A look back at the week's health policy news with a
focus on ACA implementation
This week's issue is brought
to you by the letter M with everything from uninsured rates in Minnesota and Massachusetts, More
premium numbers, Marketplace developments,
Medicaid battles, MaineCare backlogs and so much More...
ACA: Enrollment
While we can all get caught up in the enrollment numbers
game/hype - (myself included!) the real win is when more people have access to
care. The way we measure that is by
looking at the change in the number of uninsured. Previously we've seen very encouraging national
numbers from Gallop - this week, more detailed evidence from two states that
have seen a precipitous drop in the number of uninsured: Obamacare
cut Minnesota's uninsured rate by 40 percent and Mass.
Inches Toward Health Insurance For All.
ACA: Opposition
It is also easy to get caught up in the story of the moment
- but when we do that we can sometimes lose our perspective. Trust Ken Burns (of Civil War and Baseball
documentary fame) to take the long view:
Ken
Burns: Go Ahead, Campaign on the Affordable Care Act - It will likely go down
in history as 'one of the great pieces of social legislation,' the documentary
filmmaker said. At the same time a
reminder from Paul Krugman that in fact the worst did not happen: Meanwhile,
On the Health Front
While I won't fully cover this week's big political story,
one side effect of Cantor losing his primary is that it makes it even less
likely that the Republican's will vote on an ACA replacement: No
Eric Cantor, no Obamacare ‘replace’ vote.
Of course saying this is like saying it's less likely that immigration
reform will pass this year - the truth is neither issue was very likely result
in a Congressional vote even before Cantor's defeat.
ACA: Premiums/Costs
More information this week on proposed rate increases. "Good" news out of California where
Anthem's
Obamacare rates to increase less than 10% in California. Good being in quotation marks since a 10%
increase is not really good, but it is better than CA residents may have
otherwise seen in the absence of the ACA.
Also encouraging out of that report is that " the age and projected medical costs of
new enrollees are in line with the company's expectations thus far" . This was always the key, not that enrollees
looked like the population as a whole, but that they met expectations.
Very mixed results in Maryland where CareFirst
seeks price hikes for individual health plans (of 23 to 30 percent) while
at the same time "Two other insurers, Kaiser Foundation Health Plan and
Evergreen Health Cooperative, are proposing to lower rates for next year, by 12
percent and about 10 percent".
Meanwhile, a look back at existing rates (for the first
open-enrollment period) showed that overall, Report:
Health plans cheaper on exchanges.
ACA: Marketplaces
Another sign of the Marketplaces success (in addition to
states announcing low premium increases) is the raw number of insurers offering
plans. Not only are More
insurers joining ObamaCare but Obamacare
is adding insurers where they’re most needed. Here in Maine we will see a third insurer (Harvard
Pilgrim) join the marketplace, while our neighbor to the southwest (NH) will go
from having only one insurer participate to having 5!
Last week we took a look at the number of cases on the
marketplace that had data inconsistencies.
This week the GOP
Says Tax Man Cometh for Health Law Enrollees by claiming that many of those
people will see a tax bill due to receiving subsidies that are too high. Of course they failed to note that most of
the inconsistencies would result in no change to the subsidy already calculated
and among those who may be receiving incorrect subsidy amounts, there is a
limit as to what they will have to repay (chart on page 8: http://www.cbpp.org/files/QA-on-Premium-Credits.pdf).
And finally, an in-depth look at the technical state of
healthcare.gov and how in the next open-enrollment period we won't be seeing
similar problems to last year: Why the New
Obamacare Website Is Going to Work This Time.
ACA: Employers
Unfortunately, as much as the individual marketplace became
a delicious glass of lemonade last year, the small business marketplace stayed
a lemon (SHOP
flop: Obamacare for small businesses).
Discussions regarding the employer mandate continue Obamacare’s
employer mandate is under attack from both sides. Will it survive?. (Here is a look back at some of my thoughts
on the topic: Employer
Mandate: Theory, practice and those pesky federal deficits . . .)
