and then change their minds again, about the root-beer-flavored or the banana-flavored popsicles.

My mother and grandmother were telling me loud and clear that as we live our lives, we have to stop running and chasing what we think leads to happiness, and slow down before we rush past the very thing we’ll wish we had more of at the very last hours of our days.

It’s not too late to make sweet memories of children or grandchildren skipping alongside us, of us just being and not doing, of grateful children looking up to us smiling with orange-stained mouths, yelling excitedly, “Thank you for waiting for me until I picked my flavor, Grandma! I didn’t know if I wanted the green or the orange!”

After hearing these words — not once, but twice — from loved ones who know everything they are about to leave behind, I know this is something I’ll be working on to change.

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Tony Yahle Declared Dead, Comes Back to Life After 45 Minutes

A man, whose heart stopped beating for 45 minutes, credits his faith for being alive and says stunned doctors who declared him dead aren’t sure what happened.

The body of diesel mechanic Tony Yahle was being prepared by nurses to be seen by his family Aug. 5 when he began to show signs of life, doctors said. He fully awakened at the hospital five days later.

Yahle, a 37-year-old West Carrollton, Ohio, resident, has been a topic of conversation since, said cardiologist Dr. Raja Nazir.

“In the last 20 years, I’ve never seen anybody who we have pronounced dead … and then for him to come back, I’ve never seen it,” Nazir told the Dayton Daily News. “Actually, I’ve never heard of it.”

Yahle says it’s a miracle and that doctors couldn’t find any defects in his heart. Their last guess was that it was all the result of a possible viral infection, he said.

Yahle’s teenage son said he spoke to his father shortly before he revived, the newspaper reported Tuesday.

“I pointed at him and said, ‘Dad, you’re not going to die today,’ ” said 18-year-old Lawrence Yahle. “I stood there for a few more seconds. I was about to walk back to comfort the family, and that’s when he started showing signs of a heartbeat.”

The teen said he “went from hopeless to hope in an instant.”

Linda Ronstadt Says She ‘Can’t Sing a Note’ Due to Parkinson’s Disease

Linda Ronstadt, the smooth-voiced singer who racked up 11 Grammy awards during a decades-long career, just revealed she “can’t sing a note” due to Parkinson’s disease.

Ronstadt, 67, received the diagnosis eight months ago, but showed signs of the disease as long as eight years ago – although she initially dismissed them as related to a tick-borne illness and shoulder surgery, she tells aarp.org in a story to be published on their website next week.

“I couldn’t sing,” she says in the interview, “and I couldn’t figure out why. I knew it was mechanical. I knew it had to do with the muscles, but I thought it might have also had something to do with the tick disease that I had. And it didn’t occur to me to go to a neurologist. I think I’ve had it for seven or eight years already, because of the symptoms that I’ve had. Then I had a shoulder operation, so I thought that’s why my hands were trembling.”

When she finally did see a neurologist, his diagnosis floored her.

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“When … he said, ‘Oh, you have Parkinson’s disease,’ I was completely shocked. I wouldn’t have suspected that in a million, billion years,” she says.

Now, she walks with the aids of poles on uneven ground and uses a wheelchair while traveling.

Singing, she says, is out of the question.

“No one can sing with Parkinson’s disease,” Ronstadt says. “No matter how hard you try.”

That means she can’t perform the many hits she has released since beginning her career in the 1960s – when she became lead singer of folk-rock trio The Stone Poneys before going solo – including “Blue Bayou” and “Don’t Know Much” (her popular duet with Aaron Neville).

Yet fans can still relive the highlights of her life in her upcoming memoir, Simple Dreams, out Sept. 17. The book does not include details of her diagnosis, but apparently touches on her high-profile relationships with men including George Lucas and former California Gov. Jerry Brown.

Ronstadt has kept a low profile for the last decade, but made news in 2004 when she was booted from a Las Vegas hotel for praising filmmaker Michael Moore during a performance.

Yet the Wall Street Journal couldn’t help but praise her vocal abilities at the time. “She doesn’t need the kind of publicity to drive her career,” said a review. “As a musician, she still has the