A blog covering the health/care ecosystem and people.

CNN called it, “the ancient perfume store you never heard of,” but the Officina Profumo-Farmaceutica di Santa Maria Novella had its literal roots in medicinal herbs. With scents wafting onto a 13th century Florence piazza, the Farmacia now operates as a pharmacy storefront for homeopathic and herbal supplements, along with perfumes and home scents. A visit to the pharmacy today is a journey into medicinal time-travel, back to the year 1221. I spent time in the pharmacy today to learn about the literal roots of the shop in medicinal herbs cultivated in a monastery garden and reformulated by monks into

People want to live healthier lives, and consumer good companies are responding to these demands to keep and gain market share and profit margins. Consumer product firms reformulated over 180,000 consumer products in 2016 for in response to consumers’ health and wellness wishes, based on data collected by Deloitte for The Consumer Goods Forum project (CGF) and published in The CGF Health & Wellness Progress Report. The CGF is an industry network of some 400 consumer goods, retail, and service companies supporting the global adoption of standards and practices. This Report focused on the CGF members’ progress toward health and wellness

The non-vote for and withdrawal of The American Health Care Act on March 24, 2017, was a win for the retail health market, at least in the short-run. Before the vote, there had been some pronouncements that the passage of the AHCA would have been a boon to retail health. Here’s one story stating that, “A boom in medical tourism to Mexico predicted if Obamacare ends.” Another article asserts, “Why the American Health Care Act Works for Retailers,” a public policy statement from the National Retail Federation (NRF). But NRF, please don’t fret. Retail health is consumer-driven and will persist beyond the

Yesterday, the Tweeter-in-Chief President Donald Trump tweeted, “I am working on a new system where there will be competition in the Drug Industry. Pricing for the American people will come way down!” Those 140 characters sent pharma stocks tumbling, as illustrated by the chart for Mylan shares dated 7 March 2017. This is one issue that Americans across the political spectrum agree on with the POTUS. The latest Zogby poll into this issue, conducted for Prescription Justice, found 3 in 4 Americans agree that pharmaceutical companies are “getting away with murder,” as President Trump said in a TIME magazine interview

Telehealth has come of age at HIMSS in 2017. No longer is the concept relegated to footnote or edge-booth status on the conference floor. Instead, telehealth, broadly defined, is now a mainstream concept embraced by healthcare providers, payors and, increasingly, consumers. I spent time brainstorming telehealth with one of the pioneers of modern telehealth in the U.S., Dr. Roy Schoenberg, who co-founded American Well with his brother Ido Schoenberg, in 2007. As such, the company is among the most mature telehealth entities operating in America, delivering live video health visits to millions of health consumers through the American Well telehealth

Nine in 10 U.S. consumers think pharma and biotech put profits above patient interests, according to the latest Harris Poll studying reputation equity across organizations serving health care. Notice the relatively low position of the green bars in the first chart (with the exception of the impression for “strong financial performance); these are the pharma/biotech consumer impressions. The health industry stakeholders consumers believe would more likely place them above making money are health care providers, like doctors and nurses, hospitals, and pharmacists. Health insurance companies fare somewhat better than pharma and biotech in this Poll, although rank low on social

Consumer electronics (CE) aren’t just big screen TVs, sexy cars, and videogames anymore. Among the fastest-growing segments in CE is digital health, and health-tech will be prominently featured at the 2017 CES in Las Vegas hours after the champagne corks have popped at the start of the new year. On the second day of 2017, I’ll be flying to Las Vegas for several days of consumer technology immersion, learning about connected and smart homes and cars, and shiny new things all devoted to personal health. Welcome to my all-health lens on CES 2017, once referred to as the Consumer Electronics

Why can’t the healthcare consumer experience be as easy as online banking? asks Tom Skelton, the CEO of Surescripts. That’s the expectation of most U.S. healthcare consumers, based on Surescripts latest survey results, summarized in the 2016 Connected Care and the Patient Experience report. The key findings are that U.S. consumers, Want their medical information delivered electronically, easily accessible and shareable; Are dissatisfied with the time and effort they spend on dealing with their medical information and waiting times in health care offices, both doctors and pharmacies; and, Prefer and expect innovative ways to get care and prescriptions. People are getting

