A look back at the week's health policy news with a
focus on ACA implementation
You want polls? We've
got lots of polls! We've also got a cool
use of the word shenanigans, a calculator for Maine's 2015 marketplace rates,
lots on the coming open-enrollment period, a large employer-health care survey,
two global health comparison reports and since I like you, a comic medical
video of the week.
ACA: Polls/Opposition
The stars were aligned this week so we saw three ongoing
measures of public perceptions of the ACA released at the same time. The Kaiser
Tracking Poll (Kaiser
Health Tracking Poll: August-September 2014), the Wall Street Journal/NBC
News Poll (Americans
Still Not Sold on Obamacare – WSJ/NBC Poll) and the Washington Post/ABC News
Poll (Even
in Romney states, more want to keep Obamacare than repeal it). If you were
to write a single headline for all three polls, it would be "dog bites man"
or to put it another way, nothing really new.
If there was a surprise it came from the Kaiser poll which
showed that the ACA was only the dominant issue for 3% of registered voters
going into this year's election.
This article put it well: Politically,
Obamacare Isn't About Health Care - Partisanship, not personal experience,
seems to guide public approval of the law.
As much as we've seen the laws successes over the past 6 months, the
needle on public opinion just has not moved. It's clear that when people react
to "Obamacare" they are talking about their feelings about the
President, not about a complex health care reform law whose provisions the
majority of people support.
This op-ed in the NY Times put it well: Stop
the Anti-Obamacare Shenanigans, plus there is the added bonus of the use of
one of my favorite words shenanigans :)
Another poll out this week Poll:
Medicaid Expansion - Does have some
interesting news, confirming what we've seen here in Maine, nationally "...62% of all voters in
states that have not expanded Medicaid believe all states should expand the
program as provided under the ACA."
Meanwhile, the old hits keep on playing with the House
returns to anti-Obamacare votes and An
‘Obamacare’ attack ad stuck in a time warp. Maybe next week I'll just copy
a column from six months ago where I reported on the same things...
ACA: Premiums
A good summary piece from our friends at Wonkblog looking at
premium news: Some
good news — and some concerning news — for health insurance premiums.
As you recall from last week, the numbers in Maine are
looking good! Maine's BoI has now
released a handy calculator for the new rates: Maine Bureau of Insurance
2014 Rate Calculator now available (Go to their main page and look for
"NEW! 2015 Rate Calculator Now Available" to download the spreadsheet.
Note that macros need to be enabled in Excel.)
These rates are now "almost final" having been reviewed by BoI
and in some instances changed as a result of the review. They have been sent to
CMS who will also do a review, but absent some unforeseen circumstance, given
the work already done by BoI CMS should accept them as is.
ACA: Marketplaces
The ramp-up to the next open-enrollment period is gaining
steam. First up we have the new navigator grants being announced: HHS announces
$60 million to help consumers navigate their health care coverage options in
the Health Insurance Marketplace. Last year's grants were just for one year.
Here in Maine the awards went to the same two groups as last year - taking
advantage of the experience and the benefits of continuity. Of course here in
Maine in addition to the Federal grant recipients we also have a broad range of
community groups receiving support from MeHAF to do this important work.
And speaking of open-enrollment, this blog post is a good
overview, complete with cautions, about the renewal process: Do
Nothing to Renew or Get an Updated Eligibility Determination? CMS Puts out
Final Marketplace Renewal Rules. Remember, there are New
challenges for O-Care’s second year, so buckle up, it may be a bumpy ride!
Another bumpy ride is testifying before Congress... HHS and IRS
officials got to do just that this week, unfortunately the sound bites were not
always clear. We had an HHS
Official: Healthcare.gov Updates Will Be 'Improvement But Not Perfection'. While
it's good to set realistic expectations they might have been better served by
stopping before the "not perfection" part. Meanwhile, the quote from
the IRS
chief: 'Whenever we can, we follow the law' prompted the inevitable
question, why don't you follow the law all the time... In both instances, their
words were fair in the full context of the remarks but the full context is not
what the media always focuses on.
And speaking of focus, the Health
Chief Seeks to Focus on Insurance Site. Her comments also talked about
moving beyond politics... I'll let you
use your imagination to gauge how likely that is.
Also looking towards November (open-enrollment, not the
elections), the insurance industry is still nervous: Reform
Update: Insurers brace for potential IT problems in second open enrollment.
Some seem to be particularly concerned about the reenrollment process - what
happens behind the scenes when and individual chooses a new plan instead of
accepting the reenrollment.
