In a speech to hospital executives earlier this week, new Health and Human Services Secretary Alex Azar outlined his agenda for improving the value of health services provided to patients. He clearly understands that the number one problem in U.S. health care is the prevalence of wasteful spending on services that drive up costs without improving the health of patients.
The many previous efforts aimed at tackling this immense and complex problem have barely put a dent in it. Azar made it evident that, from his perspective, the solution is a market-driven system with informed and active consumers making cost-effective decisions about their own care. He was also appropriately ambitious as he begins his tenure, putting everyone on notice — including those with vested interests in the status quo, as well as his own HHS employees — that big changes are coming, one way or another.
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Medicare Accountable Care Organizations (ACOs) were created by the Affordable Care Act (ACA) to improve the efficiency of the networks of hospitals and doctors that deliver services to Medicare patients and thereby lower the government’s costs. So far, however, ACOs haven’t produced any savings for the federal government. ACOs would become more efficient and innovative if they were forced to compete with the other options beneficiaries have for getting their Medicare-covered benefits.
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Congressional Republicans are hoping to pass a temporary funding bill that would keep the government open until mid-February, thus allowing negotiations to continue on immigration and other matters. To attract more support for the stop-gap bill, Republican leaders have proposed combining it with other unrelated and more popular provisions, including a two-year delay of the so-called “Cadillac tax.” Delaying the “Cadillac tax” again — it was already pushed back once — is a bad idea. It would set back the cause of market-driven health care rather than advance it.
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It took longer than expected, but the Trump administration finally moved earlier this month to provide broad exemptions to the Obama administration’s notorious HHS contraceptive mandate. The mandate requires employers sponsoring health-insurance plans to cover contraceptives, including some products that induce abortions, for all workers enrolled in their plans. The Trump administration issued two interim final regulations providing ready pathways for employers with religious or moral objections to get out from under the requirement.
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Sen. Alexander deserves credit for trying to steer the GOP out of the health care wilderness. But the deal Sen. Alexander negotiated with Sen. Murray has a major flaw: It would fund the cost-sharing reduction payments authorized by the ACA for two years, through 2019. The GOP should not agree to fund cost-sharing reduction payments beyond 2018 absent a much more comprehensive deal on health care. An agreement to fund the cost-sharing subsidies through 2019 would all but ensure that Democrats in Congress will stonewall further negotiations on health care until after the mid-term elections in November 2018.
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Obamacare has not done much to slow the growth of health care costs. Government actuaries project that health spending will grow 5.8% a year over the next decade — substantially faster than growth in the economy. Could Republican proposals to sell health insurance across state lines bend the cost curve and make premiums health plans more affordable ?
The idea seems simple enough. Right now, if you are buying your own health insurance, that coverage must be sold by an insurer regulated in your state. Instead of a national market, health insurance is sold in 51 state markets (including D.C.) with differing regulations.
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Senate Minority Leader Chuck Schumer says he and his colleagues are ready to work with Republicans on an adjustment to the ACA “that stabilizes markets, that lowers premiums.” However, framing the purpose of the talks in this way discourages rank-and-file Republicans to participate in negotiation that has the singular purpose of shoring up the ACA. What is needed is a thorough, top-to-bottom negotiation between both parties over fundamental aspects of the entire health system. For example: How much flexibility should states have to run Medicaid? What can be done to bring more cost discipline to the entire system? What can be done to ensure major health entitlement programs are affordable over the long-term?
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How do you define “single payer”? A common theme is to give government a dominant role in the pricing and possibly delivery of services—supporters often assert that some measure of cost would be reduced. The Urban Institute’s Health Policy Center says that Bernie Sanders’ previous proposal in 2016 would have increased federal costs by $32 trillion over the next decade. Even Democrats would have a hard time getting support for this unprecedented expansion of federal spending. In spite of the superficial allure of Medicare for all, Democrats are not eager to upend the health system that President Obama created.
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Suppose you wanted to sabotage Obamacare and could not get Congress to help. Short of repeal legislation, the next best strategy would be to cut off funds to health insurers—in other words, starve the beast. That should work, right?
Surprisingly not, according to a new report from the Congressional Budget Office (CBO). Responding to a request from House Democrats, CBO considered what could happen to health coverage, insurance premiums, and taxpayer cost if the federal government stopped paying insurers for cost-sharing reductions (CSRs). Under CBO’s scenario, the federal government would stop making payments to insurers totaling $118 billion between 2018 and 2026. As a result, the federal deficit would rise (not fall) by $194 billion, low-income individuals would pay about the same (not more) for coverage, and more people (not fewer) would be insured.
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It’s pretty hard to get a head start on President Trump in trying to shift blame onto others for the late night culmination of massive political failure in the presumptively Republican Senate. But let’s provide a short report from the medical examiner on the causes of death to the once soaring rhetoric and more recently depressing reality of “repeal and replace.”
- Yes, the procedural minefield through budget reconciliation was narrow, murky, and treacherous. But even the entire inventory of legislative tricks, gimmicks, and sidesteps attempted still needed to be anchored to a larger commitment than just avoiding political-party embarrassment.
- Republicans in Washington never met the challenge of offering a sufficiently unifying message to constituents that all the uncertainties and sacrifices immediately ahead from disruptive changes were aimed at actually making their lives BETTER eventually, rather than just not quite as bad as a host of maladies and calamities attributed to Obamacare…
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