A look back at the week's health
policy news with a focus on ACA implementation
This week I've introduced section heading to help make the
newsletter more readable - let me know what you think.
ACA: Impact
With no new numbers released this week the media took a step
back to try and gauge some of the impact of the law. We discussed last
week the extent that the eight million number is only one piece of the
puzzle. Politico followed suit and
provided this analysis: Beyond 8 million: Obamacare math. We're also reminded that this is just the beginning,
or as some would say, it's a marathon, not a sprint. While millions gained coverage, many made the
decision to continue to go without. Here
is a snapshot of four people who made that decision: Looking
at Costs and Risks, Many Skip Health Insurance.
ACA: Plan
Cancellations (?)
Note the question mark in the title above, one of the talking
points of opponents to the law is that while some people are enrolling in
coverage, many (and some say many more) are losing their coverage. New analysis out this week shows the fallacy of
that statement. The study (Health
Affairs Web First: October 2013′s Insurance Cancellation Firestorm In Context)
looks at the volatility of the individual market before the law took
effect. It confirms what many of us
already knew - the amount of churn is high to the point where many more people
drop their coverage each year than received cancellation notices (Study
questions Obamacare impact on canceled plans).
The rhetoric around plan cancellations has gotten so
divorced from reality that the Washington Post Fact Checker gave out a rare
four Pinocchios (or in other words, liar liar pants on fire!) to Rep. Tim
Huelskamp of Kansas who keeps saying that the ACA has resulted in an increase
in the number of uninsured (The
bogus claim that Obamacare has boosted the number of uninsured).
Let's also remember why plans were cancelled - it was
because they provided inadequate coverage and so were not true insurance. Additionally,
there is another whole class of plans called "fixed benefit" plans
that have previously been judged to not meet the requirements of the mandate -
so if someone bought one of these policies they still needed to buy an ACA
compliant plan. The Feds are now
contemplating expanding that ruling to say that someone may not purchase one of
these plans unless they show proof of ACA compliant coverage. This change would very much be in the
consumers' best interests. These plans
only supply a fixed amount of money per day when certain conditions are met, so
while the amount may help towards an individual's out of pocket costs they are totally
inadequate to pay the full cost of treatment for most conditions. So prepare for more headlines along the lines
of If
you like your health plan, you might lose it. Again.
ACA: Politics
The New York Times in conjunction with the Kaiser Family
Foundation released poll results for four Southern states (POLLS
IN FOUR SOUTHERN STATES: April 8-15, 2014).
These polls while especially relevant to the Senate races in the four states, but they also indicate a possible
shift in perceptions regarding the law.
While Southerners
Don’t Like Obamacare. They Also Don’t Want to Repeal It. These results and others seem to indicate
that Obamacare's
Success Is Destroying the GOP's Midterm Strategy.
But that is just once perspective. Opposition is still strong (Obamacare
Bashing or Bust, 38
GOP lawmakers join Ron Johnson’s Obamacare lawsuit) even as Democratic
Candidates Grow More Vocal in Supporting Health Law (and Landrieu:
I’ll put GOP foe on defensive on health care).
As you can see, there are as many different perspectives on
the politics of the situation as there are political pundits. That's how you can get dueling headlines
like: Here’s
why Obamacare is still a major problem for Democrats and Here’s
Why Obamacare Will Help Democrats and Hurt Republicans.
My bottom line is we don't yet know what's going to happen
in November, the landscape and resulting public are changing to fast and in too
unpredictable a manor.
Costs
When we talk about the ACA, although there is much more to
the law, for the most part we are talking about increasing access to care. But long term, the cost of care will
determine if we can afford to provide access to everyone. Before we dive in to this week's developments
regarding cost, a bit of a reminder about two its components. Here in the US we spend a greater percentage
of our GDP on care for the same (or worse) outcomes as other nations. This is principally due to the prices we pay
for that care, they are much higher in this country than in others. So
some of our efforts need to be focused on controlling the existing prices. We are also facing, along with the rest of
the world, disproportionate increases in
the cost of care. Often referred to as
medical inflation or trend, historically it has outpaced overall inflation
resulting in health care taking an ever increasing share of our personal and
national income. So we also need to be focusing on the rate of increase.
