Health

The Painkiller Epidemic Grows

The Washington Post got an early look at a Kaiser Family Foundation survey which shows 40% of Americans know someone who has been addicted to prescription painkillers, including 25% who say it was a close friend or family member and 2% who acknowledge their own addiction.

More from the survey:

  • 16% say they know someone who has died from an overdose of prescription painkillers, including 9% who say that person was a family member or close friend.
  • 56% of the public say they have some personal connection to the issue.
  • Prescription painkiller abuse is most common among whites (63%) and the affluent (63% among people with incomes of $90,000 or more).

John Bel Edwards Victory is Victory for Medicaid Expansion

Times Picayune: “Governor-elect John Bel Edwards called expanding Medicaid ‘among the highest priorities’ of his new administration, though he said Sunday (Nov. 22) he may not be able to approve an expanded program on Day One.”

Edwards: “‘The expansion of health care coverage for working families is among the highest priorities. It’s something I’ve been working on for three years, and I never once during this campaign shied away from that particular issue,’ Edwards said during a news conference with reporters in New Orleans. ‘So we are going to expand the Medicaid program in Louisiana. We’re going to do it as soon as we possibly can and as responsibly as we possibly can.'”

With Edwards’ victory, “supporters of ObamaCare are increasingly hopeful that Medicaid expansion could sweep through the deep-red South,” according to The Hill.

“More recently, there was surprising news out of Alabama, as a commission appointed by Republican governor Robert Bentley recommended expansion. Bentley said earlier this month that he is ‘looking’ at the possibility of broadening Medicaid.”

Secretary of Health and Human Services Sylvia Burwell: “What is going to happen is that support for Medicaid expansion will continue to build … You hear the Alabama governor. You’ve heard conversations in Louisiana.”

“Supporters of Medicaid expansion hope that if they can get a foothold in the South, other states will follow … One option is the Arkansas model, where the expansion enrolls people in private health insurance plans instead of government-run Medicaid.”

Most Americans Say Government Should Ensure Healthcare Coverage

Politico: The government should ensure the health care coverage of all Americans, 51 percent of adults said in a new Gallup survey released Monday. That is slightly more than the 47 percent of Americans who said it is not the government’s responsibility, though the difference is still within the poll’s margin of error.

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The 51 percent is the highest share of American sentiment in that direction since 2006, when nearly seven in 10 (69 percent) said government is responsible and just 28 percent did not. In the years following, only in 2011 did Americans have a more positive view of the role in government in health care than negative.

Though at its lowest level in recent years, 55 percent to 41 percent expressed support for a health care system based on private insurance rather than one run by the government. In 2014, 61 percent to 35 percent felt the same way.

Americans Concerned About Health Care Costs

Gallup: Americans continue to name the cost of (22%) and access to (20%) healthcare as the most urgent health problems facing the U.S. Obesity and cancer are next on the list, cited by 15% and 14%, respectively. No other issue receives more than 2% of mentions from Americans.

Trend: Cost and Access Remain Most Commonly Named as Urgent Health Problems

The Obama administration has made a major effort to address healthcare cost and access by passing the Affordable Care Act. Since its major provisions went into effect, there has been a drop in the percentage of Americans who lack health insurance. But the law probably did not affect the healthcare situation for the large majority of Americans, most of whom get health insurance through an employer or Medicare. The percentages mentioning both cost and access are down from the later years of George W. Bush’s administration, even though they remain the top overall issues.

Fewer Employers Choosing to Terminate Coverage Due to Obamacare

Forbes: “The likelihood that small employers will terminate health coverage for their workers due to the Affordable Care Act is far less likely than the ‘early days of the health reform debate,’ according to a new analysis.”

“Employee benefits consultancy Mercer … said just 7% of employers with 50 to 499 employees now say they are ‘very likely’ or ‘likely’ to terminate coverage for their workers within the next five years.”

“This is in sharp contrast to the early days of the health reform debate when employers worried the law would ad layers of bureaucracy and higher costs from various new rules and mandates. In 2013, one in five small employers, or 21%, said they were ‘very likely’ or ‘likely’ to terminate their health plans, the Mercer annual employer health survey shows. And in 2014, the likelihood of employers dropping coverage fell to 15% of these smaller employers.”

Few employers now say they will drop coverage due to issues related to the Affordable Care Act. Source: Mercer’s National Survey of Employer-Sponsored Health Plans

What Are Americans’ Most Urgent Health Problems?

