Health Policy Updates: August 20 2016

The big story this week from the world of health reform was news that Aetna, another large insurer, is massively scaling back its participation in the ACA/Obamacare exchanges. Large financial losses are cited as the reason. Here is a sampling of related stories:

Announcement from Aetna:

Following a thorough business review and in light of a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since January 2014 in our individual products, we have decided to reduce our individual public exchange presence in 2017, which will limit our financial exposure moving forward.

Obamacare pullouts have left some areas of the country with very few options, as reported in Bloomberg:

“The dropouts also undermine a key promise of the law: multiple insurers would compete for consumers’ business each year, and the power of the market would control costs and raise quality. Instead, the opposite is happening.”

Continue reading Health Policy Updates: August 20 2016

Health Policy Updates: August 14 2016

A large part of the ACA/Obamacare was to expand Medicaid; many (though not all) states elected to do so. New data out this week in JAMA Internal Medicine suggests that patients are benefiting. Compared to states that did not expand Medicaid, previously uninsured patients who have now gained access to Medicaid coverage do better on many metrics, including better access to outpatient care, increased diabetes screening, and reduced non-compliance due to cost.

The Oregon Medicaid experiment from a few years ago left Medicaid skeptics with some reason to be agnostic as to whether Medicaid actually improves people’s health. These data lessen the foundation for such skepticism, and should  thus should help move the conversation forward. Continue reading Health Policy Updates: August 14 2016

Health Policy Updates: August 7 2016

I’m a week behind in sending this link out, but Sarah Kliff at Vox had a great post on “narrow networks,” an effective (if unpopular) strategy used by health care insurance companies to hold down costs and premiums. Insurance companies can lower costs and improve the experience for everyone by restricting their provider networks to the lowest-cost providers in each geographical region…but consumers are often surprised not to see their doctor or favorite big-name hospital on the list.

“So this, then, is Oscar’s coming pitch: less choice of where to get care but a much better, more seamless experience once you’re getting care…Oscar plans to work especially closely with doctors in these systems to eliminate the frequent hassles of obtaining care. Patients with Oscar will be able to see doctors’ schedules, for example, and make appointments on the insurance plan’s website and app.” Continue reading Health Policy Updates: August 7 2016

Health Policy Updates: July 31 2016

With the prices of many new specialty pharmaceuticals skyrocketing, the number of patients qualifying for Medicare’s “catastrophic” prescription drug provision is skyrocketing as well.

“Experts say the rapid rise in spending for pricey drugs threatens to make the popular prescription benefit financially unsustainable. Nonpartisan congressional advisers at the Medicare Payment Advisory Commission have called for an overhaul. The presidential candidates, as well as the Obama administration, have proposed giving Medicare legal authority to negotiate prices.”

Continue reading Health Policy Updates: July 31 2016

Health Policy Updates: July 24 2016

A very detailed, and very good, piece in Politico about the ongoing cost problem facing the ACA/Obamacare. Fewer young and healthy people have signed up than anticipated, leaving the average costs higher for everyone else. As a result, insurance companies are losing money, and are raising their prices to try to catch up. Trends like this are concerning that we may be seeing the early stages of a “death spiral,” in which prices continue to rise higher than more and more people are able to afford.

I found this article to cover both the successes and the problems of the ACA in a fair and comprehensive way, and recommend it highly.

“A close look at what’s really keeping the exchanges underwater suggests that some of the problems are self-inflicted wounds by Obama and his administration; others are the handiwork of Republican saboteurs, who undercut the safeguards intended to help companies weather the uncertainty of the new law…None of the problems are insurmountable, but if they aren’t fixed, the law could find itself in a mounting crisis—what observers call a “death spiral”—in which competition vanishes, costs skyrocket, and a dwindling pool of insurers offer policies so expensive that health insurance is as out of reach as it ever was.” Continue reading Health Policy Updates: July 24 2016