ACA: Employers
A major employer survey was released this week from Kaiser (2014
Employer Health Benefits Survey (Primary Source)). While overall the
results were positive (Obamacare
Hasn’t Driven Up Employers' Health Care Premiums), on a practical basis, Yes,
you are paying a lot more for your employer health plan than you used to.
While the historic cost increases have moderated recently, results
of this survey show that the trend of employers putting more of the burden on
employees continues. One of the basic flaws of our reliance on
employer-sponsored health plans is that Health
insurance premiums are eating American workers' raises. Take special note
of the second chart in that link which looks at workers contribution increases,
premium increases, wage increases and inflation. It's not pretty...
The survey also showed that another of the horror story predictions
by the laws opponents has not come to pass as Workplace
insurance coverage levels steady in year one of Obamacare.
Also on the employer front, reports that there is a Flaw
In Federal Software Lets Employers Offer Plans Without Hospital Benefits,
Consultants Say. Hopefully the spotlight put on this by the media will
result in a quick correction to the software.
When discussing healthcare, I often talk about the move to
evidence based care - that is doing things that have been proven to work. What
is true for health care is also true for health policy (and policy in general).
We should be doing what we know works. Unfortunately, as we've seen time and
again with health care, that's not always the case.As wellness programs
continue to grow, and Businesses
are testing employees’ body fat and paying them to lose weight, the
evidence says that often these programs just don't work. "One example is
that they’re very fond of workplace wellness programs. This is surprising,
because while such programs sound great, research shows they rarely work as
advertised." (Do
Workplace Wellness Programs Work? Usually Not)
ACA: Other
Brookings released a complex economic analysis this week
looking at how each state's residents did under the ACA. The study, which
looked at 48 of the 50 states, found Maine enrollees did the best. " Looking
at the states individually, she finds that the law benefitted enrollees in at
least 13 states (Alaska, Connecticut, DC, Indiana, Kentucky, Maryland, Maine,
North Dakota, New Hampshire, Nevada, New York, Rhode Island, and Vermont), with
Maine enrollees gaining the most at around $1500 per market participant
annually, whereas Oregon (a state with severe glitches on its website and
roll-out) experienced the greatest loss – around $850 annually per participant."
(The
Early Impact of the Affordable Care Act -Primary Source). The measure of
welfare used is determined by a formula based on enrollment figures, changes to
premiums and changes to the cost of providing care.
You can see summaries of the paper here: Measuring
the impact of states’ Obamacare decisions and here Obamacare
Participants Worse Off, But Don’t Blame Washington — Blame States, Paper Says.
Also out this week is an Urban Institute study of the impact
of the ACA on the uninsured rate for children. The findings show that Obamacare
has reduced the uninsured rate for virtually everyone — except kids. This
result is hardly surprising, given the already low rate of uninsured among
children (thanks to Medicaid and CHIP). It's hard to get those last few
percentage points. In Health Affairs you can read the study's authors discussion
of the results: A
First Look At How The Affordable Care Act Is Affecting Coverage Among Parents
And Children.
But wait, there's more!
Yet another study looks at the quality of care provided by those
"narrow networks" everyone's been talking about. It finds that Narrow
Health Networks: Maybe They’re Not So Bad and Maybe
You Don't Need a Big Doctor Network to Get Good Care: Injecting some data into
an Obamacare controversy.
Thought I was done with the studies? No, one more, this one from JAMA which asks: Obamacare
lets young adults stay on their parents’ insurance longer. Has that made them
better off? The bottom line answer is "not so
much". "...the results are a reminder that providing health insurance
is just one part of the equation. Changing someone's behavior can be tougher."
And finally, while all these studies and all the data are
important, sometimes it takes a story to drive a point home. Here is a look at
how the ACA changed one woman's life: The
simple ways health insurance can change your life. A great reminder of what
this is all about.
Costs
Last week saw the release of lots of cost data, this week
the Census Bureau has it's say: Census
Bureau: Health Costs Inch Up As Obamacare Kicks In. Here's the bottom line:
" CMS is the Centers for Medicare & Medicaid Services, the
government's main health care bookkeeper. Last week CMS projected that
health-expenditure growth would accelerate to 5.6 percent this year from an
estimated 3.6 percent in 2013. ... But health and social spending as measured
by the Census Bureau grew by only 3.7 percent from the second quarter of 2013
to the same quarter of 2014."
Or to put it another way, as of this quarter health spending
increases are still on track to remain at historically low levels. As Sarah
Kliff puts it, we are in The
"pay less, get more" era of health care.
