Health Policy Updates: February 18 2017

It hasn’t been a good week for Obamacare. More insurers are pulling out, and the Trump Administration seems to be split on whether it wants the exchanges to die now or hang around a little longer to provide for a smooth transition.

“The administration’s zigzags haven’t placated worried insurers, who see another year of red ink from enrollees that are older and sicker than they had expected. Congress’ paralysis on repeal and replacement translates into precisely the kind of uncertainly that makes risk-averse insurers want to run for cover. And Trump’s executive order, signed just hours after his inauguration, unnerved the health plans with its call for government agencies to abolish as much of the law as possible through administrative action. That fueled fears that his administration won’t enforce the individual mandate requiring most Americans to get coverage.”

Depending on where you are in the country, your likelihood of getting certain medical treatments varies greatly from other areas. And not because people in different areas of the country need them more than anywhere else. What, then, accounts for this “regional variability” in health care delivery? Austin Frakt walks through several possible answers at the NYTimes Upshot page.

“Our best guess comes from a study by Harvard and Dartmouth researchers…It found that regional variation in Medicare spending is associated with variation in physician preferences for intensity of cardiac treatments, and to a greater degree when the evidence is ambiguous. Patient preferences exerted almost no influence.”

After an outcry, Marathon Pharmaceuticals is thinking twice about charging $90,000 per year in the US for a drug that has been selling for $1,200 in Europe for years.

“The drugmaker had announced an $89,000 annual price tag for its newly approved drug last week but patients and lawmakers immediately cried foul. ‘What you’re doing is robbing my insurance company,’ said Dana Edwards, a mother from New Jersey whose 12-year-old has taken deflazacort, the generic version of the drug, since he was five years old.”

One thing that the ACA/Obamacare did away with was the concept of “lifetime limits” for health insurance – insurance companies can no longer stop paying for your care once you hit some lifetime “cap”. That’s good for people with expensive chronic diseases; of course the rest of us will have to pay higher premiums in the mean time.

Sarah Kliff of reports that lifetime limits may return with ACA repeal:

“Republican replacement bills are split about whether to allow the return of lifetime limits. House Speaker Paul Ryan’s plan expressly calls for maintaining the health care law’s ban on lifetime limits. But Health and Human Services Secretary Tom Price’s plan, written when he was a Congress member, would kill the provision.”

More data out this week that the health care “cost slowdown” from roughly 2008-14 is over, and that health care costs are once again growing at their historical faster-than-inflation pace.

“Over the next decade (2016–25), growth in nominal (not adjusted for inflation) national health expenditures (NHE) is projected to average 5.6 percent, outpacing average growth in gross domestic product (GDP) by 1.2 percentage points. As a result, the health share of the economy is expected to climb from 17.8 percent in 2015 to 19.9 percent in 2025”

Seema Verma, the executive’s pick to oversee Medicare and Medicaid, has a history in Medicaid reform.

“Except with respect to the most fragile and vulnerable beneficiaries, Verma regards Medicaid not as a health care program but as a temporary pathway ‘for people to lift themselves out of poverty toward a state of self-sufficiency.'”


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