The newly-reported results of the ORBITA clinical trial caught my eye this week. Patients with chronic, stable angina with severe coronary blockages were randomized to angioplasty+stenting vs. ongoing medical therapy alone. Interestingly, the medical therapy patients also received a “sham” cardiac procedure, so the patients were blinded to whether or not they had actually received PCI. There was no significant improvement in angina symptoms with PCI, as measured by exercise duration. Does this mean that the huge number of stents placed annually in the US for angina symptoms is not money well-spent?
Continue reading Health Policy Updates: November 4 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
This week, a bipartisan bill emerged to stabilize the ACA insurance market. It remains unclear whether this compromise proposal will enjoy enough support to pass.
“Alexander said the deal he struck with Murray would extend CSR payments for two years and provide states ‘meaningful flexibility’ under the ACA, allowing them to make changes to insurance offerings as long as the plans had ‘comparable affordability,’ which is a slightly looser definition than the existing one…The framework would also allow insurers to offer catastrophic insurance plans to consumers aged 30 and older on ACA exchanges, while maintaining a single risk pool…”
Sarah Kliff at Vox.com gave the shortest, quickest rundown of the different ACA insurance subsidies, and exactly how the recent Trump executive order would change things:
“The Trump administration is not ending insurance subsidies. Instead, they have created a policy where they spend more money to insure fewer people — something you probably won’t see on the president’s Twitter feed.”
Continue reading Health Policy Updates: October 22 2017
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