A look back at the week's health
policy news with a focus on ACA implementation
7.5 million and counting, that's where we stand with respect
to those choosing a plan through the Marketplace - just wanted to get that out
of the way before we dive in to this week's news. Soon to be ex-Secretary of HHS Katherine Sebelius
gave the updated number on Capitol Hill yesterday. If you're wondering when we'll see the March
enrollment report, if the past is any indication HHS will release it between
the 11th and 14th. That said there is no
official word on if they will do so again or wait until the end of April when
they can include the enrollments through the extension deadline of April 15th (the
report would then include the 7.5 million and more).
For those confused by the "soon to be ex" in front
of Sebelius above, it's because last night we learned that she will be resigning
as Secretary of HHS and current Office
of Management and Budget (OMB) chief Sylvia Burwell will be nominated to take
her place.
This is big news, but in the end not very surprising. If there was ever a time for her to make a
graceful exit, this is it, after the successful end of the open-enrollment
period and before the start to this year's election season. There will be (and has already been) much written
about her legacy (Health
Secretary Resigns After Woes of HealthCare.gov, Website
fiasco will taint Kathleen Sebelius’ legacy but I look at it this way. She was a great Insurance Commissioner and then
Governor in Kansas and has done a lot of good at HHS. With our 20-20 hindsight we now know that she
was not the right person to oversee the creation of the website, but the
botched rollout should not be the only way she is remembered (The
Sebelius Legacy: One Epic Tech Failure, Millions of Newly Insured Americans,
Republicans
pile on at news of Sebelius’s exit).
In fact, it can be said that her resignation now is a
positive sign, in the words of Ezra Klein: Kathleen
Sebelius is resigning because Obamacare has won. (Yes, our old friends Ezra and Sarah are back,
their new site vox.com is now live - and no, I
don't believe there is a wonk bubble.)
The President's choice to replace her, Sylvia Burwell, is an
impressive one. In addition to being the
current head of OMB she served in the White House during all eight years of the
Clinton presidency in various roles, is a graduate of Harvard and a Rhodes Scholar. Additionally, in her work both during the
shut-down and during the budget deal to follow, she showed she can work with legislators
on both sides of the aisle.
In fact, one of the first reactions to her nomination came
from Senator McCain who tweeted: “Sylvia
Burwell is an excellent choice to be the next HHS Secretary”. You can read more about her background here Meet
the nominee to lead HHS and here Sylvia
Mathews Burwell: Six things to know about the new White House budget director
(March 2013). But that doesn't mean
the opponents of the ACA won't be playing this event for all it's worth: Sebelius
exit opens new Obamacare front.
Even before this news hit on Thursday night, there was a lot
to talk about this week. Rand issued a
new report regarding the previously uninsured who are now have health coverage:
"The survey, which comes with
some caveats, finds that of the previously uninsured who gained new coverage,
7.2 million were covered by employer plans, 3.6 million were covered by
Medicaid and 1.4 million signed up through the Obamacare exchanges. In all,
employer coverage increased by 8.2 million since September, Rand said." (Forget
about Obamacare exchanges. Employer coverage is booming, survey finds)
While many were surprised by these numbers, we shouldn't have
been. Remember, the greatest number of
people in this country with health insurance get it from their employer. One of
the benefits of the mandate is it encourages more people to accept that offer
from their employers. These numbers for the first time show the extent of that
increase (Should
we have expected this week’s big surprise on employer health insurance?, The
best evidence we have that Obamacare is working). You can read the primary source and link to the
actual survey here: Survey
Estimates Net Gain of 9.3 Million American Adults with Health Insurance.
There were other numbers released this week as well, a
Gallop poll showed the number of uninsured continues to decline (note that
these do not even reflect the March enrollment surge Another
Day, Another Sign That Obamacare Is Working). Other number released showed that as
expected, it was the sicklier individuals who signed up first (Study
Finds Sicklier Enrollees in Earliest Stage of Health Law) which can also be
understood to be a positive since these people needed care (More
Evidence Obamacare Is Getting Insurance To People Who Need It).
As part of the doc fix legislation discussed last week,
there was an ACA fix included to eliminate the requirement that employer plans
adhere to a different standard re out-of-pocket costs than individual
plans. To me, this represented the first
substantive adjustment to the law supported by both proponents and opponents of
the ACA (GOP
seeks coverage choices in health law they hate). For a while it looked like we would see
another example - this time as a standalone bill (House
to pass new, bipartisan ObamaCare tweak) with an adjustment to requirements
for ex-pats. However, the compromise
wording ended up failing to win the expected bipartisan support and did not
pass the House (House
rejects expatriate Obamacare bill).
For those keeping track, mid-April was when we were going to
finally see the Republicans' alternative to the ACA, alas that is not to
be: House
GOP: We'll Have That Obamacare Alternative Soon! Really!. In perhaps one of the most revealing quotes
on this topic, you had a Republican staffer admitting what proponents of the
law have been saying all along - the ACA is the most conservative friendly way
to accomplish the goal of universal coverage:
"If you want to say the further and further this gets down the
road, the harder and harder it gets to repeal, that's absolutely true. As far
as repeal and replace goes, the problem with replace is that if you really want
people to have these new benefits, it looks a hell of a lot like the Affordable
Care Act. ... To make something like that work, you have to move in the
direction of the ACA. You have to have a participating mechanism, you have to
have a mechanism to fund it, you have to have a mechanism to fix parts of the
market." (The
Right Searches for Obamacare Replacement, Finds Obamacare)
Of course there are those who don't want a conservative
friendly solution to the issue and are trying a different tact - you can find
some of them in Vermont (Forget
Obamacare: Vermont wants to bring single
payer to America).
