Health Policy Updates: May 6 2017

In an interview with CBS, Donald Trump was noted to tell several blatant lies about the contents of the current version of the AHCA:

  1. Pre-existing conditions will continue to be required to be accepted for insurance.
  2. Premiums will be lowered by the law.
  3. That the bill includes the popular conservative idea to allow interstate insurance markets.

This article, with excerpts from interview the interview, is quite revealing. It’s almost as if the president doesn’t know anything about health care, or is very comfortable lying about it. Or, both.

“This part of the interview is a bit bizarre…Now Trump appears to be saying that he’s ready to reverse course, that this part of the Republican bill is currently “changing.” So either Trump is announcing a big policy shift that would likely lead to Freedom Caucus opposing the bill — or he’s misunderstanding what is actually in the bill. From the interview, its hard to know.”

Nevertheless, as we are all aware, the AHCA managed to pass the House by narrow margins. Here is a refresher from Health Affairs on what the final, amended version of the bill contains.

“Insurers could not…exclude consumers with preexisting conditions, although they could charge high-cost consumers risk-underwritten premiums that would effectively exclude them.”

A lot of doctors, hospitals, and guideline-writing committees have conflicts of interest with the drug industry. This month’s issue of JAMA is devoted to COIs. Highly recommended! This is an area that I’ve published about before, and is very pertinent to the current practice of oncology.

Massachusetts’ health care expansion resulting in a natural experiment to inform the question of how sensitive low-income people are to the cost of health insurance. The answer seems to be “very sensitive,” with enrollment dropping of quickly as the price of coverage increases. This is an ominous finding for the impact of the AHCA (were it to pass), which would result in such increases for many Americans.

“The Republican health bill wouldn’t raise people’s costs by only a small amount, either. It would force many low-income families to pay hundreds or thousands of dollars more for insurance — and most of them would likely respond by not buying insurance. The people who still buy plans would disproportionately be sick people, which would then cause costs to rise even higher.”

Here is an appropriately snarky take on the 11th-hour amendments to the AHCA before passage:

“As a policy matter, this makes no sense. If you think it’s cruel to withhold insurance from people with preexisting conditions, then you should retain the rule banning discrimination on the basis of health status. Instead, the Upton amendment tries to correct a problem that the AHCA itself creates.”


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