Gallup: “Americans continue to name the cost of (22%) and access to (20%) healthcare as the most urgent health problems facing the U.S. Obesity and cancer are next on the list, cited by 15% and 14%, respectively. No other issue receives more than 2% of mentions from Americans.”

Trend: Cost and Access Remain Most Commonly Named as Urgent Health Problems

“The percentages mentioning both cost and access are down from the later years of George W. Bush’s administration, even though they remain the top overall issues.”

Despite Successes, Americans’ View of Obamacare Tilts Negative

Wall Street Journal: “By now, supporters and opponents of the Affordable Care Act often divide along ‘glass half full or half empty’ lines over similar facts, and each perspective was on display at the Wall Street Journal CEO Council on Tuesday.”

“’We believe coverage in general has been improved’ by the 2010 law, said Health and Human Services senior counselor Leslie Dach. ‘That’s an important beginning.’”

“His agency has estimated that the law has extended coverage to 17.6 million people, between its provision requiring plans to cover young adult dependents to their 26th birthdays, the expansion of Medicaid, and the availability of subsidized private coverage to everyone through HealthCare.gov and state equivalents. The law also imposes new requirements on insurance plans on what they must cover, and says they must price coverage equally regardless of people’s medical history, and these affect everyone who gets insurance on their own.”

Despite the progress, Americans views on Obamacare have tilted negative, according to a recent Gallup poll.

Americans' Views of the Affordable Care Act

Gallup: “The law’s continued survival and its empirical success in lowering the uninsured rate has not made much difference in how Americans feel about the law. As such, it seems doubtful that the law will be broadly accepted in the U.S. political system in the near future. It will likely remain the target of efforts to repeal or significantly modify it, which could finally prevail if Americans elect a wholly Republican federal government in 2016.”

In Defense of Obamacare’s High Deductibles

Megan McArdle comes to the defense of the high deductibles of the exchange policies that most people are buying.

“Health-care wonks have started to see health insurance less as a way to ensure health, and more as a way to avoid financial disaster. (As one health-care economist told me … Insurance is a financial product, and what it does really well is give people financial protection.) In other words, the alternative to buying health insurance may not be ‘dying young’; it may be bankruptcy, or at least, a trashed credit report after you’ve negotiated settlements on all your medical bills.”

“It’s not Obamacare’s fault that it didn’t manage to do the impossible: provide cheap, nearly comprehensive health-care coverage without ballooning the deficit. No other reform could have done it either, without tackling provider prices — and no politically feasible reform could have tackled provider prices, because America’s 12 million health-care workers would have been marching on Washington with pitchforks, or at least running tear-jerking ads to great popular effect.”

“You can’t really blame Obamacare for the fact that the most ‘affordable’ insurance offers rather scanty coverage for the average user. Though of course, you can blame the law’s architects for overpromising. They should have been more honest, with themselves and with voters, about the limits of what they could actually do. But of course if they had been, the law probably would never have passed.”

 

Medicare Premiums to Increase by 16% not 52%, as Initially Projected

According to the most recent Kaiser Family Foundation newsletter, as a result of the recently enacted budget deal in Congress, “the 2016 Medicare Part B monthly premium will be $121.80, increasing by 16 percent over the 2015 amount—far lower than the increase initially projected by the Medicare actuaries, a new brief from the Kaiser Family Foundation explains. The Part B premium increase will affect 3 in 10 Medicare beneficiaries. The remaining 7 in 10 beneficiaries will pay the same $104.90 monthly premium in 2016 as they paid in 2015, thanks to protections in Social Security law that exempt them from the increase.”

Figure 1: Medicare Part B Monthly Premiums, 2015-2016

“The brief describes how the Medicare Part B premium and deductible are affected for 2016 by the Bipartisan Budget Act of 2015, including a new $3 per month fee for some beneficiaries to offset federal spending. It also lays out the connection between the Medicare Part B premium, the Social Security COLA, and the so-called ‘hold-harmless’ provision, and why, without the change in law, Medicare premiums would have increased by 52 percent for the 30 percent of beneficiaries not protected by the hold-harmless provision.”

Despite Bad Politics, GOP States Are Sticking With Medicaid Expansion

Washington Post: “Republican-led states that expanded Medicaid are sticking with the change, despite qualms and intense political pressure within the GOP about embracing a key part of President Obama’s health-care law.”

