A look back at the week's health
policy news with a focus on ACA implementation
Never underestimate the American public's ability to
procrastinate! The President announce on
Thursday (4/18) that as of the end of the extended open enrollment period, over
8 million people had selected a plan on the Marketplaces (Enrollments
Exceed Obama’s Target for Health Care Act). Coupled with several other sets of numbers
this week that I'll discuss below, the President was jubilant during the White
House press briefing where he announced the new number (Obama
on health care law: 'This thing is working').
When the Federal Marketplace launched in October (or failed
to launch) no one thought we would get here.
Even before the technical issues, initial projections did not go this
high. But as pointed out by many
yesterday, in retrospect we shouldn't be surprised by the late surge. At the end of the day, Obamacare
succeeded for one simple reason: it's horrible to be uninsured. That's the simple truth that many pundits
(who probably have never been uninsured a day in their lives) can't seem to
understand. Enrolling in insurance might
be hard, but there is a tremendous carrot at the end of the process - you are
covered.
And lest we forget this is much more than those using the marketplace. The HHS fact sheet released in conjunction
with the announcement (FACT
SHEET: Affordable Care Act by the Numbers) reminded us that "Up to 129
million Americans with pre-existing conditions – including up to 17 million
children – no longer have to worry about being denied health coverage or
charged higher premiums because of their health status. 71 million Americans with private insurance
have gained coverage for at least one free preventive health care service such
as mammograms, birth control, or immunizations in 2011 and 2012. and more.
For a full review of the announcement you can read America's
Sherpa through the ACA landscape, Tim Jost, in his Health Affairs blog post: Implementing
Health Reform: The Latest Affordable Care Act Coverage Numbers
If there was a disappointment
yesterday it was that we did not get a full enrollment report, only top-line
numbers. While we wait for the formal
HHS report, I was able to find one state specific projection that said Maine's Marketplace
total would end up at 52,000 (Maine
Projections: 52,000!)!
Before we leave yesterday's announcement and get to the rest
of the week's news, let's pause to note that The
Other Important Number In The President's Obamacare Briefing: 24. That's the number of states that have not
participated in the Medicaid expansion. So
while the law is benefiting many, some are still being left out. Here in Maine the battle continues with one
more try to get past the Governor (Final-hours
push for Maine Medicaid expansion appears headed for another LePage veto).
In some ways yesterday's announcement was the icing on the
cake (or CAHC considering all the great work they've been doing). Let's start with the question of how many
people are actually newly insured.
That's been one of the big criticisms of the HHS releases to date - they
don't say how many people are newly insured.
Well Gallup has come galloping to the rescue (sorry, couldn't resist).
New poll results released this week said that: Obamacare
effects are bigger than expected, poll finds:
New Gallup survey data suggest that about 12 million previously
uninsured Americans have gained coverage since the fall.
Additionally, the poll notes that not all the newly insured
are getting coverage through the marketplace: Newly
Insured in 2014 Represent About 4% of U.S. Adults: Half of newly insured obtained health
insurance through exchanges.
Remember, the mandate is also working to encourage people to enroll in
their employer-sponsored plan and many who had not previously done so are doing
so now.
Unfortunately but not surprisingly, the poll also showed that
Uninsured
Rate Drops More in States Embracing Health Law. This is not a single national implementation,
this is 51 state-by-state implementations (plus DC). And these results show it matters as to if
the state has built their own Marketplace and if they are participating in the
Medicaid expansion.
Other good news came this week from the Congressional Budget
Office (CBO). They updated their cost
estimates for implementing the law showing that it will cost much less than
originally estimated (Obamacare's
price tag just got cut by $104 billion) due to lower than expected premiums
(Lower
premiums (yes, really) drive down Obamacare’s expected costs, CBO says). You can read the actual report here: Updated
Estimates of the Effects of the Insurance Coverage Provisions of the Affordable
Care Act, April 2014 (CBO direct link).
And speaking of premiums, New
data signal smaller jump in health care costs:
" Statisticians working with
insurers to project next year's insurance premium rates say they expect to see
an average increase of about 7%, well below the feared double-digit increases making
recent headlines. "The double-rate
increases we've been hearing are probably exaggerated," says Dave Axene, a
fellow with the Society of Actuaries, adding that there would be wide variation
across the country."
More good news came from the United Healthcare. They indicated that they would be
participating in more Marketplaces for the next enrollment season (The
nation’s largest insurer thinks Obamacare exchanges are doing just fine) in
spite of having some profit problems due to the new Hepatitis C drug (Biggest
Insurer Shocked With Hepatitis C Costs).
Of course a week can't go by without some controversy, and
the Census Bureau was able to provide us one for this week. They announced that they will be changing the
way they collect information on how many people are insured. This caused an immediate uproar by opponents
of the law who thought it was a conspiracy to mask how ineffective the ACA
actually was. The problem with that
theory is that the changes are being made to how the numbers for 2013 are
calculated - note that is before the access provisions of the law took effect
so there will be a new baseline established before the law's impact is
measured. (Don't
freak out about the changes to the Census yet.)
We learned last week that Secretary Sebelius was resigning and Sylvia Burwell was nominated
to take her place. It was pointed out
this week that although she was approved unanimously by the Senate for her
current position, don't expect her confirmation hearings for HHS to go as
smoothly: Burwell
hearings to be debate over health care, Obama's
new health secretary nominee draws early Republican fire. There is no question she has a lot to do when
she gets there, but this week's numbers should help make the job a little
easier (Burwell's
top five challenges at HHS).
While The
right can’t admit that Obamacare is working and Obama
tells Democrats: Defend my law, we might finally be seeing perceptions of
the American public catching up with the reality of the law's successes (Americans
increasingly prefer Democrats on healthcare: Reuters/Ipsos poll .
We can't forget what this is all about, a Mainer wrote about
her journey to help us remember: Saved
by Obamacare . And a doctor wrote
about how the system as it currently exists sometimes creates incentives that
increase risks (A
patient nearly died to save him $1110).
On a larger scale, new numbers remind us that Our
health spending problem is all about prices.
On the transparency front, New
medical data could allow comparison shopping. We know that Price
transparency stinks in health care. Here’s how the industry wants to change
that. The new report (which can be
read here) Price
Transparency in Health Care: Report from the HFMA Price Transparency Task Force
is the first industry blueprint for how they want to address the problem.
Before we end with our laundry list of system transformation
developments, let's focus on diabetes for a moment. A new study shows that we are making real
progress in getting them appropriate treatment (For
Diabetics, Health Risks Fall Sharply) and the efforts will continue for the
newly insured (With
new health law, insurers target diabetics). Good news all around - getting the treatment
of chronic conditions under control is crucial to controlling costs.
Some additional system transformation stories I found
interesting this week:
- Ex-senator in Maine: Health care going from illness to wellness system
- FAQ On ACOs: Accountable Care Organizations, Explained
- Providers should be active in helping patients follow directions
- The population health benefits of EMR implementation done right
- Spending more to save more? It's working.
And finally, I'll end which long-term could be the most
important story of the week. Using
existing data to do outcomes research - the holy grail of "big data"
in health care, and one of the unsung reasons for moving to EMRs, just got a
step closer: Scientists
embark on unprecedented effort to connect millions of patient medical records
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"