For those interested in following the employer side of
things, Mercer
Launches Health Care Reform Content Portal to Provide Latest News, Research,
and Commentary on Implications for Employers, Employees. Anyone is free to sign up for the site - but
be warned, for most of you it's way more information than you want.
ACA: Other
Some court developments this week. First, another Court
upholds Obama's birth control mandate although this is far from the last
word on the topic. Also, the Obamacare
Hill subsidy case to go to court - for those not familiar with this one, it
involved the ability of the Federal Government to contribute to congressional
staff's health coverage on the individual marketplace. Remember, as a rule employees with coverage
available at work don't use the individual marketplace, so the law doesn't
cover this circumstance. However the ACA
requires congressional staff to use the marketplace (for purely political
reasons) leading to a situation not planned for by the law. In an attempt to
continue to treat congressional staff like the rest of the federal workforce,
their existing employer contributions were carried over to the marketplace,
creating an uproar among opponents of the law.
November (and the next open-enrollment period) is just
around the corner, so this week Community Catalyst released a report that
"showcases the many successful strategies employed throughout the country
by consumer health advocates and their partners": Connecting
Consumers to Coverage: Mobilizing for Enrollment.
Also this week, AHIP (America's Health Insurance Plans) made
recommendations about how they would like to see the law changed: Health
care reform: Insurers propose changes to Affordable Care Act (surprising
only for the restraint of those recommendations which can at most be looked at
as tinkering).
A review of where various states stands re the renewal of
noncompliant plans: The
Extended "Fix" for Canceled Health Insurance Policies: Latest State
Action
A look at narrow networks, as we've said in the past, They
Annoy Patients. They Scare Docs. But Narrow Networks Might Be a Good Thing.
And finally a review on where Vermont's efforts to create a
single payer system for their state stand: A
progressive alternative to Obamacare.
VA
Over the past few weeks I've been reporting on the VA
scandal due to its prominence, its interaction with the ACA (at least in
people's perceptions) and its importance to the health care system as a whole. However, as I continue to cover pieces of it
please understand that I don't claim to offering full coverage of the
topic. With that in mind:
Last week we saw the deal made between McCain and Sanders,
this week the Senate
passes VA reform bill. The house
passed its own version as well and Lawmakers
Hope To Send Unified VA Bill To Obama By Late June.
Results from the audit were released: VA
audit: 57,000 veterans waiting more than 90 days for appointment at medical
facilities and the F.B.I.
Begins Criminal Inquiry in V.A. Scandal.
Meanwhile as the VA
takes first steps to address scandal others were looking at solutions. A Pilot
program in Maine could be model to ease VA backlogs nationally but warnings
that Privatization
won’t fix the VA.
And finally, while
the focus is on waiting times within the VA, a reminder that Outside
the VA, waits for doctors can vary widely.
Medicaid
Lots of focus on the goings on in Virginia this week. The Governor
has been trying to pass Medicaid expansion and a budget. Coverage at the beginning focused on Virginia
is having an insane fight over Medicaid expansion. Previously, the VA state senate had been
evenly split between Democrats and Republicans - the a Democratic Senator
resigned breaking the deadlock. There
was talk that Virginia
Governor May Try to Expand Medicaid on His Own but finally, the Republicans
prevailed and Virginia
passes budget with Medicaid restriction (although as of this writing the
Governor still had several days to decide if he would sign the budget).
An insightful look at the difference Medicaid expansion can
make - by looking at a town where you have expansion on one side of the street
but not the other: In
Texarkana, Uninsured and on the Wrong Side of a State Line.
While the Michigan approach to expansion is not my preferred
approach, you can get a good understanding of what they are trying to do here: Michigan
To Reward Medicaid Enrollees Who Take ‘Personal Responsibility’.
Additional reminders this week of the continuing hangover
from the technology problems with the healthcare.gov rollout with More
Than 1.7 Million Consumers Still Wait For Medicaid Decisions. And here in Maine, Thousands
stuck in MaineCare application backlog.
