A look back at the week's health policy news with a
focus on ACA implementation
Have you had time to recover
from the first ACA open-enrollment period?
I hope so, because although November is still six months away it's time
to start talking about the next one.
This week we saw the first premiums for 2015 trickle out. We also saw lots more evidence about what a
problem it is getting the word out on the benefits of the ACA. Medicaid and Medicare were in the news as
well as some fascinating technical developments you'll find under the System
Transformation heading. So let's get
started.
ACA: Premiums
As Drew Altman (the CEO of the Kaiser Family Foundation) put
it so aptly, it's time now for The
Next Big Health-Care Issue. Namely
what will the premiums look like for the next open enrollment period. Or to put it another way, How
Will 2015 Health Insurance Premiums Compare to 2014?
A couple of key points to keep in mind that are going to get
lost in the coming frenzy. Health care
costs have been going up since way before passage of the ACA. Also remember that there is not one
"Obamacare" plan or one health insurance market - there are over 500 separate
rating areas in the country and each will have different experience. Sarah Kliff reviews those issues and more
here: Six
reasons Obamacare premiums are going up next year.
There are some actual data points already (Early
data suggests Obamacare premiums aren't skyrocketing, One
health insurer wants to cut rates 6.8 percent. Another wants to hike them 26
percent. What gives?) but they are probably useful primarily as a Rorschach
test to gauge your opinion of the law as opposed to an indication of where
rates will actually land.
One of the reasons so much of this is guesswork is the
uncertainty of how the "three Rs" (Reinsurance, Risk Corridors, and Risk
Adjustment) will work. These programs
were designed to smooth out rates between insurers in the first few years of
the ACA's implementation but there is continuing uncertainty about how they
will be implemented (Risk
Corridors And Budget Neutrality).
ACA: Polls/Opposition
Another non-event this week in Sylvia Burwell path to
confirmation as Secretary of HHS. In her
second Senate hearing once again, among those introducing her was a
conservative Republican, this time Senator Tom Coburn from Oklahoma. And while she was questioned about certain ACA
implementation issues, there were no fireworks.
She is expected to be confirmed by the full Senate before the Memorial
Day recess (Another
Breezy Hearing for Obama Health Pick).
This week yet another reminder of the amount of work left to
be done in communicating the law (enough already with the reminders). In a McKinsey report we saw that "About
two-thirds of the respondents who were subsidy-eligible but didn't sign up for
health insurance were unaware of their eligibility." One way to understand this is that The
dirty truth about the GOP attack on Obamacare: It worked. You can read the full report here: Individual
market: Insights into consumer behavior at the end of open enrollment (McKinsey
report).
Yet another poll showing people want to keep and improve the
law rather than repeal it (CNN
Poll: Should Obamacare be kept or repealed?). And a look at how the battle is raging in our
neighboring state of New Hampshire (Democrats
struggle to win over skeptical Americans on Obamacare).
Since we're on the topic of reminders, more evidence that a
rose by any other name would not smell as sweet. Or in this case, a law by any other name
would be much more popular (Kentuckians
only hate Obamacare if you call it Obamacare).
There were efforts this week by supporters of the law to
embrace the positive (Bill
Clinton urges Dems to defend Obamacare, Liberal
groups launch campaigns to boost turnout based on Obamacare support). While opponents of the law (at least in Congress)
continued to be subdued (GOP
goes quiet on ObamaCare, The
GOP's Incredible Disappearing Quest To Repeal Obamacare).
ACA: Marketplaces
We've talked about the Marketplaces before and the wisdom
(or folly) of trying to reinvent the wheel by building them state by
state. Here is a look at what was spend
on some of the failures ($474M
for 4 failed Obamacare exchanges) and a more detailed look at two of them (How
Massachusetts screwed up Obamacare, Insurance
CEO: Shut down Hawaii health exchange).
ACA: Employers
The Urban institute came out with a study regarding the
impact of eliminating the employer mandate.
Spoiler alert, they did not think it would have much impact (Axing Obamacare's employer mandate
would do little harm, study says).
Read the full report here Why Not Just Eliminate the
Employer Mandate? and if you are
interested, my reaction to the report here: Employer Mandate: Theory, practice and those pesky federal
deficits . . .
ACA: Other
In the courts, we saw an Appeals
court hears health care tax credit case.
This is the case where opponents are arguing that the law did not intend
for the Federal Marketplace to offer premium subsidies. Every time there has been a decision on this question
it has been in favor of offering subsidies, but the filers of the suit continue
to appeal and this was another step in the case's inevitable journey to the
Supreme Court.
Kaiser released a report looking at Women
and Health Care in the Early Years of the Affordable Care Act: Key Findings
from the 2013 Kaiser Women’s Health Survey.
