I spent way too long looking at the maps in this article, which shows how the death rates from various causes have shifted over time in the US. Amazing to see how much drug related deaths really are up, and how much heart disease really is down. Sample below, for heart disease:
There has been immediate hypothesizing about the future of Obamacare given the election result. Sarah Kliff at Vox.com 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.”
A couple studies came out recently looking at the impact of the ACA/Obamacare’s Medicaid expansion. The first, published in JAMA, found that Medicaid expansion reduces the amount of uncompensated “charity care” that hospitals have to provide, reducing their operating expenses and improving profitability. Blog commentary here.
“…as we debate policy as to whether it’s “worth it” to expand Medicaid, it’s worth nothing that the data arguing that it might be bad for hospitals not only isn’t lacking, it’s somewhat refuted.”
And, this piece out in the NEJM showed some very clear and convincing charts that the numbers of uninsured people have been dropping in Medicaid expansion states, in contrast to those that did not expand Medicaid:
Continue reading Health Policy Updates: November 6 2016
The big policy news from this last week was that the Center for Medicare and Medicaid Services (CMS) released the so-called “final rule” on the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA.
What is MACRA, you ask? And what is a “final rule”? Well, you may remember intermittent debates, fights, and panics a few years ago about the Sustainable Growth Rate, and Medicare reimbursement formula that always threatened to drastically cut doctors’ pay under Medicare, except for the fact that Congress kept “temporarily” delaying it for years. MACRA is the replacement – no huge cuts to doctors’ pay immediately, but it does put into place a new regime of cost-controlling strategies linked to holding physicians accountable to a range of quality-of-care measures. The final rule finalized, ahem, the exact cadre of payment incentives, deductions, and implementation time frames that constitute MACRA. Health Affairs summarizes here.
“As an initial sign they hit the target, key Members of Congress have already weighed in applauding the Rule. Here’s a tip: when Members applaud a regulation like this so quickly, two things are going on: 1) they are taking a solid helping of credit for changes the agency has made; and 2) they are putting affected stakeholders on notice that they have an uphill battle in securing new changes soon. Read: this is as good as it’s going to get.”
The beginning of last week saw the second presidential debate, in which health care policy finally got some attention. I will include some discussion of the various points that the candidates raised below.
Kaiser Health News unpacks Donald Trump’s statements about increasing insurance prices under Obamacare:
“There are several reasons for the increases. One is that insurers charged premiums that were simply too low to begin with, and now they are catching up in order not to go broke. Another goes back to the CBO prediction above, about employers sending workers to the individual market to buy their own insurance.”
Sarah Kliff at Vox.com does her best simply to translate what the two candidates were proposing (or were trying to propose):
“…it is possible to decode what actually happened. Clinton defended the Affordable Care Act while offering a blunter critique of the law than the Obama administration typically does — while Trump mostly attacked Obamacare for its costs, while offering an Obamacare repeal proposal that would leave millions uninsured.”
Harold Pollack was not impressed by the ideas that were put forward:
“More than anything, ACA requires pragmatic, bipartisan problem-solving in an era of divided government and unprecedented polarization exemplified by Trump’s nomination itself. Our next president must find a way to work within that environment. I didn’t hear much tonight – or on any night – about how this might be done.”