Obamacare Is Splitting in Two

The Hill: “Increasingly, there are two ObamaCares.”

“There’s the one in coastal and northern areas, where the marketplaces include multiple insurers and plans. And there’s the one in southern and rural areas, where there is often little competition, a situation that can lead to higher premiums.”

“The trend is likely to be accelerated by the departure of Aetna and UnitedHealthcare from ObamaCare marketplaces in 2017. The loss of those insurers won’t affect all parts of the country equally, experts say. ”

“Adding to the geographic disparities under ObamaCare, many of the same states where insurance competition is lacking declined the health law’s expansion of Medicaid. Because of that, many lower-income people have no insurance option at all. “

Six Years into Obamacare, Who Are the Uninsured?

New York Times: “Roughly 20 million more Americans have health insurance now than when President Obama’s health care law was passed in 2010. But as Mr. Obama prepares to leave office, there are still about 24 million adults with no coverage, according to a survey by the Commonwealth Fund, a health research group. That translates to an uninsured rate of about 13 percent, down from 20 percent in 2013. Who are the remaining uninsured?”

“Forty percent of the uninsured are Hispanic. That’s up from 29 percent in 2013…”

“Forty-one percent of the uninsured are white (down from 50 percent in 2013), 12 percent are black (down from 13 percent) and 6 percent are Asian and other races (unchanged from 2013).”

“Fifty-eight percent of uninsured Americans — a bigger chunk than in 2013 — are men.”

“The uninsured tend to be very poor; 39 percent have incomes under the federal poverty level, which is $24,250 for a family of four.”

“Almost half of the uninsured live in the South, where many of the states that haven’t expanded Medicaid — including the two largest, Florida and Texas — are.”


Arizona County At Risk of Having No Obamacare Option

The Hill: “Aetna’s retreat from most Obamacare marketplaces this week is rippling across rural America, starting with Pinal County in Arizona.”

“The county, which has a population of about 400,000, no longer has any insurers planning to sell coverage through ObamaCare next year.”

“State regulators still have until Aug. 23 to try to lure other companies into the marketplace, but it could be a tough sell after one of the nation’s largest insurers decided to pull back because of costs.”

“Aetna announced late Monday that it would pull out of ObamaCare exchanges in 11 states, including Arizona, Florida and Texas. The company’s CEO, Mark Bertolini, cited $200 million in losses over the past few months as a major reason for the move.”

Judge Rules Ohio Cannot Defund Planned Parenthood

The Hill: “A federal judge is halting a Ohio law that would have defunded Planned Parenthood starting this year, a major decision that will be closely watched by other states with similar measures.”

“Judge Michael Barrett ruled Friday that Ohio’s health department could not defund Planned Parenthood because the group’s patients could face ‘irreparable injury,’ according to the 23-page opinion.”

“The 2016 law was signed by Ohio Gov. John Kasich this spring during his GOP presidential bid, amid a politically charged national debate over Planned Parenthood.”

Republican Candidates Moderate Their Stances on Obamacare

Politico: “A handful of moderate House Republicans in tight reelection contests have done something that most Republicans would consider unthinkable — renounce the GOP catechism on repealing Obamacare as they fight for their political lives. They say they oppose the health law but are reluctant to tear it up completely.”

“The break with party leaders in the deeply contentious health care fight reflects a larger change on the campaign trail throughout the country: For the first time since Obamacare’s passage six years ago, and after House Republicans have taken over 60 votes to try to repeal it, the crusade appears to be losing its fire as a political rallying cry, taking a back seat to worries over national security and the economy.

“…it shouldn’t be mistaken for support of the law: They just aren’t eager to repeal it without a replacement.”

“It’s also living proof of Democrats’ claims — and GOP worries — that it may be impossible to repeal the ACA now that millions of people have gotten benefits for a few years.”

Obamacare Appears to Be Making People Healthier

New York Times: “Obamacare has provided health insurance to some 20 million people. But are they any better off?”

“A few recent studies suggest that people have become less likely to have medical debt or to postpone care because of cost. They are also more likely to have a regular doctor and to be getting preventive health services like vaccines and cancer screenings.”

“A new study, published Monday in JAMA Internal Medicine, offers another way of looking at the issue. Low-income people in Arkansas and Kentucky, which expanded Medicaid insurance to everyone below a certain income threshold, appear to be healthier than their peers in Texas, which did not expand.”

“Their survey found people in Arkansas and Kentucky were nearly 5 percent more likely than their peers in Texas to say they were in excellent health in 2015. And that difference was bigger than it had been the year before.”

How Common Procedures Became 20 Percent Cheaper for Many Californians

New York Times: “At a time when health care spending seems only to go up, an initiative in California has slashed the prices of many common procedures.”

“The California Public Employees’ Retirement System (Calpers) started paying hospitals differently for 450,000 of its members beginning in 2011. It set a maximum contribution it would make toward what a hospital was paid for knee and hip replacement surgery, colonoscopies, cataract removal surgery and several other elective procedures. Under the new approach, called reference pricing, patients who wished to get a procedure at a higher-priced hospital paid the difference themselves.”

