It has not been a good week for US health care.
This week the Senate passed “a health care bill disguised as a tax cut.” The result, argues Sarah Kliff, will be a sweeping change to many parts of the US health care system, starting with (per the CBO) 13 million Americans dropping health insurance coverage.
“First, the bill repeals the individual mandate, a key piece of Obamacare that requires most Americans get covered. Economists expect its elimination to reduce enrollment in both the Affordable Care Act’s private marketplaces and Medicaid by millions. The money saved will be pumped into tax cuts for the very wealthy. The bill also includes tax cuts so large that they would trigger across-the-board spending cuts — including billions for Medicare. The last time Medicare was hit with cuts like this, patients lost access to critical services like chemotherapy treatment.”
Continue reading Health Policy Updates: December 3, 2017
The Alexander-Murray bill, a bipartisan compromise to try to stabilize the Obamacare insurance markets, already faced some big hurdles, such as ambiguous support from the White House. This week, an alternative “stabilization” bill emerged, this one entirely Republican, which seems to look a little bit more like Obamacare repeal than simply an insurance market patch.
“Hatch-Brady adds explicitly partisan objectives that Democrats will likely reject: the cuts to the Obamacare mandates and the introduction of anti-abortion restrictions to the CSR payments…Hatch and Brady have now introduced two of the most divisive issues in health policy — the individual mandate and abortion — to the Obamacare stabilization talks. Their plan is more akin to a slightly skinnier version of ‘skinny repeal’ from the summer than an Obamacare stabilization package that both parties would likely support.”
Continue reading Health Policy Updates: October 28 2017
A large part of the ACA/Obamacare was to expand Medicaid; many (though not all) states elected to do so. New data out this week in JAMA Internal Medicine suggests that patients are benefiting. Compared to states that did not expand Medicaid, previously uninsured patients who have now gained access to Medicaid coverage do better on many metrics, including better access to outpatient care, increased diabetes screening, and reduced non-compliance due to cost.
The Oregon Medicaid experiment from a few years ago left Medicaid skeptics with some reason to be agnostic as to whether Medicaid actually improves people’s health. These data lessen the foundation for such skepticism, and should thus should help move the conversation forward. Continue reading Health Policy Updates: August 14 2016
Why don’t market forces seem to apply to health care? In the rest of the world, competition drives prices down. Imatinib (Gleevec) was the first of the now-numerous tyrosine kinase inhibitors, a class of drugs that brought chronic myloid leukemia to its knees and have proven very effective for other cancers as well. However, despite increasing competition from other drugs that are just as effective, as well as (presumably) increased efficiency over the past 2 decades in manufacturing the drug, the price of imatinib is now higher than ever.
“In 2010, Gleevec gained more direct competition from both drugs, which were approved for newly diagnosed leukemia patients. At this point, Gleevec’s price increases veered quickly into larger hikes that brought it closer to its competitors. An era of price increases of 10 percent or higher began.” Continue reading Health Policy Updates: March 19 2016
I’ve written before, in my health care spending map here, about the problems with fee-for-service reimbursement in medicine. When our financial interest is to provide patients with more medical care, then we doctors tend to do so – often, more than the patient actually needs. There is a new study out this week further demonstrating that doctors do, in fact, respond to the reimbursement incentive. Blog commentary here. Continue reading Health Policy Updates: February 28 2016