And finally, it's not too soon to start worrying about CHIP
reauthorization - without congressional action the program ends in 2015: The
clock is ticking on funding health insurance for kids
Drugs
The NY Times takes a look at the widening use of naloxone by
first responders (and family) to treat drug overdoses: Anti-Overdose
Drug Becoming an Everyday Part of Police Work. You may recall that Maine passed its own bill
(enacted when unsigned but not vetoed by the Governor) during the last
legislative session (Maine
Enacts Life-Saving Naloxone Bill).
In an effort to combat prescription drug interaction, Hospitals
Put Pharmacists In the ER To Cut Medication Errors.
Meanwhile, those altruistic pharmaceutical companies which
always have the consumers interests at heart say PhRMA,
Advocates: Specialty Drug Costs For Patients Too High. The industry group that supports sky high
prices for certain drugs is shocked that
insurance companies are seeking higher cost-sharing for some of those drugs. It reminds me of something, not sure what (Shocked!). Anyway... while it is certainly true that some
prescription cost sharing is too high, we should recall that it's only a
symptom of a more fundamental pricing problem with those drugs.
Costs
Reports of some successes from the ACO arena: Anthem,
HealthCare Partners save $4.7 million by coordinating care.
A reminders that there is still a long way to go: Coast-to-Coast
Health Care Woe: Cost and some additional data on the disparity of costs -
sometimes without any rational basis: Most
expensive for a doc visit? San Francisco. Least costly cholesterol test?
Pittsburgh.
And finally, highlighting the paradox of payment/system
reform - if hospitals do everything we ask them to, they will see less revenue Maine
Hospital's Dilemma: Improved Care Shrinks Bottom Line.
System Transformation
The social determinants of health - a clunky but crucially
important phrase. We've talked before
about the need to treat the whole person.
One way to put it is Prescriptions
Must Address More than Medicines "...in the U.S. patients may get top
notch medical care and then return to a life guaranteed to keep them in ill
health – because where we live, learn, work, and play can have a far greater
impact on our well-being than the treatment administered in a clinic or
hospital."
We can see evidence in the need to Address
the racial disparity of colorectal cancer and a case study of Two
New Mexico Counties: One’s Healthy, One’s Not. Why?.
Our friends at vox.com review Four
ways to fix American health care that neither Republicans nor Democrats will
touch. I'd like to think that all four
can be implemented as we work to fix the system.
What, you do want another reminder that the system is
broken? Here you are: Hit
by a car, an emergency doctor experiences firsthand the shortcomings in ER care.
And speaking of ERs we can ask the question when is an ER
not an ER? Stop
the war being waged in the emergency department and look at ways to
redefine emergency and urgent care to make the best (and most cost-effective)
use of existing facilities.
This week's winner for misleading headline yet interesting article
goes to: Patients
Can Face Grave Risks When Doctors Stick to the Rules Too Much. Our very own healthcare click bait. The real issue is not with rules per say, but
with rules that have firm cut-offs.
These types of rules lead to the presence of the "cliff effect"
(which we discussed last week in a very different context). Rules with a firm boundary lead to treating
cases very differently even though they present with only marginal
differences. To me the problem is the
way the rules are written, not with the presence of the rule.
One of the ever present issues when discussing quality is
how and what do you measure. Here's a look at Some
Costly Hospital Complications Not Tracked by Medicare, Analysis Finds.
As suspicious as we all must be with respect to unsolicited
phone calls, sometimes they can help us.
A
Health Insurer Calls, With Questions.
When in doubt about the source of the call, thank the person, hang up
and find the phone number for the insurer yourself. But remember, your insurance company may be
calling based on your claims information with a program that is in fact in your
best interest.
I haven't gone off on a rant about the need to vaccinate in
several weeks, so we'll end with a this piece which makes the point in a much
more clever and unique way than I could ever hope to do: Applying
the anti-vaccine mentality to car seats.
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"