Think “Hormel,” and you may have visions of SPAM, Chi-Chi’s salsa, Skippy peanut butter, and Dinty Moore corned beef hash. So what’s Hormel doing in the title of a Health Populi post, anyway, you might ask? Like many food companies, Hormel is broadening its product portfolio expanding with health. The company isn’t just moving to healthy eating for wellness’s sake, but boldly going where most food companies haven’t yet gone: developing products for people battling cancer. Vital Choices, a well-titled line of frozen meals, was developed by Hormel in collaboration with the American Cancer Society, Cancer Nutrition Consortium, the Culinary Institute

“The patient is the best sensor,” asserted Jamie Heywood, founder of Patients Like Me, during the perennial meeting sponsored by PwC, the 180° Health Forum. This event featured several panels of PwC’s curated group of so-called “provocateurs” in healthcare, and I was grateful to be one of nine selected for the event. Heywood joined Dr. Leanna Wen, Baltimore City Health Commissioner, and me in a panel called, “Strange Bedfellows or Soul Mates? The New Dating Game in Health.” The theme of our collective brainstorm was how collaborations across the ecosystem could help make health and healthcare better. The drawing is

It’s the 9th of November, 2016, and Donald Trump has been elected the 45th President of the United States of America. On this morning after #2016Election, Health Populi looks at what we know we know about President Elect-Trump’s health policy priorities. Repeal-and-replace has been Mantra #1 for Mr. Trump’s health policy. With all three branches of the U.S. government under Republican control in 2018, this policy prescription may have a strong shot. The complication is that the Affordable Care Act (aka ObamaCare in Mr. Trump’s tweet) includes several provisions that the newly-insured and American health citizens really value, including: Extending health

People feel like get-no-respect Rodney Dangerfield when they deal with health insurance, government agencies, or pharma companies. Consumers feel much more love from personal care and beauty companies, grocery and fitness, according to a brand equity study by a team from C Space, published in Harvard Businss Review. As consumer-directed health care (high deductibles, first-dollar payments out-of-pocket) continues to grow, bridging consumer trust and values will be a critical factor for building consumer market share in the expanding retail health landscape. Nine of the top 10 companies C Space identified with the greatest “customer quotient” are adjacent in some way to health:

Technology is high on U.S. consumers’ holiday shopping lists for the 2016 holiday season, according to the CTA (Consumer Technology Association). And wearable activity trackers are a fast-growing segment of consumer technology purchases expected in shoppers’ carts (both physical and online virtual) this fourth quarter of 2016, CTA notes in its 23rd Annual Holiday Outlook consumer survey research. The line graph illustrates the hot categories in this year’s holiday gift mix, led by smart phones (in red), tablets, laptops, and video game systems. But the proportion of people intending to purchase smartwatches now ties with video game system sales, closely followed

  1 in 3 consumers track health or fitness via an app, wearable technology, or smartwatch, according to GfK’s global survey on Health and fitness tracking published in September 2016. The key reasons people monitor health or fitness are to maintain or improve physical condition/fitness (for 55%) and to motivate oneself to exercise (for 50%), across the 16 countries GfK surveyed. Improving energy level, feeling motivated to eat and drink more healthfully, improving sleep, making tracking part of a daily routine, losing weight, and being more productive were cited as reasons to health-track by at least one-fourth of health citizens

More U.S. patients are faced with spending more out-of-pocket for health care services, to meet high-deductible health plans and rationally spend their health savings account investments. As rational economic men and women, some are seeking care outside of the United States where many find transparently priced, high-value, lower-cost healthcare. Check out the table from the Medical Tourism Association, and you can empathize with cash-paying patients looking for, say, gastric bypass surgery or a heart valve replacement. My latest column in the Huffington Post discussed this trend, which points first to the Cleveland Clinic — a top-tier American healthcare brand that’s

Walmart is already in the healthcare business, serving 140 million customer visits weekly, millions of whom fill prescriptions at the store pharmacy, seek personal care in the health and beauty aisles, track blood pressure using a Higi health kiosk, and shop for healthier foods in the grocery aisles. The world’s largest company on the Global Fortune 500 list hosted a Retail Health Summit in June, the details of which have been published in . The Summit, produced by Dan Mack’s Mack Elevation Forum and , convened stakeholders from across the retail health landscape: including over-the-counter medicines, personal care, aging-at-home, caregiving, genomics, disease

