It hasn’t been a good week for Obamacare. More insurers are pulling out, and the Trump Administration seems to be split on whether it wants the exchanges to die now or hang around a little longer to provide for a smooth transition.
“The administration’s zigzags haven’t placated worried insurers, who see another year of red ink from enrollees that are older and sicker than they had expected. Congress’ paralysis on repeal and replacement translates into precisely the kind of uncertainly that makes risk-averse insurers want to run for cover. And Trump’s executive order, signed just hours after his inauguration, unnerved the health plans with its call for government agencies to abolish as much of the law as possible through administrative action. That fueled fears that his administration won’t enforce the individual mandate requiring most Americans to get coverage.”
Continue reading Health Policy Updates: February 18 2017
I have written about price variability in medical care in this space previously. New this week is a study in Health Affairs further demonstrating the huge differences in prices for medical procedures, depending on where you get them done. The related problem of the lack of price transparency to US consumers is included in my health care spending map.
Sarah Cliff talks about the study in Vox. Continue reading Health Policy Updates: May 1 2016
There have been several recent high-profile studies describing the ways that health care spending varies widely in the United States, with little apparent relationship to how much medical care people living there actually need. Some of the research seems to support different reasons for the variation, however. A recent Health Affairs post attempts to make sense of it all.
“This is an eye-opening result that lays out the lack of transparency in prices in the under-65 private insurance markets. First, Cooper and associates show that markets with more hospitals exhibit lower prices — competition works. Second, even within markets, prices are all over the map, even for common procedures such as colonoscopies. This has little to do with increasing the number of hospitals, but everything to do with the lack of pricing transparency, like ordering from a menu without any prices.” Continue reading Health Policy Updates: January 10 2016
The Washington Post’s Wonkblog reports on a new study out of UNC-Chapel Hill, finding that significant out-of-pocket prescription drug costs still exist for seniors on Medicare. Even once the “donut hole” closes, prohibitive coverage gaps for seniors will still exist.
“What the researchers found is that closing the coverage gap will save money – about $2,500 at current cancer drug prices. But that still means around $4,000 to $10,000 out-of-pocket spending for patients, which may be unattainable for people on a fixed income. And that assumes that drug prices stay stable and do not increase, as they’ve been doing for many cancer drugs.” Continue reading Health Policy Updates: December 19 2015
Should we warn them?
““We’re confident in choosing Epic as our strategic partner as we continue to enhance Mayo Clinic’s excellence in health care and medical innovation,” said John Noseworthy, MD, Mayo Clinic’s president and CEO, in a statement announcing the partnership
The latest from Amitabh Chandra, one of my favorite health economists. He is a big proponent of comparative effectiveness research, and his “big idea” is that the effectiveness of an intervention should be linked reimbursement, to nudge people towards choosing more effective care and reducing waste. Vaccines? Prenatal care? We’ll give those to you for FREE. Want proton beam therapy rather than just-as-effective conventional radiation for your prostate cancer? You might have to pay some of that out-of-pocket.
“The problem of consuming minimal-benefit care is compounded by insurance, which insulates patients and physicians from financial cost so that they don’t weigh it against benefits.”
One common criticism of Medicaid from the conservative side is that it provides inadequate care – too many doctors don’t accept medicaid, so the economically disadvantaged patients on it can’t receive timely care. The liberal response is that the reason so many doctors don’t accept Medicaid is that it is simply underfunded – pay doctors more to accept Medicaid patients, and you would see this access problem go away.
New data in the NEJM (http://www.nejm.org/doi/full/10.1056/NEJMsa1413299?query=featured_home) seem to support that conclusion. When Medicaid reimbursements recently increased, more doctors started seeing Medicaid patients. Discussion/commentary here:
So is the solution for Medicaid just to throw more $$$ at it?
Ongoing developments in Colorado provide a pretty good study in the rubber-hits-the-road of ACA implementation. Prices vary by region, change year to year, and overall make the picture very complex and difficult to sort out. Here is a great NYT piece on this, with a cool infographic showing the price variability for different insurance plans across the state:
“The wild disparity in prices results from many insurers trying to attract more customers by pricing plans as low as they can. But it is not at all clear that the low prices will be sustainable, so prices may well swing sharply upward as time goes on.”