Congress has been working on new budget legislation with bipartisan support. Some parts are clearly positives, such as the restoration of funding for community health centers, and an even-farther-into-the-future extension of CHIP funds. On the other hand, it proposes the death of the Independent Payment Advisory Board, an Obamacare institution intended to hold down health care costs (though the board itself has never actually materialized). This may represent an important symbolic (if immediately immaterial) retreat from the idea of “bending the cost curve”.
“In a rare show of bipartisanship for the mostly polarized 115th Congress, Republican and Democratic Senate leaders announced a two-year budget deal that would increase federal spending for defense as well as key domestic priorities, including many health programs…The deal does appear to include almost every other health priority Democrats have been pushing the past several months, including two years of renewed funding for community health centers and a series of other health programs Congress failed to provide for before they technically expired last year.”
Despite efforts at “sabotage” from the executive branch, the ACA/Obamacare markets have been remarkably stable over the last year:
“With all states now reporting, ACA plan enrollment ticked downward this year, a report out Wednesday shows, but states running their own marketplaces saw slight gains and did better than those relying on the federal exchange. About 11.8 million Americans enrolled in 2018 coverage, down 3.7 percent from last year’s total, according to the National Academy for State Health Policy.”
Margot Sanger-Katz in the NYTimes on the United States’ historical accident of employment-based health insurance:
“But the employer system also has points in its favor. For one, proponents note employers have multiple incentives to get health insurance right. They want their workers to be happy with their full slate of compensation — an employer that offered deceptive plans, for instance, might not hold onto good employees for long. Employers also want workers who are healthy and productive, able to work hard and to focus on their work. Employers tend to be insulated from the political considerations that can make it hard for government plans or large insurers to try new strategies.”
More medical ethicists argue against the “Right to Try” legislation currently moving through Congress:
“Despite its name, “right to try” doesn’t give patients any new rights. It doesn’t require companies to provide the drugs being requested. Instead, it takes the FDA review away. And for companies that are hoping to receive eventual FDA approval for their products, giving away their drugs-in-development without sign-off from the FDA is a nonstarter. Nobody will get access to drugs via right to try.”