With the reconciliation tax bill headed towards passage, it looks like the individual mandate may be done for.
In the lead-up, I had heard conflicting reports of how the repeal of the individual mandate would affect the rest of Obamacare going forward – everything from “meh” to “instant death spiral.” A couple of resources to get a handle on where we are at:
- Julie Rovner’s “What the Health” podcast at Kaiser focused on mandate repeal this week.
- Sarah Kliff addressed the question in a recent article.
“Economists roundly expect premiums to rise if the individual mandate disappears, as healthier people exit the market, leaving behind a sicker, more expensive insurance pool. Some Americans may gladly exit the marketplace, happy to no longer pay insurance premiums. But there would also be those who exit unwillingly, people who want to buy coverage but cannot afford the rising cost of health insurance.”
Continue reading Health Policy Updates: December 16 2017
The Atlantic on the ongoing efforts in the Senate to pass a bipartisan “improvement bill” to stabilize Obamacare insurance exchanges:
“The hearings are the brainchild of Senator Lamar Alexander of Tennessee, the Republican chairman of the Health, Education, Labor, and Pensions Committee, who has been talking for months about the need to stabilize Obamacare’s individual insurance market…Alexander, aides said, has an ambitious goal of moving quickly from hearings to drafting legislation that would, at minimum, guarantee the continued payment of cost-sharing reduction subsidies to insurance companies and allow states more flexibility to adjust insurance rules…”
Continue reading Health Policy Updates: September 2 2017
There was a new study out this week in JAMA Internal Medicine assessing the impact of Accountable Care Organization on health care spending. The ACO model of reimbursement, with the ACA/Obamacare has supported the growth of, is a form of capitation. The idea is that if health systems get paid for the overall care of each patient but not for each additional test it performs, then the financial incentive to order more tests will decrease, as will overall spending.
That is indeed what this study found, though the effect was modest – about $136 per patient per year. Continue reading Health Policy Updates: August 27 2016
A new study published in JAMA Internal Medicine this week had some surprising findings relating to gifts to physicians from pharmaceutical companies. The authors asked whether physicians who received a free meal from a drug company were more likely to prescribe expensive, brand-name medications produced by that company. The answer – surprisingly or not – was “yes.” And, it remained “yes” even for single meals less that $20 in value (though the association tended to be higher for more and/or more expensive meals). This study has obvious implications regarding the ethics of physician-industry financial relationships.
“The differences persisted after controlling for prescribing volume and potential confounders such as physician specialty, practice setting, and demographic characteristics. Furthermore, the relationship was dose dependent, with additional meals and costlier meals associated with greater increases in prescribing of the promoted drug. Our findings were consistent across 4 brand-name drugs, including rosuvastatin…” Continue reading Health Policy Updates: June 25 2016
Growth in health care spending, low for the past several years for reasons that are still unclear, has been increasing again. This is reflected in a new projection of health care spending over the next decade.
“Recent historically low growth rates in the use of medical goods and services, as well as medical prices, are expected to gradually increase.” Continue reading Health Policy Updates: September 19 2015