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.

Social Spending, Not Medical Spending, Could Be Key to Health

Brookings Institution’s Stuart Butler: “Given the cost of health insurance, prescriptions, and deductibles, few Americans would be surprised to learn that we spend a much higher proportion of our economy on healthcare than other major countries. The major European countries, for instance, spend between about 9 and 12 percent of their GDP on health services. We spend more than 17 percent.”

“But despite this heavy investment in medical services, we actually have similar or worse outcomes on several key measures of health, such as infant mortality and the prevalence of chronic diseases. So why do we get so little when we spend so much?”

“A clue comes from the balance of spending in America between medical services and social services, including such things as housing assistance, food aid, and child support. Medical experts are increasingly coming to the conclusion that improving these ‘social determinants’ often results in better long-term health than does intensive and expensive medical care.”

“The US is very much the outlier on spending devoted to social services compared with medical care. The major (OECD) countries on average spend about $1.70 on social services for each $1 on health services. But the US spends just 56 cents per health dollar. Yet research shows that basic measures of health in countries are more closely and positively associated with social service spending than with health spending.”

President Obama’s Report on the Future of Health Care

President Barack Obama, penning a report for The Journal of the American Medical Association, provides advice to future legislators regarding his cornerstone Affordable Care Act and U.S. health care in general.

Citing declining uninsured rates under the new law, enhanced fraud prevention measures, and increased quality of care, Obama lauds the ACA’s progress. However, he notes that “too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewildering system; and remain uninsured.”

Obama’s conclusion: “Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges.”

Medicare’s Main Trust Fund Is Running Out of Money Fast

The Hill: “Medicare’s main trust fund will run dry by 2028, two years earlier than previous estimates, according to a review released Wednesday by the Obama administration.”

“‘Medicare faces a substantial, long-term shortfall that needs to be addressed,’ Treasury Secretary Jack Lew told reporters.”

“The long-term financial picture for Medicare is worsening despite a spate of government actions to reduce healthcare costs system-wide.”


Public Opinion and Politics Out of Step With Realities of ACA 

The Hill’s Lawrence R. Jacobs: “It’s policymaking 101: When a policy delivers benefits to people, support for the policy grows. Political scientists call situations like these “policy feedback loops,” and they are a big part of the story of how Social Security and Medicare became so entrenched in American life. But what happens if hyper-partisanship stops the loop? Consider the Affordable Care Act (ACA).”

“The numbers are stark. Monthly tracking polls show that 49 percent hold unfavorable views of the ACA versus just 38 percent holding favorable views. These assessments fly in the face of the ACA’s accomplishments.”

“Why have overall assessments of the ACA remained so divided and largely negative? The culprit, we found, is the political environment. Prevailing attitudes of distrust in government, strong partisanship and ingrained attitudes — not features of the law itself — are perpetuating the public’s negative opinion.”

ObamaCare Fight ‘Effectively Over,’ Says Obama’s Top Lawyer

The Hill: “In an interview with MSNBC, Solicitor General Donald Verrilli, who is stepping down from his post, noted that the chief justice upheld the law as it currently stands in King v. Burwell last year, writing for not just five, but six justices.”

“’I think the debate is effectively over,’ Verrilli said.”

“House Republicans are suing the administration, saying that it does not have the power to make certain payments to insurers without an appropriation from Congress.”

“A federal district court judge ruled for Republicans in May, but the decision will be appealed. Many experts think it will be thrown out due to a decision that the House does not have the legal standing to sue the president.”