“GOP governors and legislators have balked at repealing expansion partly because of the benefit of providing federally funded health insurance to large numbers of constituents, analysts say.”

“They also wish to keep the billions of dollars of federal funds that … gives states that broaden Medicaid.”

“Of the 10 states in which Republican governors expanded Medicaid, none has backed out in the face of frequent efforts by GOP legislators to reverse the decision.

“’Once you step over the threshold and have tens or hundreds of thousands of people getting coverage, it’s very hard to go backward, which is why for opponents it’s a battle to the death to make sure it doesn’t happen in the first place,’ said Sara Rosenbaum, a professor of health law and policy at George Washington University.”

Uninsured Rate Hits a Record Low

The Hill: “The uninsured rate has fallen to a new low of 9 percent, marking 16.3 million more people with health insurance since ObamaCare’s coverage expansion took effect in 2013, according to data released Thursday.”

“The survey from the Centers for Disease Control and Prevention (CDC) finds that the uninsured rate was 9 percent in the first six months of the year, corresponding to 28.5 million people, ticking down from 9.2 percent in the first three months of the year.”

“But those changes seem major when compared to previous years. The 9 percent figure is down from 11.5 percent uninsured in 2014 and 14.4 percent in 2013.”

“That corresponds to 7.5 million more people with insurance compared to 2014 and 16.3 million more compared to 2013.”

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Americans Most Satisfied With Government Health Plans

Gallup: “Americans’ satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all.”

Satisfaction With the U.S. Health System Varies by Insurance Type

“Americans who get their health insurance through government-sponsored or assisted plans, such as Medicare and Medicaid or veterans insurance, are more likely to be satisfied with the way the healthcare system is working for them than those who have employer-paid insurance or who pay for insurance themselves. There may be a number of reasons for this, such as government plans being more inclusive and having a lower direct cost to the insured person than employer plans or personally paid-for plans. Additionally, the question asks about healthcare generally, and not cost specifically. Therefore, other aspects of the government plans such as access to more specialists, the availability of different services or ease of scheduling appointments may also factor into the higher satisfaction levels.”

Bevin Already Hedging His Obamacare Repeal Pledge

Politico: “Matt Bevin won the Kentucky governorship on a vow to dismantle Obamacare, but the obstacles he faces rolling back a law that covers nearly one in 10 Kentuckians offers a preview of the struggles that a Republican president would face living up to a ‘repeal and replace’ pledge in 2017.”

“Even before the votes were cast, Bevin had started hedging his repeal bet, saying he would not take coverage away from people who have it. He can give the health law in his state a more conservative veneer. But he can’t scrap it completely.”

“And if he tries to scale back Medicaid too much, he could crash into another complication: an obscure 1966 state law that requires the state to draw on all the federal dollars available for Medicaid. Advocates say any move to leave federal dollars untapped would likely lead to a lawsuit. The federal government is fully funding expansion through 2016, and will pay at least 90 percent in future years.”

“’The ultimate lesson here … is that because so many people have gained coverage already through the Affordable Care Act that legislation is a whole lot more resilient than the rhetoric you hear from its opponents.’”

Could an Upset in Kentucky Herald a Rollback for Obamacare?

Modern Healthcare: “Kentucky’s status as a one of the few Southern states to embrace the coverage expansions of the Affordable Care Act was thrown into question Tuesday with the election of Republican Matt Bevin to succeed Democrat Steve Beshear.”

“The Obama administration has hailed Kentucky’s success at extending health benefits to more residents under the Affordable Care Act. The number of uninsured in the state dropped from 20% in 2013 to about 9% this year.”

Matt Ford in The Atlantic: “The impact on health care in the Bluegrass State would be significant if both programs are reversed. About 400,000 Kentuckians qualified under the ACA’s Medicaid expansion, according to the Huffington Post, and another 100,000 received health insurance through KYnect.”

“Kentucky would be the first state to reverse the expansion after its acceptance. Bevin’s success (or failure) could herald the next wave of political battles to be fought over the implementation of President Obama’s signature domestic legislative achievement.”

Modern Healthcare: “Bevin may face some opposition, however, if he moves to eliminated the programs. In a recent poll, fewer than a quarter of respondents were in favor rolling back the healthcare programs and more than half were opposed.”