  Some 18% of U.S. consumers use a wearable device, according to the 2016 UPS Pulse of the Online Shopper survey. UPS researched tech-savvy shoppers with an eye to understanding where and how people buy stuff – and of course, how they ship it given the company’s core logistics business. (“Tech-savvy” in this study means consumers had purchased at least two items online in a typical 3-month period). Overall, Millennials adopt devices and do more tech-shopping compared with other generations, but UPS notes that other groups are indeed shopping for tech and shipping it, too. Millennials are leading the way,

Rationing has long been seen as a common practice in national, single-payer health systems like the UK’s National Health Service and Canada’s national health insurance program (known as “Medicare”).  However, over half of U.S. physicians say they ration care to patients. In a peer-reviewed column in the Journal of General Internal Medicine published in July 2016, Dr. Robert Sheeler and colleagues at the Mayo Clinic, University of Iowa, and University of Michigan, found that 53% of physicians surveyed personally “refrained” in the past six months from using specific clinical services that would have provided the “best patient care” due to cost.

Personal fitness equipment is getting connected in the growing Internet of Things ecosystem (IoT), and fitness enthusiasts are getting more digitally connected well beyond their wristband tracking device. , a healthy living portal, looked into fitness consumers’ digital habits and found a health-engaged cohort that’s online in the Web 1.0 world — sharing workout tips in social media communities but not so much product information. Product information is still learned Old School-wise, via product websites, traditional magazines, from peers and word-of-mouth (offline), and trying new gear out at the gym in real time. This survey was conducted among HellaWella’s readers,

When consumers consider the many stakeholder organizations in healthcare, a majority trust pharmacists first, then doctors and dentists. Hospital and health insurance execs, and members of Congress? Hardly, according to a survey from Meyocks, a marketing consultancy. Meyocks conducted the survey via email among 1,170 US adults, 18 years of age and older. This survey correspondends well with the most recent Gallup Poll on most ethical professions, conducted in December 2015. In that study, pharmacists, nurses and doctors come out on top, with advertisers (“Mad Men”), car salespeople, and members of Congress at the bottom, as shown in the second

Millions of U.S. patients have more financial skin in the American health care game. But are they behaving like the “consumers” they are assumed to be as members in consumer-directed health plans? Not so much, yet, explained John Park, Chief Strategy Officer at Alegeus, during a discussion of his company’s 2016 Healthcare Consumerism Index. This research is based on an online survey of over 1,000 U.S. healthcare consumers in April 2016. Alegeus looks at healthcare consumerism across two main dimensions: healthcare spending and healthcare saving. As the chart summarizes, consumers show greater engagement and focus on buying a TV or car, choosing

“Gas ‘N’ Health Care” is one of my most-used cartoons these days as I talk with health/care ecosystem stakeholders about the growing and central role of consumers in health care. You may be surprised to learn that the brilliant cartoonist Michael Maslin created this image back in 1994. That’s 22 years ago. When I first started using this image in my meetings with health care folks, they’d all giggle and think, ‘isn’t that funny?’ Legacy health care players — hospitals, doctors, Pharma, and medical device companies — aren’t laughing at this anymore. At a Costco a 20 minutes’ drive from

There’s growing recognition of the role of food in health, on both the supply side of grocers, food growers and consumer marketers; and, among consumers who are, increasingly, shopping for food with health on their minds. 8 in 10 consumers in the U.S. enter a grocery store thinking about the health attributes of what they’re about to choose from the aisles that are stocked with more gluten-free, GMO-labelled, and organic products, according to the 2015 Deloitte Pantry Study. Our physicians have begun to “prescribe” food, especially as the collective BMI of Americans has reached medically catastrophic levels. See this forecast from

Cost ranks first among the factors of selecting health insurance for most Americans across the generations. As a result, most consumers are likely to shop around for both health providers and health plans, learned through a 2016 Xerox survey detailed in New Insights on Value-Based Care, Healthcare Attitudes 2016. The younger the consumer, the more important costs are, Xerox’s poll found, shown in the first chart. Thus, “shopping around” is more pronounced among younger health consumers — although a majority people who belong to Boomer and Greatest Generation cohorts do shop around for both health providers and health insurance plans —

“Health comes to your local store,” explains the recently-launched portal, GoHealthEvents. This site is a one-stop shop for health consumers who are seeking health screenings and consults in local retail channels like big box stores, club stores, drug stores, and grocery stores. Events covered include cholesterol, diabetes, heart health, nutrition, osteoporosis, senior health, vaccinations and immunizations. By simply submitting a zip code, a health consumer seeking these kinds of services can identify where and when a local retailer will provide it. I searched on my own zip code in suburban Philadelphia, and found the following opportunities taking place in the

