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 Cassidy-Graham Obamacare repeal bill that is currently under consideration in the Senate would be a big step towards allowing insurance companies to once again exclude people on the basis of pre-existing conditions:
“The bill says states cannot tether an individual’s premiums to ‘sex or membership in a protected class under the Constitution of the United States.’ Anything else — a cancer diagnosis, a history of breast cancer, a mild case of asthma — is fair game. In states that did pursue and receive these waivers, health plans would have full authority to charge sicker patients higher premiums to offset their costs.”
Continue reading Health Policy Updates: September 23 2017
There were a couple of great articles in JAMA Internal Medicine this week on cancer drug development and pricing.
The first, discussed in this NYTimes article, did a thorough job of tallying the total R&D cost to bring a new cancer drug to market. The study authors ended up with a significantly lower number than has been reported in the past.
“Following approval, the 10 drugs together brought in $67 billion, the researchers also concluded — a more than sevenfold return on investment. Nine out of 10 companies made money, but revenues varied enormously. One drug had not yet earned back its development costs.”
Continue reading Health Policy Updates: September 16 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
As of Tuesday, the Senate voted to open debate on a bill which, 24 hours prior, its members did not know the contents of.
“…there are at least four different draft health care bills floating around right now…The lack of clarity is part of a larger lack of direction for Senate Republicans’ six-month health care effort…Throughout this process, Republicans have struggled to articulate what exactly they want to achieve — aside from delivering on a seven-year campaign promise to repeal and replace Obamacare.”
Votes on the BCRA and then “full” Obamacare repeal followed shortly thereafter, and were both defeated by slim margins. Attention then turned to the so-called “skinny repeal,” which would leave the ACA/Obamacare’s Medicaid expansion intact and get rid of only the individual and employer mandates to have health insurance. Finally, even skinny repeal went down in a vote early Friday morning, with John McCain breaking party ranks (and joining Sens. Collins and Murkowski) to become the decisive “no” vote, in a dramatic fashion on the Senate floor – video here.
It remains to be seen whether the ACA repeal effort is truly dead this time, or will continue to rise from its own ashes.
Continue reading Health Policy Updates: July 29 2017