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
I reported last week on the Trump Administration’s CMS rollback of Medicare cost-saving bundled payment programs. Two Obama-era health policy advisors penned a Wall Street Journal op-ed to further describe why these changes are a bad move.
“This fee-for-service model, which has dominated American health care for decades, is hardly efficient. Paying for inputs—tests, procedures, hospital stays and the like—creates incentives for overtreatment, with little regard for coordinating care or improving patient outcomes…Now the Trump administration is re-embracing the old fee-for-service model. In six months, the Department of Health and Human Services has gone from driving innovation to dragging health care backward.”
Continue reading Health Policy Updates: August 27 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
There was some buzz this week that the AHCA, as passed by the House, might actually run afoul of Senate budgetary rules that would invalidate the bill. Potentially, this could mean having to revise and re-pass the bill in the House, separately from any process going on in the senate. The potential issues appear to stem from requirements that laws not add to the deficit. I have seen some skepticism that this potential scenario would actually play out; Vox.com offered an explainer.
“Depending on what the CBO says, the House might have to change the American Health Care Act and pass it again or even start over, according to Bloomberg…Experts have wondered if the House bill would work under the Senate’s rules, which are supposed to restrict a bill considered under “budget reconciliation” to make sure it affects only federal spending and revenue. If those strict conditions are met, then the Senate can advance a bill with just 50 votes. Republicans are using that process because otherwise Democrats could block the legislation.”
Continue reading Health Policy Updates: May 20 2017
This week Republicans made some amendments to the AHCA before continuing it along its legislative course to passage. Including work requirements for Medicaid recipients and large tax cuts for high-income Americans, these changes seem oriented more towards placating hard-Right opponents such as the Freedom Caucus rather than fixing the many problems with the bill that health policy wonks – both left and right – have been pointing out.
“These aren’t changes that address the core problems the GOP health care bill will create for voters, insurers, or states; instead, it’s legislation that tries to solve some of the problems the bill creates for conservative legislators….None of these provisions meaningfully change the underlying legislation, nor any of its flaws. These are mostly tweaks meant to win over hardcore conservatives and Congress members from New York.”
Ultimately, however, these efforts were not effective in winning enough support among Republican members of Congress. Rather than see the bill go down in defeat, Speaker Ryan pulled the bill from the House floor on Friday before any vote took place. The consensus is that this means efforts to repeal the ACA *currently* dead.
“Then, the Friday vote was abruptly canceled, as Republicans failed to whip enough votes for the bill. And so, Ryan concluded, Obamacare remains the law of the land.”
Continue reading Health Policy Updates: March 25 2017