Tag Archives: Trump Administration

Health Policy Updates: September 9 2017

The September issue of Health Affairs was a special edition, focusing on the topic of health care market concentration in the US. I’ve pointed to the closely related issue of hospital consolidation as one of the biggest drivers of increasing health care costs.

As one of the featured studies in this special issue found, the health care market in the US continues to concentrate, with more and more health systems merging into larger and larger networks. The end result of this is not more efficient care for the patient, but simply higher prices, as these large networks exert their monopoly power:

“Although provider concentration could produce efficiencies that benefit purchasers of health care services, the evidence does not point in that direction. For example, reviews of studies of hospital markets have found that concentrated markets are associated with higher hospital prices, with price increases often exceeding 20 percent when mergers occur in such markets. Of even greater concern, the reviews found that these price increases did not appear to improve quality: In some cases, higher hospital concentration was associated with higher mortality rates.” 
Continue reading Health Policy Updates: September 9 2017

Health Policy Updates: April 1 2017

The ACA remains the “law of the land” (to use Speaker Ryan’s language) for now. But what happens next? There are still many things that the Republican-controlled Congress and Executive can do that might seriously impact the law’s outcomes.

“But Price could do two things now that would have huge effects on the marketplaces: He could drop a court case left over from the Obama administration, a move that would cut some subsidies to more than half of marketplace enrollees, and he could loosen the most hated part of the law, a mandate requiring most people to have coverage or pay a penalty at tax time.”
Continue reading Health Policy Updates: April 1 2017

Health Policy Updates: February 5 2017

With each news story being rapidly overshadowed by the next, discussion of ACA/Obamacare repeal has given way to rapid developments ensuing from executive actions on immigration. If you are a reader of this blog, you certainly do not need me to explain what these actions are. Actions do have unintended (are they unintended?) consequences, however, which I will highlight here (links in the text):

“The American Association for the Advancement of Science, the world’s largest general science society, also issued a statement warning that the ban would prevent the international collaboration that characterizes most science today, and would hurt the United States’ ability to attract talented researchers from around the world.”

As the story of a Cleveland Clinic doctor forced to leave the U.S. thanks to the Trump White House’s move swept the nation, hospitals and academic medical centers braced for potential damage to future staffing and recruiting of medical researchers, educators and clinicians.”

“Since the restrictions, some institutions, including the University of Pennsylvania and the University of California system, have advised students or faculty members from Iran, Iraq and the other affected countries not to travel overseas until further notice…The order could prevent many foreign researchers from making short-term trips to attend conferences and other scientific meetings overseas for fear of not being able to return.”

Continue reading Health Policy Updates: February 5 2017

Health Policy Updates: January 28 2017

One of the first (the first?) actions that Donald Trump took as president was an executive order to begin to dismantle the ACA. Authors at The Incidental Economist reviewed all the things that could be accomplished by executive order alone, without any additional action from Congress.

“Whether and which actions a Trump HHS chooses to pursue will depend on the administration’s willingness to gamble the stability—already quite fragile, in some states—of the individual market. And it will depend, too, on what Congress is willing to do through legislation.” Continue reading Health Policy Updates: January 28 2017

Health Policy Updates: January 21 2017

News surfaced this week raising serious conflict-of-interest and corruption concerns regarding Trump’s nominee to head the department of Health and Human Services, Tom Price. It seems that he bought shares in a device manufacturer immediately before introducing legislation to protect reimbursement for the use of such devices, maintaining demand for the company’s products.

“After Price offered his bill to provide Zimmer Biomet and other companies relief from the CMS regulation, the company’s political action committee donated to the congressman’s reelection campaign…The issue has become a major liability for the congressman after The Wall Street Journal reported last month that he traded roughly $300,000 in shares over the past four years in health companies while pursuing legislation that could impact them.”

Margot Sanger-Katz of the NYTimes walks through exactly what the ACA/Obamacare does, which provisions are likely to go or stay if repeal happens, and what that would mean.

“When Republicans talk about repealing Obamacare, they tend to focus on the parts of the law that expanded insurance coverage and regulated health insurance products, not these ancillary parts. That means that portions of the Affordable Care Act that people don’t associate with the word “Obamacare” are likely to endure.”

Donald Trump continues to double-down on promises to “cover everyone” with his health insurance plan, and also drastically lower drug prices. This is in contrast to the leading Republican plans for ACA replacement, which do neither of these things.

“The objectives of broadening access to insurance and lowering health-care costs have always been in conflict, and it remains unclear how the plan that the incoming administration is designing — or ones that will emerge on Capitol Hill — would address that tension.”

The Congressional Budget Office has run the numbers on Obamacare repeal and found that it would add an additional 23 million Americans to the uninsured roles over the next 10 years. Will whatever “replacement” plan that ends up surfacing be able to make up that difference?

“The agency put up a blog post that said it won’t let Republicans count especially skimpy coverage as health insurance. It argued that health insurance needs to provide ‘financial protection against high medical costs’ for CBO to count the people who buy it as covered. Republicans hadn’t even submitted a replacement plan yet, at least not publicly. So it seems notable that CBO proactively decided to go ahead and lay down the ground rules for scoring in a very public way.”

A slew of papers came out in JAMA journals last week, focusing on the issue of conflicts of interest in medicine. Propublica summarizes.

“‘The very way we all think about disease — and the best ways to research, define, prevent, and treat it — is being subtly distorted because so many of the ostensibly independent players, including patient advocacy groups, are largely singing tunes acceptable to companies seeking to maximize markets for drugs and devices,’ researchers Ray Moynihan and Lisa Bero wrote in an accompanying commentary.”