“For all the endless talk about reforming the health care system these past five years, it’s remarkable how little we’ve done to solve its actual problems. Spending hundreds of billions of taxpayer dollars to subsidize insurance coverage for several million people? That’s the easy part. The hard part is addressing the fact that American health care is so expensive.
The high price of U.S. health care is the fundamental reason tens of millions of Americans are uninsured. It’s the principal suppressor of middle-class wage growth. It’s a constant threat to businesses’ operating margins, and it’s the primary driver of the federal debt.
In May the American Health Policy Institute surveyed the chief human resource officers of 360 large employers, representing 10 million workers. When asked what troubled them the most about the Affordable Care Act, 85% said “increasing access to the health care system without making significant improvements in the efficiency and affordability of that system.” Only 6% believed that “the ACA will help my company more effectively control health care costs”; 82% disagreed.
According to the Congressional Budget Office’s 2014 Long-Term Budget Outlook, the United States remains on an “unsustainable” trajectory, driven entirely by growth in the big federal health care entitlements: Medicare, Medicaid and Obamacare.”
“In April 2014, the Centers for Medicare & Medicaid Services (CMS) published detailed information on the $77 billion that 880 000 health care practitioners billed for some 6000 Medicare Part B services in 2012. This commentary by a former CMS administrator discusses how these data can be helpful, what is missing that might lead to misinterpretation, and why such transparency is here to stay.”
“Last Monday, Jed Graham of Investor’s Business Daily reported that insurers say Affordable Care Act enrollment is shrinking, and it is expected to shrink further. Some of those who signed up for insurance on the exchanges never paid; others paid, then stopped paying. Insurers are undoubtedly picking up some new customers who lost jobs or had another “qualifying life event” since open enrollment closed. But on net, they expect enrollment to shrink from their March numbers by a substantial amount — as much as 30 percent at Aetna Inc., for example.
How much does this matter? As Charles Gaba notes, this was not unexpected: Back in January, industry expert Bob Laszewski predicted an attrition rate of 10 to 20 percent, which seems roughly in line with what IBD is reporting. However, Gaba seems to imply that this makes the IBD report old news, barely worth talking about, and I think that’s wrong, for multiple reasons.”
“The American Hospital Association’s expenditures increased by 7% in 2013, to $117 million, spurred in part by efforts to convince states to expand Medicaid, according to the organization’s most recent tax return.
The group spent $3.3 million on grants to state hospital associations last year to assist with efforts to convince states that they should expand Medicaid to households with incomes up to 138% of the federal poverty level.
Under the Patient Protection and Affordable Care Act, the federal government will pick up 100% of the tab for the first three years of Medicaid expansion and 90% of the cost thereafter.”
“The number of Connecticut residents covered by health insurance purchased through the state’s individual market rose by nearly 60,000 since last year, a 55 percent increase since the implementation of major provisions of Obamacare, according to figures released by the Connecticut Insurance Department.
The data also show that more than half the people who bought their own health insurance last year have maintained their old policies or other plans purchased late in 2013. But more than 50,000 of them won’t be able to keep their health plans beyond this year, potentially setting up a repeat of last fall’s turmoil and frustration among people whose policies were discontinued.”
“The deadly Ebola outbreak spreading through Africa is so extreme, it is driving health officials to do something that they would instinctively resist in normal circumstances: Subject patients to unproven experimental drugs.
The drugs are risky. Some have not even been tested on humans. Even so, a World Health Organization ethics committee just declared such use ethical, and its reasoning is hard to dispute, at least for patients who would otherwise die. Some chance is better than none, even with unknown side effects.
Too bad American patients suffering from terminal illnesses have so much trouble getting the same chance.
The process for getting experimental drugs is so daunting that fewer than 1,000 people sought and got federal approval to take such drugs last year.
Food and Drug Administration rules require patients to clear a series of hurdles. First, they and their doctors must find a company to provide its drug. Many drug makers — worried that a patient’s death will spur a lawsuit or harm their chances for final FDA approval — refuse.”
“WASHINGTON — Ending insurance discrimination against the sick was a central goal of the nation’s health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers.
The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there’s reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors.
With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act’s anti-discrimination provisions. Some regulations have been issued; others are pending after more than four years.
More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that “are highly discriminatory against patients with chronic health conditions and may … violate the (law’s) nondiscrimination provisions.”
Among the groups were the AIDS Institute, the American Lung Association, Easter Seals, the Epilepsy Foundation, the Leukemia & Lymphoma Society, the National Alliance on Mental Illness, the National Kidney Foundation and United Cerebral Palsy. All supported the law.
Coverage of expensive drugs tops their concerns.”
“New information related to physician-industry interaction is scheduled to be released to the public for the first time on September 30. The public database from the Centers for Medicare & Medicaid Services (CMS), which is part of the Sunshine Act implementation, will focus on payments that biopharmaceutical and medical technology companies have made to physicians. Although the release date is less than six weeks away, concerns about what the data will look like and its effect on medical innovation are already being brought to light by stakeholders across the board.
One of the primary concerns that PhRMA shares with more than two dozen other patient and industry organizations is that the data needs to include context to explain what the payments represent – collaborations that benefit patient health and innovation. It’s critical to note that the new database will include information on many different types of interactions. For example, the data could reflect an oncologist partnering with a biopharmaceutical company to lead a clinical trial on an innovative cancer treatment or a family practice physician’s attendance at an industry-sponsored speaking event led by a peer to further her education about geriatric care. However, if the data released includes only names and numbers, the public is likely to be confused and the information is left subject to misinterpretation.
Additionally, many physicians are not aware about the Sunshine Act, what it means for them and their ability to be part of this collaborative process. It is important for CMS to provide physicians with more information about their ability to register and review data reported on them.
To compound this lack of information, physicians also face a confusing registration process with a very short timeline. Given how instrumental relationships between companies and physicians are to driving future innovation, we want to ensure that both groups can provide input on the process of Sunshine Act reporting.”
“There has not exactly been an overabundance of good news on Obamacare. So it did come as some surprise two weeks ago when the Department of Health and Human Services issued a press release with the headline: “Consumers have saved a total of $9 billion on premiums,” and the subheading; “Health care law will return to families an average refund of $80 each this year.”
There is nothing unusual or even untoward about the Obama administration doing what it can to put a positive spin on the law. But what makes this item interesting is it reveals how little the administration actually has to tout about Obamacare and how far it must reach to manufacture a success story.
The purpose of the press release was to announce data on the effects of Obamacare’s “medical loss ratio” regulation, which “requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities. If insurers spend an excessive amount on profits and red tape, they owe a refund back to consumers.”
For the 2013 plan year, insurers will be required to pay $332 million in premium refunds to 6.8 million individuals. That works out to $43.78 a person, or HHS’ figure of $80 per household for 4.1 million households. In other words, HHS is crowing that Obamacare benefited 2 percent of Americans by getting them small refunds from their insurers.
And by small, we mean small. The $332 million in refunds are out of the $270 billion insurers collected last year in premiums for individual and group major medical coverage subject to the MLR. That means about a penny in refunds for every $10 of premiums.”