Category: Investigations

“ObamaCare creates incentives for state and federal politicians and bureaucrats to exert direct control over the premiums of health plans. However, because health plans largely pass through costs from medical providers, artificially limiting increases in premiums cannot actually result in lower health costs. Instead, it results in reduced access to care and threatens the solvency of health plans. ObamaCare also introduces at least five critical uncertainties that make it difficult to estimate future medical costs accurately, and suggest that Obamacare will be much more disruptive to health insurance than the Administration has advertised.”

“Comparative Effectiveness Research (CER) measures the effects of different drugs or other treatments on a population, with the goal of finding out which ones produce the greatest benefits for the most patients… The 2009 federal stimulus law allocated $1 billion for CER programs, and the 2010 health-care overhaul created an institute to promote CER and disseminate the results of this research to doctors and payers… Our results suggest that CER will not fulfill its promise unless it is implemented differently by researchers and understood differently by policymakers. Simply put, seeking the treatment that is most effective on average will not improve health or save money.”

“Amidst Washington’s bruising battles over Medicare and Medicaid reform, one of the few ideas that still enjoys broad bipartisan support is comparative effectiveness research. CER is designed to compare drugs, medical devices or surgeries and determine which treatment offers the best outcome for the greatest number of patients… CER should remain a critical component of health care reform efforts. Paradoxically, however, it can go astray easily and result in greater health care spending and worse health care outcomes unless policymakers and researchers revisit some of its key assumptions.”

“The Obama Administration is handing out waivers far and wide for its health-care bill, but behind the scenes the bureaucracy is grinding ahead writing new regulations. The latest example is the rule for Accountable Care Organizations that are supposed to be the crown jewel of cost-saving reform. One problem: The draft rule is so awful that even the models for it say they won’t participate.”

“Children with Medicaid are far more likely than those with private insurance to be turned away by medical specialists or be made to wait more than a month for an appointment, even for serious medical problems, a new study finds. Lower payments by Medicaid, delays in paying and red tape are largely to blame, researchers say.
The study, with findings that match anecdotal reports from other parts of the country, is one of only a few efforts to measure access to health care among people with Medicaid. Nationwide, those patients are caught between states’ threats to cut Medicaid payments and the Obama administration’s plans to use the program to cover more and more people as part of its health care law.”

“‘Sixty-six percent of those who mentioned Medicaid-CHIP (Children’s Health Insurance Program) were denied appointments, compared with 11 percent who said they had private insurance.’ Half of ObamaCare‘s projected coverage gains (16 million out of 32 million U.S. residents) comes from expanding the Medicaid program.”

“A report by McKinsey & Co. has found that 30% of employers are likely to stop offering workers health insurance after the bulk of the Obama administration’s health overhaul takes effect in 2014. The findings come as a growing number of employers are seeking waivers from an early provision in the overhaul that requires them to enrich their benefits this year.”

“The cost and quality of healthcare will get worse because of healthcare reform rules that let the federal government review rates and set limits on how insurance companies spend their money, small businesses and insurance agents said Thursday.”

“The folks at The Cleveland Clinic, a highly integrated provider organization that has been touted as a model for the sort of team-driven health care that ACOs are supposed to encourage, aren’t buying the promises made by the administration and its backers. Last month, I noted that the Clinic was disappointed with the regulations. Since then, its officials have expanded their criticism in a new letter written to Medicare director and superstar ACO-wonk Donald Berwick.”

“Physician Hospitals of America (PHA) has filed a formal notice of appeal in its ongoing battle against growth restrictions in the healthcare reform law that make it nearly impossible for physician-owned hospitals to expand, according to PHA.
PHA and its coplaintiff, Texas Spine and Joint Hospital in Tyler, Texas, are arguing that provisions that prevent new or expanding physician-owned hospitals from qualifying for Medicare are unconstitutional, as well as limit patient access to high-quality hospitals.”