Health Policy Updates: October 8 2017

This week, reports surfaced to confirm that the Trump administration is actively engaged in ACA sabotage. The strategy is to quite literally inflict financial harm on the American people, by way of increasing insurance premiums on the exchanges.

“For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application. “

As long as Trump is out to sabotage things, how about women’s health and rights?

“The new rules take effect immediately. And they allow large, publicly traded companies to seek an exemption from the birth control requirement if they have a religious or moral objection to providing such coverage. The Obama administration barred these large businesses from such exemptions.”

On September 30, Congressional inaction allowed funding for the Children’s Health Insurance Program (CHIP) expire, placing the health care of nearly 9 million US children in jeopardy. The Kaiser Family Foundation gives an explainer on this program, and a survey of when the various states can expect to start running out of funds for the program:

“Because states have assumed continued federal funding in their state budgets, the majority of states will face a funding shortfall if Congress does not extend federal funding. Addressing these shortfalls will likely require special legislative sessions and/or Governor action because state budgets have already been passed. States will face challenges replacing federal dollars since many were already facing budget shortfalls heading into FY 2018.”

This was my favorite academic piece of the week – in Health Affairs, a recent report found that 29% of new drugs approved since 1999 are no better than the older ones they are theoretically replacing. Some of them are actually worse! Health Policy experts Aaron Kesselheim and Jonathan Darrow discuss.

“Many people mistakenly assume that the FDA and other gatekeepers sufficiently screen drugs for meaningful benefit. With efficacy assumed, efforts by patient groups are directed at promoting faster availability and lower cost. Policy makers have responded by repeatedly focusing on expediting the availability of new drugs, most recently seen in the push for pre-approval expanded access. A commensurate focus on the efficacy of new drugs is needed.”

In my view, this is evidence that we need to raise the bar for drug and device approvals. Specifically, having drugs beat placebo isn’t good enough; they need to be better than the current standard of care, if they are actually going to help anyone!

This story is actually about my dad’s hospital in rural Western North Carolina, where he *used to* work delivering babies. Their L&D department was just shut down by Mission, the controlling hospital network in that part of the state. This is emblematic of the national trend towards decreasing health care access in low-income, rural areas.

“These hospitals were especially hard hit when the Republican-led North Carolina General Assembly refused to expand Medicaid in 2013. Eighteen other states made the same decision, and the impact was clear: more than 70 percent of the rural hospitals that shut down in the past seven years were in 16 of those states.”

More evidence – narrow networks are an effective way for insurance companies to hold down health care costs.



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