“During the period of time Calpers saw 20 percent price declines for reference-priced services, typical health care prices paid by employer-sponsored plans rose by about 5.5 percent.”

In Closing Months, The Obama Administration Wants to Revolutionize How Health Care Is Paid For

To complement the Affordable Care Act, the Obama Administration has been working on “an equally sweeping project to transform the way America’s doctors, hospitals and other medical providers deliver care,” The Los Angeles Times reports.

“The foundation of this effort involves scrapping the way medicine has traditionally been paid for – a system akin to auto repair in which each service a doctor or hospital provides is billed separately, no matter how well it is performed and what the long-term outcome is.”

“In place of that, the Obama administration is trying to build a system that pays doctors, hospitals and others based on how their patients recover and how much their care costs.”

Health and Human Services Secretary Sylvia M. Burwell told the Times, “The Affordable Care Act was about so much more than coverage… We have to broaden the concept. The increased access is tremendous, but health outcomes are the place where we have to make historic changes.”

“Financial incentives will cause better coordination of care. That will lead to better quality and lower costs.”

Healthcare Inequality On the Rise

The Hill: “In healthcare, as in the rest of American life, the gap between rich and poor is growing. That’s the take-home message from our analysis of 50 years of data on healthcare use and expenditures that appears in the July issue of the journal Health Affairs.”

“In the bad old days of the 1960s—before Medicare and Medicaid—the wealthy got twice as much care as the poor. But those programs changed things. By 1977, the poor were getting 14 percent more care than the wealthy— an appropriate difference since the poor are sicker and need more care.”

“The pattern changed again in 2004. Over the next eight years, use of care by the wealthiest fifth of Americans grew by 19.7 percent, outpacing growth for the middle class by 57 percent. Meanwhile, care for the poorest fifth actually fell.”

“By 2012 the wealthy were getting 40 percent more doctor visits than other Americans. Overall, after adjusting for differences in age and health, the wealthy got 43 percent more care than the poor— $1,743 per person— and left the middle class in the dust too; the latter got $1,082 less care than the rich.”

Don’t Wait for Washington to Fix Health Care

Real Clear Policy: “Democratic and Republican governors know that rising health-care costs — for public employees and those with Medicaid — are, increasingly, restricting spending on other state priorities, from education to roads and bridges. They also know a bitterly divided Washington is unlikely to provide any help any time soon. Yet there are plenty of levers governors can pull to help bring costs in line, especially by increasing competition in health-care markets.”

“1. Incorporate reference pricing for common procedures and tests into state benefit designs… The Health Care Cost Institute estimates that as much as 43 percent of spending through employer-based coverage is attributable to potentially “shoppable” services that could benefit from tools like reference pricing.”

“2. Ban anti-tiering provisions. Large hospital systems can use their leverage to prevent insurers from offering patients lower co-pays at less expensive in-network hospitals (a strategy called tiered networks).”

“3. Drive price transparency by setting up an all-payer claims database (APCD). APCDs collect information on all health-care claims paid from all payers. Pricing information allows consumers, employers, and providers to shop for the best values.”

“4. Expand Access to Direct Primary Care, including for Medicaid patients.”

“5. Repeal regulations that hamstring competition. States should repeal certificate of need laws, which protect incumbent hospitals from competition, and prohibitions on the corporate practice of medicine, which prevent for-profit companies from buying and reorganizing health care firms.”

Affordable Care Act Premiums Are Lower Than You Think

Brookings Institution: “Since the Affordable Care Act’s (ACA) health insurance marketplaces first took effect in 2014, news story after story has focused on premium increases for certain plans, in certain cities, or for certain individuals. Based on preliminary reports, premiums now appear set to rise by a substantial amount in 2017.”

“What these individual data points miss, however, is that average premiums in the individual market actually dropped significantly upon implementation of the ACA, according to our new analysis, even while consumers got better coverage. In other words, people are getting more for less under the ACA.”


Obama Administration Will Fight to Block Health Insurance Mega-Mergers

Vox: “The Obama administration wants to block two health insurance mega-mergers. The Department of Justice announced Thursday that it would file lawsuits against the proposed merger of Cigna and Anthem, and of Humana and Aetna.”

“Right now there are five major health insurers in the United States — and if these mergers went through, that would drop to three. Taken together, those three companies would cover around 132 million Americans — about half the population under age 65.”

“‘These mergers would restrict competition for health insurance products sold in markets across the country and would give tremendous power over the nation’s health insurance industry to just three large companies,’ US Attorney General Loretta Lynch said in a statement Thursday. ‘Our actions seek to preserve competition that keeps premiums down.'”


Senate Punts Zika Fight to the Fall

The Hill: “Senate Democrats on Thursday blocked a deal to provide $1.1 billion to combat the Zika virus for a second time, effectively kicking the funding fight into September.”

“Senators voted 52-44 on a procedural hurdle. Sixty votes were needed to move forward with the Zika money, which is attached to a larger military and veterans spending bill.”

“Democrats have balked at supporting the GOP deal because of how it’s paid for and a provision that blocks funding for Planned Parenthood.”
Each party accuses the other of putting “political gamesmanship” or “partisan politics” before the health of Americans.