Medicaid
The GAO took a look at the Arkansas Medicaid Private Option
program and had some issues: MEDICAID DEMONSTRATIONS: HHS's
Approval Process for Arkansas's Medicaid Expansion Waiver Raises Cost Concerns
(Primary Source). The plan (over its first three years) is supposed to be
revenue neutral when measured against traditional Medicaid. However the
findings found: GAO:
Arkansas Medicaid plan not revenue-neutral. It will be interesting to see
how the program develops over the rest of the three year period, but so far
it's not clear that what was heralded as an innovative approach to bring market
forces to bear on Medicaid will end up working out as advertised.
On the state front, we have two developments. First, Utah
Gov. Gary Herbert: We have a ‘conceptual’ deal on Medicaid. Like several
other states, when Utah began these conversations they wanted a work provision
as part of the eligibility criteria. So far, that's been a line in the sand
that HHS has not crossed. Reports are that it remains so as "HHS did not
agree that insurance subsidies would be contingent on recipients holding a job
or looking for work, but the agency did agree that employment can be a goal of
Utah’s program, Healthy Utah."
Second, in Virginal where the legislature has thwarted the
Governor's expansion plans, a very small alternative was offered by the Governor:
With
Medicaid expansion blocked, McAuliffe unveils modest plan to insure more
Virginians (this would only benefit 25,000 people vs. the 400,000 who could
benefit from expansion).
Medicare
Kaiser likes their graphics - in cooperation with JAMA they
continue their Visualizing Health Policy series with a look at Medicare
Advantage: Visualizing
Health Policy: The Role of Medicare Advantage.
VA
While the coverage has calmed down, the work to reform the Veterans''
Administration continues. This week at the same time as the New
V.A. Secretary Says Hiring Spree Is Needed to Meet Patient Demand, the Watchdog
Says V.A. Officials Lied.
Drugs
Drugs can be lifesavers, but they also can be unnecessary
and expensive. A look at how Dementia
patients continue to get medications with little, no benefit. Sometimes
this is due to inertia, but that's not an excuse for subjecting the patient to possible
side effects and added expense for no benefit.
On a positive note, announced this week that the D.E.A.
to Allow Return of Unused Pills to Pharmacies. Previously there were only
two national prescription drug collection days a year and pharmacies were not
allowed to take back unneeded medications. With these new proposed rules that
will change.
After rejecting the same drug several years ago, this week a
New
Drug to Treat Obesity Gains Approval by F.D.A.. More research was done to
better understand the drug's impact on heart attacks and the results satisfied
the regulators.
System Transformation
More studies! Two
papers from the Commonwealth Fund looking across countries. First A
Comparison of Hospital Administrative Costs in Eight Nations: U.S. Costs Exceed
All Others by Far. No surprise there, but this report puts numbers to
something we already guessed. Second, A
Comparison of How Four Countries Use Health IT to Support Care for People with
Chronic Conditions. Results a little more nuanced here as the report talks
about each countries approach and what we can learn from each other.
On the vaccine front Nova focuses on the issue with a new
episode Vaccines—Calling
the Shots. And here a pediatrician reminds us that The
vaccination decision isn’t a purely personal one. And finally, a novel
approach finds that Australia's
free HPV vaccine program is a big success.
The New York Times asks Can
We Have a Fact-Based Conversation About End-of-Life Planning? It hasn't been possible so far, but maybe we're
getting close. The AMA is recommending that physician's be reimbursed for these
conversations, but that begs the questions End-of-life
discussions: Is extra reimbursement enough? Spoiler alert, the answer is probably
not, but at least it's a start. And finally a reminder that it's hard for both
parties in the conversation: Doctors
cannot speak about the reality of death and dying. Yes it's hard, but they
need to as shown by this story of how a little clarity made all the difference
in the world to a family.
Good news on the transparency front - not price transparency
but system transparency. First, the Feds
reverse course, will release hospital mistake data. Previously they'd said
the database was no longer useful, but at the public outcry they changed their
minds and will continue to update the database. Second, the Open
Payments Database: Despite Criticism, Still On Track To Let The Sunshine In.
While the first iteration will be more limited than originally hoped for,
better some data now than no data now.
Ever wonder how doctors ask each other questions? Turns out some of them use their smart phones:
Instagram
for doctors: How one app is solving medical mysteries. In the technology
age, a replacement for the hallway consult.
Studies show that looking for medical information is one of
the most common uses of Google. Well, Stop
Googling your health questions. Use these sites instead. A guide on where to start your search for
reliable information.
And finally, our comic medical video of the week. From the
mind that brought you Doctor House of Cards a look at childhood obesity: Baby
Phat | Lady Gaga Poker Face Parody | ZDoggMD
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
