I loved this perspective piece in JAMA on pricing inefficiencies in US health care. Authors Austin Frakt and Michael Chernew point out several areas in which the US health care system pays different prices for the same care – including 340b drug pricing, and differential Medicare reimbursement between office-based and hospital care – and how these price distortions harm care delivery. Highly recommended, in understanding some of the structural problems in our health care system.
“…Implementing site-neutral payments, and reforming how the physician fee schedule is updated are examples of potentially simple, although admittedly politically difficult, policy changes…Nevertheless, changing fee schedules is difficult because politically powerful stakeholders, such as hospitals, that succeed under the current system (many of whom built business models based on the existing prices) vigorously oppose it. These groups often maintain they need the revenue resulting from overpriced services to accomplish a valued mission.”
Continue reading Health Policy Updates: January 7 2018
Another frantic news week in health care policy, with the demise of both the Graham-Cassidy Obamacare repeal bill, and of Tom Price’s tenure as HHS secretary.
With passage of Graham-Cassidy looking doubtful, a revised draft of the bill was crafted over last the weekend. This version not-so-subtly moved additional funds to those states with “hold out” GOP senators; this move suggesting something of a vote-buying effort:
“The favoring of certain states over others in the new version of the bill, presumably to please Senators representing the favored states and obtain their votes, raises serious constitutional issues. Law Professor Brian Galle has argued that it would violate the Constitution’s Uniformity Clause, which prohibits laws specifically favoring particular states.”
The overall structure of the bill, including steep Medicaid cuts and a return of pre-existing condition exclusion, remained intact:
“Like the earlier version, the latest draft allows states that obtain block grants to waive certain consumer protections contained in the ACA…As with the earlier draft, however, the consumer protections that the bill does allow states to permit insurers to waive makes protection for people with preexisting conditions very tenuous.”
Continue reading Health Policy Updates: September 30 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
What would it take to make the US health care system the best in the world? We already spend more money (by far) on health care than any other country, but our results are middling (see the figure below). Recent thoughts on what the US might do in order to translate our huge financial investment in health into better results, in the NEJM.
“The first challenge the U.S. health care system must confront is lack of access to health care…Affordable and comprehensive insurance coverage is fundamental. If people are uninsured, some delay seeking care, some of those end up with serious health problems, and some of them die.
The second challenge is the relative underinvestment in primary care in the United States as compared with other countries…In contrast to the United States, a higher percentage of these countries’ professional workforce is dedicated to primary care than to specialty care, and they enable delivery of a wider range of services at first contact…” Continue reading Health Policy Updates: August 19 2017
The Vox.com policy podcast The Weeds gives a great recap on last week’s demise of GOP efforts to repeal the ACA. Link on Player.FM.
With GOP efforts to repeal the ACA currently stalled, a bipartisan group has begun meeting in order to improve on the ACA framework and stabilize its insurance markets.
“The roll out of their stabilization agenda follows months of private meetings between various members involved in the House’s centrist caucuses about ways to stabilize Obamacare if the GOP’s repeal effort sputtered.”
These efforts put lawmakers at odds with the President, who continued to suggest allowing (and causing) the ACA markets’ collapse.
“These problems have been exacerbated by a president who has publicly predicted that the Affordable Care Act will ‘implode’ and appears determined to help fulfill that prophecy. Mr. Trump has repeatedly threatened to cut off the subsidies, known as cost-sharing reduction payments, which reimburse insurers for cutting deductibles and other out-of-pocket costs for millions of low-income people. Without them, insurers would almost certainly raise premiums…”
Continue reading Health Policy Updates: August 6 2017