American workers are feeling financial stress and uncertainty, struggling with health care costs, and seeking support for managing finances. 75% of employees feel financially insecure, with 60% feeling stressed about their financial situation, according to the 2016 Workplace Benefits Report, based on consumer research conducted by Bank of America Merrill Lynch. The overall feeling of financial wellness fell between 2013 and 2015. 75% of U.S. workers don’t feel secure (34% “not very secure” and 41% “not at all secure”), with the proportion of workers identifying as “not at all secure” growing from 31% to 41%. Financial wellness was defined for this

As patients continue to grow health consumer muscles, their ability to vote with their feet for health care services and products grows. That’s why it’s crucial for health care providers to understand how patients perceive their quality and service levels, explained in Patient Experience: It’s Time to Rethink the Consumer Healthcare Journey, a survey report from GE Healthcare Camden Group and Prophet, a brand and marketing consultancy. 3 in 4 frequent healthcare consumers say they are frustrated with their services. One-half of less-frequent patients are frustrated. Patients and physicians are on different pages when it comes to evaluating the health care

9 in 10 people in the U.S. use some form of digital technology or electronic tools for health management, Accenture found in the company’s 2016 Consumer Survey on Patient Engagement. Younger people (18-34) tend to favor wearable technology, apps and social media for health. More older people (age 65-74) mine electronic health records (EHRs) for personal health data and more likely use tech for remote consultations with care providers. Overall, the percent of U.S. consumers accessing their EHR data grew by over 50% between 2014 and 2016, from 27% to 45% of people doing so, with older people indexing higher

When I say “Fitbit,” you may think, “digital health.” When I mention “Gatorade,” “Nestle,” and “Dannon,” you might think, “drink,” “chocolate,” and “yogurt.” But soon, the phrase “digital health” will come to mind. That’s because a growing list of food manufacturers is looking to digital technologies to bake (or cook, blend, or mix) health into their value propositions. “Gatorade Taps Into Tech-Thirsty Consumers” is an article published in today’s Wall Street Journal, page B1 in the Business & Tech section of the newspaper. Mike Estrel writes that Gatorade is going high tech, working on a “smart cap” bottle with a microchip

As HIMSS 2016, the annual conference of health information technology community, convenes in Vegas, an underlying market driver is fast-reshaping consumers’ needs that go beyond personal health records: that’s personal health-financial information and tools to help people manage their growing burden of healthcare financial management. There’s a financial risk-shift happening in American health care, from payers and health insurance plan sponsors (namely, employers and government agencies) to patients – pushing them further into their role as health care consumers. The burden of health care costs weighs heavier on younger U.S. health citizens, based on a survey from the Xerox Healthcare

Italians get the food=health connection as a natural everyday behavior. So it’s no surprise that one of the fast-selling books in Italy’s librerias is about Slow Food – a movement that’s celebrating its 30th anniversary in that hot book by Carlo Petrini, a father of the Slow Food organization. I took the photograph this evening peering into a shop window during our post-dinner walk along the Via Gucciardini past the Giunti al Punto bookstore. [In full transparency, I’ve been a long-time member of this organization, represented by the little red snail icon.] The book has a three-word title: Buono, Pulito, Giusto. This

La salute prima de tutto! Health is first of all!  I am on holiday with my favorite person in the world, my husband, and we are Italophiles. He comes by that bias genetically, and I through loving him and sharing so many joyful, enchanting experiences in la Bella Italia over our many years of marriage. The day before flying to Italy, Dr. Michael Painter, Senior Program Officer of the Robert Wood Johnson Foundation, posted a link on his Facebook page to this wonderful explanation of why Italy ranks as the second-healthiest country in the world, just after Singapore. The rankings

The so-called legacy healthcare system are the incumbents in American health care — hospitals, physician practices, pharma, health plans, and other organizations that have long-served and been reimbursed by traditional volume-based payment. Patients, now morphing in to health consumers, look to these stakeholders to provide new levels of service, accessibility, convenience, transparency and value — the likes of which people find in their daily life in other market sectors. Those consumer demands are pressuring the health system as we know it in many new ways, which I discussed with Unity Stoakes, Co-Founder of Startup Health, at the Health 2.0 Conference in

