Health Policy Updates: October 22 2016

The big policy news from this last week was that the Center for Medicare and Medicaid Services (CMS) released the so-called “final rule” on the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA.

What is MACRA, you ask? And what is a “final rule”? Well, you may remember intermittent debates, fights, and panics a few years ago about the Sustainable Growth Rate, and Medicare reimbursement formula that always threatened to drastically cut doctors’ pay under Medicare, except for the fact that Congress kept “temporarily” delaying it for years. MACRA is the replacement – no huge cuts to doctors’ pay immediately, but it does put into place a new regime of cost-controlling strategies linked to holding physicians accountable to a range of quality-of-care measures. The final rule finalized, ahem, the exact cadre of payment incentives, deductions, and implementation time frames that constitute MACRA. Health Affairs summarizes here.

“As an initial sign they hit the target, key Members of Congress have already weighed in applauding the Rule. Here’s a tip: when Members applaud a regulation like this so quickly, two things are going on: 1) they are taking a solid helping of credit for changes the agency has made; and 2) they are putting affected stakeholders on notice that they have an uphill battle in securing new changes soon. Read: this is as good as it’s going to get.”

Continue reading Health Policy Updates: October 22 2016

Health Policy Updates: October 16 2016

The beginning of last week saw the second presidential debate, in which health care policy finally got some attention. I will include some discussion of the various points that the candidates raised below.

Kaiser Health News unpacks Donald Trump’s statements about increasing insurance prices under Obamacare:

“There are several reasons for the increases. One is that insurers charged premiums that were simply too low to begin with, and now they are catching up in order not to go broke. Another goes back to the CBO prediction above, about employers sending workers to the individual market to buy their own insurance.”

Sarah Kliff at does her best simply to translate what the two candidates were proposing (or were trying to propose):

“…it is possible to decode what actually happened. Clinton defended the Affordable Care Act while offering a blunter critique of the law than the Obama administration typically does — while Trump mostly attacked Obamacare for its costs, while offering an Obamacare repeal proposal that would leave millions uninsured.”

Harold Pollack was not impressed by the ideas that were put forward:

“More than anything, ACA requires pragmatic, bipartisan problem-solving in an era of divided government and unprecedented polarization exemplified by Trump’s nomination itself. Our next president must find a way to work within that environment. I didn’t hear much tonight – or on any night – about how this might be done.”

Continue reading Health Policy Updates: October 16 2016

Health Policy Updates: October 8 2016

Bill Clinton caused a still last week for using the word “crazy” to describe Obamacare. This was particularly questionable, argues Avik Roy, given the similarity of Hillary Clinton’s plan to Obama’s during the 2008 election season.

“If Hillary had won in 2008, and it had been her plan instead of Obama’s that became law in 2010, Hillarycare would be imposing exactly the same rate hikes as Obamacare has.”

Sarah Kliff sorted through Clinton’s remarks here.

Continue reading Health Policy Updates: October 8 2016

Health Policy Updates: October 2 2016

This thought piece in the NYTimes’ Upshot column uses an analogy of a football team eating at an all-you-can-eat buffet to describe the problems of adverse selection and moral hazard as they relate to the ACA/Obamacare insurance exchanges. The author (Margot Sanger-Katz) doesn’t use the term “death spiral,” but that sure seems to be where the concerns she raises are leading…

“The restaurant analogy is useful here, too. Imagine two all-you-can-eat buffets. One offers iceberg lettuce, chicken wings and macaroni. Its competitor offers the usual fare, plus lobster, and it charges a bit more. Guess which buffet will attract lobster lovers?…That sort of problem can get worse over time. As the companies increase prices to compensate for having sicker patients, fewer healthy people will buy the insurance.”

It appears that Donal Trump has put his money where his mouth is in terms of supporting the anti-vaccine movement.

Continue reading Health Policy Updates: October 2 2016

Health Policy Updates: September 24 2016

With an election coming up (as well as the first debate, next week!), to the extent that health care gets discussed at all, we are likely to hear the idea of “high deductible” health care plans getting touted as a solution to our health care cost problem. The idea is that by putting more of the cost burden on patients (aka, “cost sharing”), these types of insurance plans will force patients to become smarter consumers of health care and shop for high-value, low-cost providers. The evidence, however, is that people don’t use lower-cost care, then just use less care in general. Which has concerning implications for long-term health outcomes.

“In one sense, then, the high-deductible plan did accomplish a key goal: lower health spending. But when the researchers looked at why spending dropped, they found it had nothing to do with smarter shopping. The average price of a doctor visit wasn’t dropping. Instead, under the high-deductible plan, workers just went to the doctor way less.” Continue reading Health Policy Updates: September 24 2016