This week also saw the historical release of physician level
Medicare claims data. This is the first
time that physician level data is available to the public. There has been a tremendous amount written
about this (a sample of links are below) but here is my take: For all its shortcomings this data is an
important part of the process of reforming our system. The data is not perfect and you need to take
some time to understand it, but it will provide a great resource for analysts
and advocates to better understand the state of our system. While there is opportunity for individuals to
look up their own providers (EASY
LOOK-UP: How Much Your Doctor Received
From Medicare) the power of the data will be in what it reveals about the
system (Nobody
Blames Doctors for High Medical Costs. That's About to Change, Disclosing
Medicare payment data could be a boon for the nation).
For those who want to dig deeper...
First the basics: Everything
you need to know about today’s unprecedented Medicare pricing data dump
Next some of the information gleaned so far: Cost
of drugs used by Medicare doctors can vary greatly by region, analysis finds,
Sliver
of Medicare Doctors Get Big Share of Payouts, Want
to see how problematic Medicare pricing is? Look to ophthalmology The
top 10 Medicare billers explain why they charged $121M in one year, How
does one doctor earn $21 million from Medicare?. No, I don't expect most of you to click on
all those links, but I want to make the point that there is a lot to be learned
from the data in spite of its limitations.
Giving equal time: The
Medicare Data’s Pitfalls, Doctors
react to release of Medicare billing records and Political
Ties of Top Billers for Medicare.
For those looking for the local take, Jackie Farwell did a
deep dive into Maine specific data: Long-secret
Medicare data reveal payments to Maine doctors.
And finally, if you really want the details, here's where
you can get the data yourself: THE
DATA: Medicare Provider Utilization and Payment Data: Physician and Other
Supplier.
Also on the Medicare front, the Administration released the
new Medicare Advantage (MA) rates. I'm
sad to report that bowing to political pressure, the new rates were not as low
as indicated in the preliminary guidance issued earlier. To recap, MA is a program that allows seniors
to enroll in a private insurance company plan instead of traditional
Medicare. This was originally introduced
because the private market said they could provide the benefits cheaper than
the traditional plan. That didn't
happen. Instead, MA plans now get more
for each enrollee than the government pays for traditional Medicare. The ACA said that's not fair to the over 70%
of enrollees who are not in an MA plan, if the private plans want to play, they
should get the same amount as everyone else.
That was the plan, but there was a lot of pressure from both
sides of the aisle (Here’s
the next part of Obamacare that has Democrats worried about November) to
keep the MA plans happy and the enrollees unaffected by any changes. As a result, the new rates issued this week
do not have the cuts originally intended (Obama
Administration Retreats On Private Medicare Rate Cuts).
Now let's move away
from the ACA and towards reforming the overall health system. First up, this week we saw some interesting
stories about the use of specific care.
Wonk superstar Nate Silver weighed in on the mammogram debate attempting
to objectively discuss this very emotional topic on his new fivethirtyeigt.com website: Are Mammograms
Worth It?. Across the pond there was
the release of a new study indicating that Tamiflu - a drug many governments
stockpile in case of a flu epidemic - may not be any better than acetaminophen. This story also highlights the need for true transparency
with respect to study data - an issue perhaps as important as the issue of transparency
with respect to prices: What
the Tamiflu saga tells us about drug trials and big pharma.
Alzheimer's is the focus of this month's Health Affairs
journal: April 2014; Volume 33,
Issue 4: The Long Reach Of Alzheimer’s Disease. And some good news out of Minnesota with more
proof that spending money on items other than direct medical interventions can
have a big impact. Here money was spent
on support for caregivers of Alzheimer's patients, thereby keeping people out
of institutions because their caregivers were better able to cope with keeping
them at home longer (Alzheimer’s
Disease Support Model Could Save Minn. Millions).
Moving even further on the aging process, some great pieces
on the end of life issue. It's not
secret we don't deal with that well either within society or within our health
care system. My feeling is the more we
talk about it, the better we'll be able to cope and make good decisions (Answers
to Tough Questions About Dying, A
‘Code Death’ for Dying Patients).
And finally, a few more stories that I found interesting
this week:
- Maine Medicaid rules reduce narcotic prescriptions
- Maine doctors ditch insurance, offer monthly subscriptions for primary care (you might recognize a certain independent consultant who is quoted in the article)
- Google Glass embraced at Beth Israel Deaconess
- Even Small Medical Advances Can Mean Big Jumps in Bills
- Medicare Seniors Like ObamaCare's Team Approach
All
comments and suggestions are welcome; please let me know what you think. And as always, thanks for reading!
Funded by support from
the Maine Health Access Foundation
*The title is a tribute to the BBC show, the NBC show and the amazing Tom Lehrer album "That Was The
Year That Was"
