Health Policy Updates: November 12 2016

There has been immediate hypothesizing about the future of Obamacare given the election result. Sarah Kliff at expects that full repeal is a real possibility, and emphasizes that his “replacement” plan would lead to an additional 21 million uninsured Americans.

“In broad terms, Trump’s plan looks a lot like the dozen or so other Republican Obamacare repeal plans that have come out over the past few years. Trumpcare allows insurance companies to go back to refusing coverage for preexisting conditions, a key barrier to coverage before Obamacare’s coverage expansion. The plan would, according to outside analysts, increase the number of uninsured Americans by 21 million people.”

Health Affairs’ Timothy Jost gets into the weeds of the ACA’s different components, and discusses which can still effectively be reversed and which have already become too ingrained to undo.

“Immediate repeal of the ACA and presumably restoring the law that preceded it would likely bring the Medicare program, for example, to a halt until new rules could be written. The ACA is inextricably interwoven into our health care system and is not going away immediately.”

Forbes’ Avik Roy frames his discussion in terms of which parts of the law Republicans may be able to achieve, given that they will not have a filibuster-proof majority:

“The best that Republicans can do is to pass a partial repeal of Obamacare using the reconciliation process, which only requires 51 votes…But critically, the partial repeal bill does not get rid of Obamacare’s tens of thousands of pages of insurance regulations, the regulations that are responsible for the law’s drastic premium hikes.”

Kaiser Health News also weighs in.

Yet even Democrats are convinced that Obama’s signature accomplishment is on the chopping block. “A lot of people say, ‘Oh, they can’t really mean it. They wouldn’t really take health insurance away from 20 million people’” who have gained it under the law, John McDonough, a former Democratic Senate staffer, said at a Harvard School of Public Health Symposium last week. “How many times do [Republicans] have to say it before we take them seriously?”

Also an election result this year, California voters rejected a proposition intended to lower proscription drug prices in the state. If these measures can’t pass even in California, do they have much hope anywhere in the US?

“…the drug industry, led by Merck, Pfizer, and Johnson & Johnson, poured at least $109 million into opposing the measure, which both sides saw as having the potential to set a precedent that could ripple across the nation and cost the drug industry billions. The drug industry’s effort to preempt that was believed to be the most expensive investment in a single ballot measure in the state’s history.”

I have written here in the past about the purported physician shortage in the United States, including it as one of the factors leading to higher health care costs in my health care spending map. Aaron Carroll provides an update on this problem, emphasizing that the crux of the problem is not our overall number of physicians, but our comparatively small proportion of primary care physicians in relationship to specialists.

“What no one seems to be debating is that we have a shortage of services. We could fix that by increasing the number of physicians, either by training more or allowing more to immigrate into the country.”

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