Recently we had been seeing a historic slowing of the health
care trend. While some of that slowing
may have been the result of initiatives within the law (such as ACOs), much of
it was due to the great recession. Unfortunately
as the economy picks back up, we are seeing a renewed acceleration in costs (Health
Care Spending’s Recent Surge Stirs Unease, Acceleration
Is Forecast for Spending on Health, Return
Of The Repressed: Spending Growth Is Back, But What To Do?).
However, all the news is not gloomy. The CBO
Finds Health Reform's Medicaid Expansion Is an Even Better Deal for States. Mostly as a result of refining their
estimates on the size of the "woodwork effect" (people who were
previously eligible but were not enrolled now enrolling) the overall budget
impact on Medicaid has been reduced.
Costs and the Drug
Industry
Turning to the cost of prescription drugs, one nuance to the
conversation is the impact of new treatments to our costs. Sometimes there is a clear benefit to the new
treatment (or drug) as is the case of the new treatment for Hepatitis C. However, what is charged for that improved
treatment can be problematic. In this
case, because the firm that created the drug was purchased before its release,
we can do a calculation on what the return on investment is for the drug. Whatever your feelings on the private markets
role in our system, I think we can agree that a 2500% ROI is outrageous (America's
Broken Health Care System: The Role of Drug, Device Manufacturers). None the less the Costly
Hepatitis C Pill Shreds Drug Industry Sales Record and has resulted in
soaring revenue for the company (Gilead
Revenue Soars on Hepatitis C Drug).
We see that the industry continues to work to preserve their
profits (Some
top Medicare beneficiaries spend heavily to lobby) while the question of
how we deal with this continues to be debated (RAND:
Medicare Should Weigh Cost In Coverage Decisions).
In other pharmacy industry news, we had FDA
Advisers Vote Against Approving New Opioid Painkiller (because they saw no
increased benefit but did see an increased risk of abuse). we also had an Alternative
to Pap Test Is Approved by F.D.A., even though it is more expensive and may
result in more false positives. (Perhaps
the result of the lobbying referenced above.)
And finally, we had three gigantic firms shift around assets
in a blockbuster deal Glaxo,
Novartis, Eli Lilly in 'major 3-part' deal, Novartis
reshapes business with GSK, Lilly deals).
Not sure how the patient benefits from this but clearly the shareholders
will.
Medicaid
While here in Maine we have not yet expanded the eligibility
requirements for Medicaid, national developments that can impact our program
move forward (Basic
Health Program. The Affordable Care Act offers states another option besides
Medicaid and the exchanges for health coverage for low-income residents., Connected
Health Opportunities For Medicaid’s Most Vulnerable Patients)
Separate from ACA reforms, we're also seeing some progress
on how Medicaid interacts with the disabled: How
Medicaid forces the disabled to be poor (but some bipartisan help is on the
way).
System Transformation
Health Care is a business.
We know that in the current system providers need to keep that in mind
in order to keep the doors open (With
Medical Debts Rising, Doctors Are More Aggressive About Payments, You're
on the clock: Doctors rush patients out the door), but don't worry, Doctors
still make good money.
Finally, this week's laundry list of articles talking about the
transformation taking place around us.
The analogy renovating the car while hurtling down the highway seems to
apply...
- An Apple a Day, and Other Myths
- Four Years Into A Commercial ACO For CalPERS: Substantial Savings And Lessons Learned
- Medicare wants to better coordinate care. Here’s why that could be difficult.
- How a hospice model can save American health care
- Is Bigger Better? Idaho Hospital Battle A Microcosm Of Debate Over Industry Consolidation
- Nurse Tenure, Education Linked to Shorter Hospital Stays
- THE MAYO CLINIC'S NEW DOCTOR-IN-AN-IPHONE: FOR $49.95 A MONTH, THE MAYO CLINIC CAN TURN YOUR PHONE INTO A PERSONAL HEALTH CONCIERGE.
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"
