A look back at the week's health policy news with a
focus on ACA implementation
We have finally hit the summer slowdown everyone has been
expecting so this may be my shortest issue yet.
Of course given the length of some of my updates, that's not saying much. This week we look at some new made up
criticism of the ACA, Marketplace developments including notices requesting
additional paperwork from some enrollees, new Medicaid enrollment figures, the
latest installment of Dr. House of Cards and as always much more. So here we go...
ACA: Polls/Opposition
As time moves on, opponents of the ACA continue to have a
hard time saying it's failing - not that things are going perfectly by any
stretch of the imagination, but there is no denying that millions of people are
receiving healthcare today who did not have access last year. Or is there?
Investor's Business Daily published an article saying that the number of
people covered was falling dramatically: ObamaCare
Enrollment Falling Significantly, Insurers Reveal. The problem is they basically made up the
story by comparing apples and oranges to come up with their statistics. You can read the details here: Scary,
Unexpected "ACA Attrition Report" Neither Scary nor Unexpected
(nice to see our enrollment expert still keeping track) Spoiler alert - all they are seeing is what I
would call a historically normal 2% a month attrition rate. When this all first started we talked about
churn - and here it is, but if anything in lower numbers than I might have
expected. Remember, there are a lot of
good reasons for people to leave their Marketplace plan (new job with benefits,
married someone with benefits, married someone on a different insurer's plan,
etc.). I guess the approach here was if
you can't beat them, make stuff up...
ACA: Premiums/Costs
Speaking of not perfect, when early this year the
administration extended the availability of transitional policies, no one was
thinking about renewal rates. Yet here
we are, and while overall the rate hike news has been good (see last week's
issue for a review of where things stand), some states are seeing troubling
numbers. Turns out the availability of
the transitional policies are partly to blame - by letting them stay on the
market, with their non-compliant benefits and resulting cheaper premiums, young
healthy people are staying out of the compliant plans. This causes issues with the rating pool: Solving
a 2014 Obamacare problem pushes premium hikes in 2015.
Meanwhile in CA, one of the states that did not take the
administration up on the offer to continue transitional plans (remember, it was
a state by state decision), the good news keeps on coming with a detailed look
at rate increases: Kaiser
cuts Obamacare rates 1.4% for 2015; Anthem hikes rates 4.6%
ACA: Marketplaces
Remember Mikey Dickerson? He was one of the healthcare heros who
desended on healthcare.gov last October to help fix it - well no good deed goes
unpunished, so the White
House Picks Engineer From Google to Fix Sites. Mikey has been hired by the Feds full time to
help bring the government into the 21st century.
Meanwhile, as we look towards the next open enrollment
period, the Feds are trying to clean up the last one. Notices went out this week to individuals
who's paperwork was still not in order: Over
300,000 Must Prove Eligibility or Lose Health Care. Most of these people are legitimately getting
subsidies, but have not yet filed the supplemental paperwork required.
Locally, 1,200
Maine consumers could lose Obamacare coverage for failure to prove legal
residency. Advocates are working to
get the word out, but if you know someone who's received a notice this week,
make sure they understand that failure to act could put their insurance in jeopardy.
Heard enough from me yet about the issues we will face with
the upcoming open-enrollment? Sorry, they
are not going away. Here Vox takes a
look at the situation: Here's
why Obamacare enrollment will be super confusing next year, too . The article links to great flowchart of
reenrollment process, but if you want to cut to the chase, you can go there
directly: Renewals
and Plan Management.
But it's not just re-enrollment that will be difficult,
getting those currently uninsured into the system has its own set of new
challenges in year 2. Basically, we've
picked the low hanging fruit so will need to work harder to get the next crop: Why
Obamacare May Have Trouble Signing Up As Many Uninsured Next Year.
On the state marketplace front, MA has decided not to use
healthcare.gov this year as they diligently work to fix their own site: Massachusetts
pioneered Obamacare — and is still struggling to make it work. To help get
there Mass
Seeks $80M More From Feds For Health Website.
