Tag Archives: Austin Frakt

Health Policy Updates: August 19 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

Health Policy Updates: August 6 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

Health Policy Updates: July 16 2017

On Thursday, the Senate released its latest version of its Obamacare-repeal bill, known as the BCRA. Vox.com ran a brief explainer on the key provisions that have changed since prior versions, including a shift towards low-premium (and low-coverage) plans:

“The bill will include a provision based on a proposal by Sen. Ted Cruz (R-TX), which allows health plans to offer skimpy coverage options so long as they have at least one plan that covers a robust set of benefits. The insurance industry opposes the policy, calling it ‘infeasible’ and fearing it would create ‘greater instability.'”

Politico ran a similar outline of the bill’s contents.

The GOP efforts at health care reform, overall, continue to be a “solution in search of a problem.”

“The GOP health care bill doesn’t even have pretextual justifications. Republican leaders like to claim that Trumpcare is necessary because Obamacare is “collapsing” into a “death spiral,” but not only is Trumpcare non-responsive to a death spiral, the death spiral they posit as the basis for Trumpcare is wholly fabricated.”


The supposed urgency behind Obamacare repeal is that it is “collapsing.” This doomsday claim is a bit premature, however, as the exchanges have continued creep along slowly but surely. In fact, a new report out from Kaiser appears to show that the Obamacare insurance exchanges are looking healthier than ever.

“Early results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability. Insurer financial results show no sign of a market collapse…Although individual market enrollees appear on average to be sicker than the market pre-ACA, data on hospitalizations in this market suggest that the risk pool is stable on average and not getting progressively sicker as of early 2017. Some insurers have exited the market in recent years, but others have been successful and expanded their footprints, as would be expected in a competitive marketplace.”


The ongoing challenge for the GOP in passing health care legislation is that different GOP senators have different goals. Some want sustained Medicaid spending, others want even deeper cuts. The NY Times gives a summary of which senators are breaking with the party line to request more changes to the bill – and which senators are pulling in opposite directions.


More great writing on Medicaid by Aaron Carroll and Austin Frakt this week. This time, the topic at hand is the idea that private insurance is inherently “better” insurance than Medicaid. This is one of the chief arguments among Medicaid critics (typically, the GOP) that Americans would be better off by defunding Medicaid and transitioning people to some for of private plans. While it is true that some doctors do not accept Medicaid, causing access problems, in general Medicaid is actually better than private insurance. Medicaid simply pays more of your medical costs; that is, it has lower “cost sharing” requirements – low/no deductibles, copayments, and coinsurance.

And based on well-established research, having low cost sharing is important for the quality of health care that people receive…

“The Senate’s health care plan, for example, would offer much less generous plans. A 64-year-old woman with an income of $11,400 would face a deductible of at least $6,000. For her, such a plan is not better than Medicaid; it is most likely much worse if she is also sick. Because of the deductible, the care she’d need would be financially out of reach.”


Kaiser Health News has recently started a new health policy news podcast called “What the Health.” I just listened to episode #3, a conversation including Margot Sanger-Katz at the NYTimes and Sarah Kliff at Vox.com about the politics behind the BCRA.

I’ll be a new subscriber! Highly recommended.


 

Health Policy Updates: July 8 2017

One of the arguments from Republicans to support the BCRA’s steep cuts to Medicaid is that it is “bad insurance” – that having Medicaid somehow causes its beneficiaries to have WORSE health outcomes than those without insurance at all. Clearly, this is an extraordinary claim; how could having health insurance make one worse off? Is there “extraordinary evidence” to support the notion that Medicaid is harmful?

Health policy experts Austin Frakt and Aaron Carroll examine the available evidence. Moving beyond purely correlational studies (Medicaid patients are also quite poorer than average Americans, and so have many reasons to be unhealthy besides having Medicaid), it becomes clear that Medicaid does not, in fact, harm people.

“Findings from more recent studies looking at expansions in enrollment, in the 2000s and then under the Affordable Care Act in 2014, are consistent with older ones. One can argue that Medicaid can be improved upon, but the credible evidence to date is that Medicaid improves health. It is better than being uninsured.”
Continue reading Health Policy Updates: July 8 2017

Health Policy Updates: February 18 2017

It hasn’t been a good week for Obamacare. More insurers are pulling out, and the Trump Administration seems to be split on whether it wants the exchanges to die now or hang around a little longer to provide for a smooth transition.

“The administration’s zigzags haven’t placated worried insurers, who see another year of red ink from enrollees that are older and sicker than they had expected. Congress’ paralysis on repeal and replacement translates into precisely the kind of uncertainly that makes risk-averse insurers want to run for cover. And Trump’s executive order, signed just hours after his inauguration, unnerved the health plans with its call for government agencies to abolish as much of the law as possible through administrative action. That fueled fears that his administration won’t enforce the individual mandate requiring most Americans to get coverage.”

Continue reading Health Policy Updates: February 18 2017