The rising cost of health care for Americans continues to contribute to self-rationing care in the forms of not filling prescriptions, postponing necessary services and tests, and avoiding needed visits to doctors. Furthermore, health care costs are threatening the livelihood of most American families, according to the Pioneer Institute. “What Will U.S. Households Pay for Health Care in the Future?” asks the title of a study by the Institute, noting that health care costs for an American family of average income could increase annually to $13,213 by 2025 — and as high as $18,251. Pioneer calculates that this forecasted spend will

It’s time to get the tea leaves out and mash up trends in my world of health, health care, technology, policy and people for 2016. We’ll start with the central player: people, consumers, patients, caregivers all. Health consumerism on the rise.  People – call us patients, consumers, caregivers – will take on even more financial and clinical decision making risk in 2016. Growing penetration of high-deductible and consumer-driven health plans will push (not just nudge) people into the role of health care consumers, and the emerging businesses and programs serving the transparency market for price and quality will gain traction

Among TIME magazine’s 25 best inventions of 2015, most relate directly or adjacently to health and health care. Among the 25 are: The EKO Stethoscope A gluten-sniffing sensor, the 6SensorLabs Nima The Sproutling baby monitor Nike Flyease 8 shoes, that you can tie with one hand Cogni-Toys Dino, the toy that talks back A smart refrigerator that can fix you a glass of nutrient-enriched water The TZOA environmental tracker for personal pollution sensing, measuring atmosphere in a specific area (e.g., temperature, particulates such as dust, pollen, mold, and car exhaust), and UV ­exposure Doppler Labs Here Active Listening earbuds The

Food + Drink, Beauty, Tech + Innovation, Retail, Lifestyle…JWT pulls out their crystal ball for 2016, and I see health, everywhere. The Future 100 – Trends and Change to Watch in 2016 is J. Walter Thompson Intelligence Innovation Group’s annual trend forecast, which I highly value and mine each year to help THINK-Health continue to hone our own environmental analyses for health and healthcare. [Here’s what I wrote one year ago about JWT’s 2015 forecast]. Health is baked into JWT’s 2016 trendscape, well beyond their “Health” chapter. Even the report’s introduction is health-flavored: “As forecasters, we’re watching the rapid metabolism

U.S. spending on medicines will approach $590 billion in 2020, increasing 34% over 2015, IMS Institute for Healthcare Informatics projects in its forecast, Global Medicines Use in 2020. Growth in spending will be attributable to innovation (new products), price increases and some patent losses of exclusivity (e.g., branded drugs going generic). The U.S. will cover the bulk of drugs spending in 2020 at 41% of the world medicines market, shown in the first pie in the first chart. U.S. medicines spending dwarfs any other country or region in the world, including China which is expected to account for 11% of

The average price for a specialty drug was $53,384 in 2013; the average household income was $52,250. Thus, even allocating 100% of a family’s annual earnings to pay for a drug wouldn’t stretch far enough to cover it in 2013, nor would it do so today in 2015. This sober health economic artifact comes from the latest Rx Price Watch Report from the AARP, detailing cost trends for prescription drugs across all segments — generics, brands and specialty drugs.  Contrast, as well, the $53K for the average specialty drug with the median 2013 Social Security benefit payout of $15,526 and median Medicare

The Old School retail clinic is going beyond checking your child’s ear infection and sore throat, giving immunizations and filling out back-to-school forms just-in-time over LaborDay  weekend. The new-new retail clinic is supporting patients’ chronic disease management, partnering with academic medical centers, and bolstering medication management. Accenture’s bullish forecast is titled “US Retail Health Clinics Expected to Surge by 2017,” making the case that these brick-and-mortar providers are shifting from a relatively limited retail scope to a broader and deeper clinical focus. The so-called surge in the number of retail clinics is projected to be nearly 50% growth between 2014 and 2017,

Two-thirds of all internet users, and 65% of all adults over 18 years of age, use social networking sites. Social Media Usage: 2005-2015, the latest report from the Pew Research Center, finds social networking is the new normal for people up to 65 years of age. One-third of people over 65 use social networking sites. Peoples’ use of social media impacts every aspect of daily living beyond sharing social updates, from home keeping and political discussions to work, parenting, and managing stress, the Pew research found. Key findings in the report are that: Seniors’ use of social networks rose from

