The Trump administration is moving ahead with enabling states to impose work requirements for Medicaid.
“‘This policy is about helping people achieve the American dream,’ Verma told reporters on Thursday. ‘People moving off of Medicaid is a good outcome because we hope that means they don’t need the program anymore.'”
Continue reading Health Policy Updates: January 14 2018
I loved this perspective piece in JAMA on pricing inefficiencies in US health care. Authors Austin Frakt and Michael Chernew point out several areas in which the US health care system pays different prices for the same care – including 340b drug pricing, and differential Medicare reimbursement between office-based and hospital care – and how these price distortions harm care delivery. Highly recommended, in understanding some of the structural problems in our health care system.
“…Implementing site-neutral payments, and reforming how the physician fee schedule is updated are examples of potentially simple, although admittedly politically difficult, policy changes…Nevertheless, changing fee schedules is difficult because politically powerful stakeholders, such as hospitals, that succeed under the current system (many of whom built business models based on the existing prices) vigorously oppose it. These groups often maintain they need the revenue resulting from overpriced services to accomplish a valued mission.”
Continue reading Health Policy Updates: January 7 2018
The individual mandate – viewed by many as an essential component of the ACA/Obamacare in order to maintain insurance market stability – was officially repealed this week with the passage of the GOP tax bill. Health Affairs has compiled a list of resources discussing the possible implications of mandate repeal.
According to health policy expert Timothy Jost:
“The CBO, in its most recent analysis of the individual mandate repeal proposal, projected that repeal would result in four million more uninsured by 2019, 13 million more by 2027. Repeal would increase premiums in the individual market by 10 percent or more in most years…But the repeal of the individual mandate penalty will not by any means bring an end to the ACA. The numbers who lose coverage will likely be much smaller than the CBO estimates.”
Continue reading Health Policy Updates: December 23 2017
With the reconciliation tax bill headed towards passage, it looks like the individual mandate may be done for.
In the lead-up, I had heard conflicting reports of how the repeal of the individual mandate would affect the rest of Obamacare going forward – everything from “meh” to “instant death spiral.” A couple of resources to get a handle on where we are at:
- Julie Rovner’s “What the Health” podcast at Kaiser focused on mandate repeal this week.
- Sarah Kliff addressed the question in a recent article.
“Economists roundly expect premiums to rise if the individual mandate disappears, as healthier people exit the market, leaving behind a sicker, more expensive insurance pool. Some Americans may gladly exit the marketplace, happy to no longer pay insurance premiums. But there would also be those who exit unwillingly, people who want to buy coverage but cannot afford the rising cost of health insurance.”
Continue reading Health Policy Updates: December 16 2017
Health care spending continues to increase – the rate of increase in 2016 was 4.3%, down from 5.8% in 2015 but still greater than inflation. Health care now takes up 17.9% of the US economy. The out-of-pocket costs borne by patients, though, are up more sharply.
“A shift toward insurance plans that transfer more of the burden of health care costs onto patients helped fuel the rise in out-of-pocket costs. In 2016, 29 percent of people who receive insurance through employers were enrolled in high-deductible plans, up from 20 percent in 2014. The size of the deductibles also increased over this time period, a 12 percent increase in 2016 for individual plans, compared with a 7 percent increase in 2014.”
Continue reading Health Policy Updates: December 10 2017