Health Policy Updates: September 23 2017

The Cassidy-Graham Obamacare repeal bill that is currently under consideration in the Senate would be a big step towards allowing insurance companies to once again exclude people on the basis of pre-existing conditions:

“The bill says states cannot tether an individual’s premiums to ‘sex or membership in a protected class under the Constitution of the United States.’ Anything else — a cancer diagnosis, a history of breast cancer, a mild case of asthma — is fair game. In states that did pursue and receive these waivers, health plans would have full authority to charge sicker patients higher premiums to offset their costs.”

The way Cassidy-Graham actually works, in terms of redistributing money among the states, is pretty complex. I didn’t have a good sense of it until I listened to the most recent episode of’s The Weeds podcast, which has a pretty good explainer.

Conservative health policy expert James Capretta also gave a pretty “high yield” rundown in Health Affairs, if you’d rather read than listen:

“A certain consequence of Graham-Cassidy is large redistribution of federal resources among the states…even if there is some uncertainty around the exact estimates, the basic direction of what would occur is clear: there would be movement of federal resources from high-income, ACA expansion states (California, Connecticut, New York), to lower-income states that did not expand their Medicaid programs (Alabama, Georgia, Mississippi, Texas).”

As discussed in STAT, the central feature of the bill is the elimination of Medicaid expansion and the Obamacare subsidies; instead, states would be given money in the form of capped block grants and then compelled to do something health care-wise with it:

“Some states have previously grappled with questions about how to structure their insurance markets and health care services. Massachusetts overhauled its health insurance markets in 2006 with legislation that ultimately inspired the Affordable Care Act. Other states haven’t even begun to do so, and would face additional pressure with a capped commitment from the federal government.”

An NEJM perspective argues why Graham-Cassidy would actually be the most harmful of all the GOP “repeal and replace” bills to date:

“There can be no doubt that Graham–Cassidy would boost the number of people without health insurance…All told, we estimate that under Graham–Cassidy, an additional 21 million people would be without insurance coverage in 2020 and later years, and this figure may be conservative”

A summary on all of the shenanigans that pharmaceutical companies use to manipulate the patent system and avoid having to compete against generics:

“In principle, a patent should be issued only for a new product that is a “nonobvious” advance over already-described products. However, this has led to controversy over the US Patent and Trademark Office authorizing patent protection for products such as esomeprazole (Nexium; AstraZeneca). Esomeprazole is simply the S-isomer of an existing product, omeprazole (Prilosec; AstraZeneca), with no compelling clinical advantage. Yet this new patent protection allowed it to become a separate multibillion-dollar per year blockbuster drug with a patent life of its own.”


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