By 2018, 90% of health care delivered to people enrolled in Medicare will be paid-for on the basis of quality, not on the amount of services delivered (that is, volume). But as providers must up their game in that new value-oriented health payment world, they are bound up in work flows and organizational structures built for fee-for-service reimbursement. This changing future is discussed in Healthcare’s alternative payment landscape, PwC’s Healthcare Research Institute report on the volume-to-value shift. PwC notes that health care providers’ ability to adapt to changing payment regimes vary and fall into four categories: traditional, lagging, vanguard and

Direct-to-consumer retail health options are fast-growing in the U.S. health ecosystem. CVS Health brought three telemedicine vendors to its pharmacy brick-and-mortar stores. CVS also acquired Target’s pharmacies, expanding its retail health footprint. Rite Aid has added HealthSpot kiosks to its pharmacies, while Walgreens expanded its relationship with MDLive. And, Cox Cable acquired Trapollo to bring remote health monitoring into subscribers’ homes, along with the cable company’s venture with Cleveland Clinic, Vivre Health. Coupled with the growing supply side of telemedicine vendors, the latest National Business Group on Health survey found that most large employers plan to expand the telemedicine services they

CVS quit selling cigarettes and tobacco products in 2014, made $139 bn, and saved 65,000 lives. That’s the best kind of retail health there is. It’s been a year since CVS quit selling cigarettes, I’m reminded by a one-page ad in today’s Wall Street Journal on page B5. This is a big investment in an ad for a business strategy that’s had a huge return-on-investment. The ad reads: “One year ago, we took a deep breath and quit selling cigarettes in our pharmacies. Now we’re working to create a tobacco-free world. We just want to help everyone, everywhere, breathe easier,”

I switched from being a devoted coffee drinker to green tea several years ago, but once in a while I still love an excellent cup of coffee (especially when I’m in Italy – stay tuned for late October posts from the 2015 Milan Expo where I’ll be all-food-and-health, all-the-time). One of my long-time favorite coffee brands is Lavazza, based in Italy. The company hadn’t allocated much resource to advertising in the U.S. But they are launching a new multimedia campaign in America; here’s a look at their initial video promotion… [youtube http://www.youtube.com/watch?v=Jfx2yL6guhk?rel=0] This ad covers many features that are relevant

Think of the word “pharmacy,” and what names come to your mind? CVS Health, Walgreens, Rite-Aid, perhaps. But it’s Wegmans who’s #1 across all pharmacy brands and types, according to the 2015 J.D. Power Pharmacy Study. The big improvement in pharmacy satisfaction in 2015 has been among supermarket drug stores, up to an index score of 851 (of 1,000), the highest consumer score. The satisfaction score for chain pharmacies increased a small 2 points, whereas satisfaction for two other channels for pharmacies — mass merchandisers and mail order — both fell from 2014. It may come as no surprise to Health

In the growing value-based era of health care, patients are looking for real consumer experiences: being treated well, with respect, and with a high level of service people find in other industries. PwC polled about 2,300 U.S. adults online in June 2014, resulting in the paper, Personal health management: The rise of the empowered consumer, part of PwC’s research into The New Health Economy. In that New Health Economy, more consumers want to take control of their health, PwC discovered through the survey. The three key parameters for this empowered health consumer are personal, proactive health management, service, and value,

Sales of computers and tablets and LCD TVs won’t be hot on peoples’ holiday shopping lists in 2015. But smartwatches, health and fitness tech, and 4K Ultra HD TVs will be in peoples’ gift wish-lists and under homes’ holiday trees. The Consumer Electronics Association (CEA) published its 2015 U.S. Consumer Electronics Sales and Forecasts report, and it shows a shifting retail picture where traditional consumer electronics categories — notably computers and mainstream TVs — are declining in demand. But new-new categories are expected to buoy 2015 retail sales. The new categories of consumer electronics will generate about $10 bn (wholesale

Now that the Affordable Care Act is settled, in the eyes of the U.S. Supreme Court, what does the 6-3 ruling mean for health/care consumers living in America? I wrote the response to that question on the site of Intuit’s American Tax & Financial Center here. The top-line is that people living in Michigan, where the Federal government is running the health insurance exchange for Michiganders, and people living in New York, where the state is running the exchange, are considered equal under the ACA’s health insurance premium subsidies: health plan shoppers, whether resident New Yorkers or Michiganders, can qualify for