And in Oregon, the vendor who allegedly messed up their site
has beaten that state to the punch as Oracle
sues Oregon over botched Obamacare exchange.
ACA: Employers
On the employer front, two major stories out of the same
survey.
First, more employers offering skinny plans than expected: 16%
Of Large Employers Plan To Offer Low-Benefit 'Skinny' Plans Despite ACA: Survey. We've talked about them before, but taking
words from the article to review: "
It works like this: Employers can shield themselves from health law penalties
by offering insurance that meets tests for affordability and value --
regardless of whether anybody signs up. At the same time, workers can avoid the
ACA's individual penalty by enrolling in a company skinny plan, which qualifies
as "minimal essential coverage" for individuals under the health law
by the mere fact that it's employer-sponsored."
Meanwhile, more of the same as U.S.
benefits enrollment season to bring more cost cutting: study. To sum up, employers talk about adding "consumerism" to employer plans -
but that's just another way of saying they will push a greater share of the costs
to employees.
And here is the source of all the information above: U.S.
Employers Changing Health Benefit Plans to Control Rising Costs, Comply with
ACA, National Business Group on Health Survey Finds (Primary Source).
Looking for more ramifications of the employer based coverage
parts of our system? Read this
discussion with an employer advisor talking about narrow networks (not a bad
thing if done right, but that's a big if) and reading between the lines, ways
of shifting costs from the employer to the employee: More
Employers Limit Health Plan Networks But Seek To Preserve Quality, Says Adviser.
ACA: Court Cases
A lull in major court decisions this week, but that doesn't
mean nothing's going on. For an update,
take a look at Jost's review: Implementing
Health Reform: ACA-Related Litigation And Special Enrollment Periods (In
addition to court cases he also provides updates on new special enrollment
periods.)
ACA: Other
More thoughts this week on the ACA related paperwork that
will be involved in filing your 2014 taxes - “That is so complicated,” CBPP’s
Solomon said. “How does anyone understand that? The folks who are helping
consumers are reeling. A consumer can’t be expected to understand this.” ( Consumers’
next Obamacare challenge: Tax forms).
Here is Jost's review of the logistics: Implementing
Health Reform: Transferring Information Among The Exchanges, The IRS, And Taxpayers.
More talk about extending the PCP Medicaid reimbursement
raise past the two years originally funded by the ACA: Democrats
in Congress want to extend this temporary piece of Obamacare.
And continuing discussion of hospitals' attempts to figure
out a way to pay their patients' premiums.
While it sounds good at first glance it can have ramifications for the risk
pool: Hospitals
Seek To Help Consumers With Obamacare Premiums.
VA
As McDonald began to take control of the VA, he, talked
about changes he will be making: New
V.A. Chief Promises to Mend Practices.
He also discussed the ramifications of some of the misbehavior by
staff: VA
chief: Firings of workers a deliberate process.
Medicaid
Numbers from CMS showed that since the Oct 1 last year
Medicaid has gained over 7 million enrollees: New
Medicaid enrollments top 7 million under Obamacare. But not all of them were in expansion states:
Medicaid
Rolls Are Growing Even in States That Rejected Federal Funds. This is the result of the welcome mat effect
(my preferred term over woodwork effect).
But think of how many more could be covered if every state
expanded eligibility. Here is a look at the ridiculousness of not
expanding: A
Deal Too Good to Turn Down, Unless It’s Medicaid. And thanks to the Urban Institute, Another
argument against the Medicaid expansion just got weaker (they show that the
Feds have never reneged on a funding commitment to the program, contrary to
what some critics site as their reason for not expanding).
Drugs
This week, Vox took a look at the science of weight loss and
Why
"metabolism boosters" are bullshit.
Meanwhile, there are lots of other drug scams out there -
some being run by physicians and compound pharmacies. They promote compounds that are expensive and
unproven for no other motivation than profit: "It may be the biggest thing in diaper
rash treatment, a custom-made product to soothe a baby’s bottom at the
eye-popping price of $1,600. ... Does it
work better than the common treatments? There is little evidence either way." It's also worth noting that "Compounded
drugs do not require F.D.A. approval."
