Tag Archives: Aaron Carroll

Health Policy Updates: January 7 2017

In the big health policy news of the week, the Republican-controlled congress has taken its first – expected – steps towards repealing the ACA/Obamacare by means of the budget reconciliation process.

“The concurrent resolution also establishes a “reserve fund for health care legislation,” which is intended to pocket any savings from repeal for subsequent replacement legislation, as well as a “deficit neutral reserve fund” to revise allocations within the budget resolution and adjustments to the pay-as-you-go ledger in the Senate to ensure that repeal legislation does not violate budget requirements. The reserve fund would allocate $2 billion of savings from the repeal toward reducing the deficit, but hold the rest for eventual replacement legislation.”

Meanwhile, away from the partisan circus of Congress, some leading conservative health policy thinkers are having serious concerns about the repeal-and-delay strategy:

“Antos and Capretta’s piece goes into much more detail on the technical problems of repeal and delay, and is worth reading in full. But they avoid the fundamental issue animating the whole strategy: Republicans don’t know how to replace Obamacare, and they don’t know how to force themselves to figure it out.”

Full details of Joseph Antos’ and James Capretta’s concerns about repeal-and-delay can be found here.

“We do not support this approach to repealing and replacing the ACA because it carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying to finance their health services, and because it is unlikely to produce a coherent reform of health care in the United States. The most likely end result of “repeal and delay” would be less secure insurance for many Americans, procrastination by political leaders who will delay taking any proactive steps as long as possible, and ultimately no discernible movement toward a real marketplace for either insurance or medical services.”

Meanwhile, with all the commotion about whether and how to dismantle the ACA, the law itself continue to truck along, providing insurance to some 20 million Americans. Sarah Kliff of Vox.com has some pretty charts showing this.

The uninsured rate is at an all-time low. The federal government announced in September that 8.6 percent of Americans lacked health insurance. That’s a big decline from 2010, when the health care law passed and the uninsured rate was 16 percent.”

In some local North Carolina health policy news, incoming governor Roy Cooper has announced plans to expand Medicaid in the state. Don Taylor of Duke shares his thoughts on how this may play out.

From Aaron Carroll at The Incidental Economist, in which the adjective “crazypants” is used to describe US health care spending.

“Between 1996 and 2013, more than $30 trillion was spent on personal health care. Let that sink in for a minute or two. Over that time period, spending increased between 3% and 4% annually for most age groups.”

The prices for drugs are going up. A lot. And not just in cancer, as I’ve written about many times, but for multiple sclerosis as well.

The 21st Century Cures act that President Obama just signed into law, which both funded the cancer “Moonshot” and weakened FDA regulatory power, is not universally loved. Drs. Aaron Kesselheim and Jerry Avorn share their thoughts in this JAMA commentary.

“Among the most concerning sections of the new law are components that address the types of data that manufacturers will be able to use to gain FDA approval of new products or additional indications for existing products…When biomarkers used as the basis for drug approval are not rigorously validated, they may not actually predict patient benefit, can mislead physicians about whether a drug works, and have the potential to expose patients to poorly effective treatments or unanticipated adverse effects.”




Health Policy Updates: November 26 2016

It is important to remember that rising insurance costs are not a phenomenon limited to the Obamacare exchange plans. Health care costs continue to rise overall, and insurance companies have to charge higher premiums and copays to keep up. Employment-based health insurance plans will be costing 5.5% more, and employee out-of-pocket costs continue to increase even faster and have now nearly doubled since 2009.

A recent study in JAMA Oncology highlighted an important point regarding the “financial toxicity” of cancer care – having Medicare coverage is often not enough to protect from catastrophic costs. 10% of Medicare patients with a new diagnosis of cancer will spend two-thirds of their annual income on health care bills.

“Beyond highlighting the need for innovative initiatives for delivery of care, the high level of hospital-associated OOP costs may also demonstrate potential adverse consequences of Medicare’s current design of benefits…Assigning beneficiaries such a high responsibility of cost sharing for inpatient care may not be an effective use of cost sharing, as hospitalizations are usually not at the discretion of beneficiaries.”

A conversation on the potential for Obamacare repeal, from The Incidental Economist bloggers Aaron Carroll and Austin Frakt.

“They’re actually in a tough policy spot. They’ll get the blame if they don’t fix or repeal the A.C.A., and they’ll get the blame if they don’t replace it with something people like better. Health policy is a very difficult and thankless task. I think they’ll opt for something they can call repeal and replace, but they could also just let Obamacare struggle and die. Neither looks good.”

In order to convince health insurance companies to engage in the ACA/Obamacare exchanges, the law included a provision known as the “risk corridors.” In sort, if insurance companies ended up losing money because they insured sicker-than-average patients who incurred higher-than-average health care costs, the risk corridor system would give them money to recoup the losses. So, insurance companies joined the ACA exchanges. And they dutifully lost money. However, Congress did not appropriate money for the risk corridors, so these insurers are still short billions of dollars that was promised to them, and are suing the government to get it.

Nicholas Bagley reports on the debacle at the NEJM.

“For now, the Justice Department is fighting the lawsuits. But the insurers’ legal arguments have considerable force. Indeed, HHS has openly acknowledged that risk-corridor payments are ‘obligation[s] of the United States for which full payment is required.'”

Surgeon General Murthy on ending the opioid epidemic.

Health Policy Updates: November 12 2016

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.”

Continue reading Health Policy Updates: November 12 2016

Health Policy Updates: November 6 2016

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: nejm-medicaid-expansion
Continue reading Health Policy Updates: November 6 2016

Health Policy Updates: September 3 2016

Given the problems that the ACA/Obamacare has faced, were there any realistic alternatives at the time the law was passed, that would have done any better? Megan McArdle, writing at Bloomberg, thinks yes. Specifically, focus on the simple expansion of Medicaid to support low-income Americans rather than trying to set up the complex Exchange infrastructure.

“Here’s my radical plan: If the Obamacare exchanges are going to result in, at best, people being able to buy Medicaid-style plans with limited choices and benefits, then why not just eliminate the middleman and give them … Medicaid?”
Continue reading Health Policy Updates: September 3 2016