health care

Fort Dodge, Iowa, is not exactly what you'd think of as a hotbed of health care innovation. But the small town in the western part of the state is part of a Medicare pilot project that economists say could be a pathway to the holy grail of health care: providing better care at a lower cost.

If you advertise it, they will come. Sign-ups for Medicaid are brisk, even in states that haven't expanded their programs with an infusion of federal dollars. Experts call that the "woodwork effect" — getting the word out to people who were already eligible.

The health care law is helping low- and middle-income Americans pay for their insurance. Where does that money come from? In part, it is a matter of the well-off helping pay for those who have less. But that's not the full answer.

President Obama's proposal — designed to help reverse the recent cancellation of some health policies — seems to leave the decision up to insurance companies. But there are other decision-makers in the mix who are just as important: state regulators.

Medicare has tied incentive payments and penalties to two-dozen quality measurements, including surveys of patient satisfaction and death rates. More than 1,200 hospitals are receiving bonuses. But more hospitals are being paid less for each Medicare patient they treat for the year that began Oct. 1.

The health care fix announced by President Obama on Thursday may be good news for some consumers, but it creates a big headache for insurance companies and regulators. An insurance industry trade group warns the last-minute change could destabilize the market and lead to higher premiums.

President Obama has acknowledged the fumbled rollout of his signature health care law has hurt his credibility and that of fellow Democrats. He offered a minor change to the law in hopes of calming Democratic nerves, and beating back bigger changes proposed by House Republicans.

The Obama administration is plugging its health care plan by saying that half of young, single people can buy health coverage for $50 a month or less. A closer look at the claim finds that it's more like a third of single, uninsured, young adults who would get a deal that good.

The Obama administration says just about 100,000 people managed to choose health plans through the federal and state health exchanges during their first month of the program. Critics say that shows the law is failing. But most analysts say the first month's numbers wouldn't have meant very much, even if the federal website had been working properly.