(Pharmacies
Turn Drugs Into Profits, Pitting Insurers vs. Compounders)
And of course our weekly Sovaldi update: First a look at how In
20 years, we can make hepatitis C rare – if we can afford the cure. Remember, Sovaldi is a case where there is no
doubt as to the improved efficacy of the drug, the issue is cost. In
somewhat of a surprise move, UK
Recommends Covering Sovaldi Hepatitis C Pill. This is a clear endorsement of just how
effective the treatment can be, but note that
""The decision was likely helped by the lower price tag in the
U.K. Gilead is selling its drug for about $56,000, according to a NICE
spokesman." That's about 35%
cheaper than its price here in the US.
Costs
Were you looking for a new cost issue to worry about? You're in luck because we've found one. The idea behind urgent care centers is that
they can provide a lower cost alternative to going to the ER. But what if both options are run by the same
system and instead of saving money, hospitlals try and use the urgent care
center as an upsell opportunity: Increasing
hospital revenues through urgent care referrals.
And speaking of hospitals, a study looked at CA hospital
charges. More data to something we
already knew; there is incredible variation in charges for absolutely no
reason. For example "One
California hospital charged $10 for a blood cholesterol test, while another
hospital that ran the same test charged $10,169 — over 1,000 times more." (Wide
Variation In Hospital Charges For Blood Tests Called ‘Irrational’).
System Transformation
We'll start this section with a story getting some
appropriate local attention - a focus on vaccination rates. We saw that More
Maine families are skipping or delaying childhood vaccines. In response, Maine
legislators to seek stronger laws to get kids vaccinated. (We've discussed this before, but for a
review of the complete nonsense that is the anti-vaxers arguments, this is one
of the best posts I've seen: Dear
parents, you are being lied to)
Next a story that needs more attention - the amazing
experiment that is Maryland and their hospital reimbursement system (yes,
unlike most states, they really have a system): An
Amazing Healthcare Revolution Is Happening In Maryland — And Almost No One's
Talking About It. Some excerpts: "The key is to establish a model that
works for all the patients, as Maryland has done. Some reforms in the Affordable
Care Act, Sharfstein argued, don't go far enough. Imagine, he mused, if Western Maryland were
reimbursed on the basis of value for only 20% of the patients, while 80%
remained on a fee-for-service model. It would never work. The diabetes clinic
would never be set up, because they would be taking money out of their own
pockets. "What we're seeing at a
place like this," Sharfstein said, "is true clinical transformation,
which is the ultimate goal.""
More this week on the impact of leaded gasoline and the
unintended benefits of eliminating it.
If you haven't "been exposed" to this research, the article
has links to some of the other work on the topic: Childhood
Lead Exposure Causes a Lot More Than Just a Rise in Violent Crime.
Imagine if a state could reduce teen birthrates dramatically
- wouldn't it be worth replicating the experiment? How
Colorado’s teen birthrate dropped 40% in four years.
Some focus on hospital issues:
- Hospital Readmission Reduction Program Reignites Debate Over Risk Adjusting Quality Measures - a review of the need to take SES (socioeconomic status) into account
- Nonprofit hospitals at a tipping point from mounting challenges - biggest challenge is declining volume - which is good, we want to reduce hospitalizations. This trend leads to more consolidations. The problem arises when there is not enough oversight and these consolidated systems start charging monopolistic prices.
Some longer reads for your summer weekend:
- Vermont Is 'Single-Payer' Trailblazer - Pew Charitable Trust status update on their progress
- Maine State Innovation Model: Q3, 2014 - The quarterly newsletter from Maine's SIM project
And finally, the latest installment of Dr. House of Cards -
you know you've been waiting: DR. HOUSE OF CARDS, EP. 3:
OZ VS. UNDERWOOD.
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"