From Families USA a study to highlight that not all Silver
plans are created equal: Designing
Silver Health Plans with Affordable Out-of-Pocket Costs for Lower- and
Moderate-Income Consumers.
Have you hugged your broker recently? Maybe you should, evidence that in CA at
least they played a key role with Marketplace enrollment, for individuals as
well as for small businesses (Insurance
agents played key role in California's Obamacare enrollment).
Medicaid
While not the case here in Maine we this week did see Another
conservative governor finds a way to expand Medicaid. The Governor of Indiana is as ant-ACA as they
come. And yet, even he has admitted what a great deal the Medicaid expansion is
for his state. The plan put forward, apparently
after negotiations with the Feds, uses an existing state plan to expand
coverage. It also includes premiums of
up to $25 a month for those earning over 100% of FLP. You can read more about it here Another
red state just caved on Obamacare and here Indiana
Seeks More Coverage for Poor, but Many Would Pay.
And while Indiana is the latest, it was not the first, Arkansas
and Michigan prove Republicans can compromise on Medicaid.
On a positive note, we did have more evidence this week that
even among non-expansion states enrollment is up among those who were already
eligible (Avalere
Analysis: Medicaid Non-Expansion States Experience Up to 10% Enrollment Growth
Due to Woodwork Effect).
But while some individuals are helped, it is not
enough. The cost of not expanding is
being made clear in several ways. One is
seen as hospitals report earnings for the first quarter Hospitals
see blue-red divide early into Obamacare’s coverage expansion. Another cost can be seen as States’
Medicaid Decisions Leave Health Centers, Patients In Lurch.
Here in Maine we saw some numbers putting a lie to the
statement that most of those who would have benefited from expansion can get
help anyway. While 70,000 would have
been eligible if expansion had passed, only 8,000-10,000 of them ended up in a
Marketplace plan (Up
to 10,000 marketplace enrollees eligible for Medicaid if it had been expanded
in Maine).
Medicare
We've talked about the costs of the Hepatitis-C cure
before. This week saw rapid developments
with respect to its coverage by Medicare.
A story highlighting the case of a Medicare enrollee who had been denied
coverage for the treatment (Medicare
Struggling With Hepatitis-C Cure Costs) led just a few days later to Medicare
Reverses Denial Of Costly Treatment For Hepatitis C Patient. Setting a precedent of coverage for many
Medicare enrollees.
Another item that could end up costing Medicare significantly
is the recommendation that certain people get annual CT scans if they are at heightened
risk for lung cancer. These scans could
end up costing $2 billion annually (Lung
cancer screening could cost Medicare billions).
That said, we know there is money in the system that is not
currently being spend appropriately as shown again by a Harvard:
Overused Medical Services Cost Medicare Billions. Now if we could just have a rational
conversation about what we should and should not be paying for (and how much we
should be paying...).
Drugs
Another recommendation, this one by the CDC, that could end
up with a large bill is with respect to those at risk for AIDs. Recommending this course of prophylactic
treatment is not without controversy, you can see the details here: Advocating
Pill, U.S. Signals Shift to Prevent AIDS.
The number of people at that group pales with those at risk
of ending up with Alzheimer's. And while
this week's news is far from a recommendation or a course of treatment, it
holds out the prospect that sometime in the future the disease could be
prevented: Preventing
Alzheimer's disease — with an antidepressant.
System Transformation
An unprecedented agreement this week as three large insurers
(Aetna, UnitedHealthcare and Humana) committed to sharing their cost data with
the Health Care Cost Institute
so that it is available to consumers in a price comparison tool (Want to shop around for health care? A tool
to compare prices).
Some good reminders that you shouldn't believe everything
you read. Overall, Should
you trust the latest health news? Here's how to tell. And specifically Don’t
take dietary advice from non-experts.
And finally, this week's laundry list of articles talking
about the transformation taking place around us, the first few highlighting new
and exciting uses of technology.
- Google Glass given to all medical students at UC Irvine - while some have questioned the use of Google Glass, the medical community has been quick to see its potential
- The doctor will see you now via webcam, smartphone - no, you don't always need to be in the room with your doctor
- U.S. Mines Personal Health Data to Find the Vulnerable in Emergencies - Big Data to the rescue? Yes! Mining health records to figure out who needs help in an emergency
- DOD seeks to overhaul eHealth records system - The military embarking on a process to update their health records - yes, they can be problematic but that doesn't mean we should give up on making them work given the incredible upside we would see once we get it right
- The Day I Started Lying to Ruth: A cancer doctor on losing his wife to cancer - and finally, your cry of the week. Don't say I didn't warn you
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"
