Health Policy Updates: November 19 2017

Just when you thought Obamacare repeal was over, it’s back – this time, as part of the GOP tax reform effort.

“The revised Senate tax bill will repeal the individual mandate, according to multiple reports. Repealing the mandate — which is the gear that makes the Affordable Care Act tick — would save more than $300 billion over 10 years, but only because millions fewer Americans would have health insurance, according to the Congressional Budget Office. It also means higher premiums, because the younger, healthier people who have an incentive to buy insurance rather than pay the mandate would be expected to exit the market while the sicker people stay in.”

This week saw the passing of Uwe Reinhardt, one of the most well-known and well-loved health economists. His thinking and writing has been influential on me, as on many others.’s Sarah Kliff sums up some of his most important ideas in her column on his life and works:

“I wanted to take today’s VoxCare to tell you about a Reinhardt paper I think anyone interested in health policy ought to read…The thrust of the argument is this: America does not have an overuse problem when it comes to medicine. We do not go to the doctor more than people in other countries — we actually go to the doctor a little bit less…We’re not consuming lots and lots of health care. We’re just paying higher price tags.”

The Freakonomics podcast took on the topic of expanded scope-of-practice for nurse practitioners, to help address the shortage of primary care physicians in the US.

“Imagine you’re a policymaker. You’d think you’d look at this finding and say — well, since nurses are plentiful, and effective, and relatively much cheaper than doctors, perhaps we should think about reassessing and maybe expanding the role nurses play in our health-care system.”

Interesting new study out in JAMA Internal Medicine studying the relationship between Medicaid reimbursement and health care access for Medicaid patients. Medicaid typically reimburses less than other insurance types (though this varies by state), and the authors used a natural experiment stemming from an ACA provision that transiently increased Medicaid rates closer to parity with Medicare to see whether this affected access to primary care. Turns out, it does – health care providers were able to make more room for Medicaid patients when they were making more money off of them.

My takeaway? Maybe we should stop arguing that Medicaid is “bad insurance”, and rather simply fund it enough so that its beneficiaries will have equal access.




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