Health Policy Updates: December 16 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:

  1. Julie Rovner’s “What the Health” podcast at Kaiser focused on mandate repeal this week.
  2. 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.”

Accountable Care Organizations are one of many kinds of “alternative payments” with the goal of moving medical reimbursement away from our current fee-for-service model, and instead rewarding outcomes and quality. Health Affairs reviews data showing that “risk based ACOs” – those in which the doctors/hospitals are on the hook if they overrun cost targets – are effective in the goal of controlling costs.

“Moreover, discussion of ACO results has tended to lump all ACO models together and to focus on short-term results. But today’s ACO models have fundamental differences in their design—most notably in the amount of financial opportunity and risk being borne by participants—and should be viewed separately.”

Medicaid comes under criticism for allowing able-bodied people to receive health benefits without entering the work force, and have proposed adding work requirements to the program. However, new research shows that (within the state of Michigan), only about 1/4 of Medicaid recipients are out of work.

If you aren’t familiar with the dysfunctional, lax, and gameable system that is our current FDA device approval process, I would highly recommend Elizabeth Rosenthal’s recent book, An American Sickness.

If you are familiar, you may be interested to know that the current administration would like to further weaken this process.

“Gottlieb said the FDA will also examine ways to speed the path to market for high-risk products by re-evaluating the amount of safety data needed prior to approval…Dr. Rita Redberg, a cardiologist at the University of California San Francisco and editor of JAMA Internal Medicine, said shifting safety monitoring from the pre-approval to the post-market setting would essentially turn patients into guinea pigs.”




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