Insurance Executives Ask for Changes to Obamacare

The Hill: “Health insurance executives went to the White House on Monday and called for changes to Obamacare that they say are necessary to keep the healthcare exchanges working.”

“The executives discussed a series of their long-running complaints about ObamaCare including tightening up the rules for extra sign-up periods, shortening grace periods for people who fail to pay their premiums and easing restrictions on setting premiums based on someone’s age.”

“The insurance officials called on the administration to enact a system where it checks enrollees’ documentation to make sure they are eligible for extra sign up periods before they sign up, as opposed to after they are already enrolled, industry sources said.”

‘Franken-bugs’ May Be our Best Weapon Against Zika

Reuters: “On Nov 8, the residents of a suburb of Key West will vote on whether to allow scientists to release genetically-modified mosquitoes into their backyards. Inserted into the mosquito’s genetic makeup would be an artificial stretch of DNA that renders them unable to reproduce.”

“As the ‘transgenic’ mosquitoes mate with wild ones, the plan goes, their offspring would die, bringing the local population of skeeters down significantly — by as much as 90 percent, according to Oxitec, the for-profit firm that wants to release the modified mosquitoes. That would potentially reduce the risk to local residents of catching mosquito-borne diseases such as dengue and Zika.”

“Among scientists, opposition to the release of transgenic mosquitoes centers on the law of unintended effects.”

“A lack of answers to questions such as these has prompted some scientists to invoke the precautionary principle: when effects are unknown, it’s best to play it safe. This sounds reasonable, but it is something of a Catch-22. By the precautionary principle, genetically modified crops would never have made it out of the lab, and yet the worst fears about their impact on human health have not been borne out. We know this because lots of people have been eating them for years.”

The States with the Biggest Obamacare Struggles Spent Years Undermining the Law

Los Angeles Times: “As insurers exit Obamacare marketplaces across the country, critics of the Affordable Care Act have redoubled claims that the health law isn’t working.”

“Yet these same critics, many of them Republican politicians in red states, took steps over the last several years to undermine the 2010 law and fuel the current turmoil in their insurance markets.”

“Indeed, eight of the nine states where consumer choices will be most limited in 2017 have rejected Medicaid expansion and taken other steps that have weakened their marketplaces, data show.”

“19 states are still rejecting federal aid to expand their Medicaid programs to poor, childless adults, a group of Americans traditionally excluded from the government safety net.”

“This has been particularly problematic for those states’ marketplaces, research suggests, as many poor – and probably sick – residents who couldn’t get Medicaid have gone into the marketplaces.”


Clinton and Trump Are Both Wrong About Medicare’s Ability to Negotiate Drug Prices

Geoffrey Joyce and Neeraj Sood: “Hillary Clinton and Donald Trump agree that Medicare bureaucrats should be unleashed to negotiate lower prices with drug companies, and predict billions of dollars in savings as a result. In this political era when any common ground between these two adversaries should be venerated, it is a shame that we must point out that they are both wrong.”

“When Clinton and Trump talk about Medicare exercising its clout to drive down prices, they are primarily targeting cancer and other specialty drugs. But Medicare can’t negotiate any better than pharmacy benefits managers with drug companies holding aces.”

“As we write in the Journal of Policy Analysis and Management, better options exist.”


Obamacare’s Four Biggest Problems and How to Fix Them

New York Times: “Here are four key challenges to the program and a survey of some possible solutions.”

One: “Choice is disappearing.”

“Possible solutions: Both President Obama and Hillary Clinton have also revived the idea of the so-called public option, which would be a government-run plan that would either compete with or be a substitute for a plan offered by a private insurer.”

Two: “Prices are rising.”

“Possible solutions: Bring down costs instead of raising prices… the narrow network strategy may be a smart way to start getting different groups to negotiate down on their prices… Another, simpler way to bring down prices would be to get more healthy people into the market, so the average insurance customer costs less, or use other tools to absorb the cost of people with complicated and expensive medical conditions.”

Three: “The market is too small.”

“Possible solutions: Change the incentives, so more people who are currently uninsured buy health insurance. Hillary Clinton has talked about giving out more generous subsidies, so insurance costs less and more people can afford to buy it. Many Republican politicians suggest another way to lower prices: eliminating current requirements that insurance cover a wide array of services. Some policy experts, including Uwe Reinhardt, a Princeton health economist, in a recent interview, have suggested tightening up the penalties for remaining uninsured, so people can’t wait and buy insurance only after they get sick.”

Four: “The rules are complicated.”

“Possible solutions: The insurers that remain in the market — particularly many Blue Cross plans — have a long list of policy requests that would make their business less risky: by making it harder for sick people to buy coverage for short periods of time, by subsidizing the plans’ losses for very expensive patients, and in some cases by charging higher prices to older customers, who are more likely to be sick. But regulators have been cautious about embracing them, because such moves would shift financial risk to taxpayers and make it harder for people who need health care to get insurance.”


How Expanding Medicaid Can Lower Insurance Premiums for All

New York Times: “The Obama administration for years has been pleading with states to expand their Medicaid programs and offer health coverage to low-income people. Now it has a further argument in its favor: Expansion of Medicaid could lower insurance prices for everyone else.”

“A new study published by in-house researchers at the Department of Health and Human Services compared places that have expanded their Medicaid programs as part of Obamacare with neighboring places that have not. They found that, in 2015, insurance in the marketplace for middle-income people cost less in the places that had expanded Medicaid.”

“A substantial body of research has shown that lower-income Americans tend to have poorer health than those who earn more. (Cause and effect isn’t clear: People may be unable to earn a higher income because of health problems.) And that difference may explain why Medicaid expansion may have lowered insurance premiums. Because the states that didn’t expand had more sick people in their middle-class insurance pool, prices went up for everyone, the paper argues.”

Climate Change Is Making Oysters and Other Shellfish Dangerous to Eat

Quartz: “Oyster happy hours are going to be getting sadder in the coming years—and we probably have climate change to blame.”

“The connection comes from a new study (paywall) in the Proceedings of the National Academy of Sciences that links the rapid rise in sea temperatures in the North Atlantic with a surge in Vibrio, a genus of bacteria that thrives in shellfish and teems in coastal waters—and can be fatal to humans.”

“It’s pretty hard to miss the truly alarming thing about the chart above: that the total number of Vibrio infection cases has been climbing steadily for years. And that’s likely due to how climate change is cooking our seas. The new research is significant because it’s the first to link rising ocean-surface temperatures to Vibrio abundance and disease incidence. Since the deadly bacteria thrives in warmer water, climate change is sickening more and more people.”


The Current State of Obamacare

Two new fairly comprehensive Obamacare analyses can be found on Vox.

Is Obamacare failing?

“The marketplaces’ failures to attract a robust group of health plans to many areas suggests that Obamacare’s insurance expansion is on the path to looking like other safety net programs we know, offering limited services to a predominantly low-income population.”

Big insurers have quit Obamacare. That means more shoppers only get one choice.

“Major insurers like Aetna and UnitedHealth have, in recent months, taken major steps to sharply reduce participation in Obamacare’s insurance marketplaces. The result, a new Vox analysis shows, is a spike in counties served by just one health plan — and a precipitous drop in ultra-competitive areas.”

See also “Is Obamacare Sustainable?” from The New York Times, in which health policy experts and leaders debate Obamacare’s future.

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.”