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.”

White House Urges States to Resist ObamaCare Hikes

The Hill: “The White House is urging states to be more aggressive against health insurance companies as it looks to prevent expected and widespread premium hikes of 10 percent or more this year.”

“The federal health department announced Wednesday that it will dole out about $22 million to boost state-level ‘rate reviews,’ considered one of the strongest weapons against premium increases.”



“The new federal grants, described as a way to ‘hold insurance companies accountable for unjustified hikes’ are likely to inflame an already tense relationship with health insurers.”

24 Million Would Lose Insurance If ObamaCare Were Repealed

The Hill: “If ObamaCare were repealed, 24 million fewer people would have health insurance in 2021, according to a new study.”

“The study from the Urban Institute finds that 14.5 million fewer people would have coverage through Medicaid or the Children’s Health Insurance Program and 8.8 million fewer people would have individual private coverage like that offered on the health law’s marketplaces. Another 700,000 fewer people would have health insurance through their jobs.”

Though the study finds that a repeal would also drastically reduce spending, the Congressional Budget Office estimates that a repeal would have unintended consequences that would increase the deficit.


GOP Surprises with Push for Smaller ObamaCare Changes

The Hill: “House Republicans are considering small-bore changes to ObamaCare even as they prepare to release an outline for replacing the entire law.”

“The task force’s replacement plan is part of Ryan’s high-profile effort to show voters that Republicans have policy solutions. The smaller-scale bills considered Friday, on the other hand, could actually move at least some distance through the legislative process.”

Though some Democrats maintained a hardline, most saw the introduction of small scale bills as progress on the GOP’s part and expressed a willingness to compromise.

“‘I’m happy about it,’ [Rep. Gene] Green (D-Texas) said. “I’ve been asking for that for about six years. Let’s go back and fix it, because any bill Congress ever passed, typically we wait a year or two, see how it works, we go back in and fix the problems. We haven’t had that opportunity because it’s always just repeal.'”

McConnell Signals Movement in Zika Funding 

New York Times: “With public health officials warning of a fast-spreading emergency, House and Senate negotiators will work to reconcile legislation aimed at providing up to $1.1 billion to combat the Zika virus and the mosquitoes that carry it, Senator Mitch McConnell said on Wednesday.”

“‘We all agree that the Zika virus is a real threat and needs to be addressed,’ Mr. McConnell, the majority leader from Kentucky, said on the Senate floor on Wednesday morning. ‘Republicans and Democrats worked together to pass a bill here in the Senate to provide funding and resources. The House passed its own version. We are now ready to go to conference and complete a final bill.'”

Senate Democrats held a news conference shortly after McConnell’s, urging Congress to move faster on the measure: “‘The mosquitoes are not waiting for Congress to act,’ said Senator Chuck Schumer, Democrat of New York.”

Trump’s Ambiguous Health Care Plans Trouble GOP

Donald Trump’s inconsistencies on health policy are baffling experts and deepening the doubts that conservatives have about his candidacy,” The Hill reports.

“Trump has repeatedly promised to “take care of everybody,” but his health plan includes no major expansion of coverage; one analysis asserted the proposal would actually end coverage for 21 million people.”

“Republican healthcare experts say the contradictions in Trump’s array of statements and positions about the issue have made it nearly impossible to discern what he really wants to do.”

“What he has said in the debates isn’t what’s on his website, which makes you wonder which version you should pay attention to,” Doug Holtz-Eakin, a longtime Republican health policy adviser recently said.


HHS Announces Steps to Improve ObamaCare Marketplaces

The Hill: “The Department of Health and Human Services (HHS) on Wednesday announced a range of steps aimed at improving the health of the ObamaCare marketplaces.”

“The moves are aimed at improving the mix of healthy and sick enrollees, known as the ‘risk pool.’ A risk pool that has been smaller and sicker than expected has contributed to financial losses for many insurers on the marketplaces. Those losses are one of the reasons many insurers are pushing premiums higher than in previous years, an issue that has been seized on by Republicans in an election year.”

The steps announced include crackdowns on insurer use of short-term policies, a mandate that “enrollees will have to provide documentation to verify that they actually qualify for whichever extra sign-up period in which they are looking to enroll,” and new methods to help people transition to Medicare when they turn 65.

Study: Insurers Committed to ObamaCare Marketplaces

A new analysis by the Commonwealth Fund found that most insurers are not looking to exit ObamaCare marketplaces, The Hill reports.

“Many insurers have been losing money on the ObamaCare marketplaces, which is likely to lead to larger premium increases for next year, a trend that Republicans have seized on.”

“The analysis finds that despite these early losses, many insurers see opportunities to grow their involvement in the marketplaces as they adapt.”

“Still, there are challenges for insurers, and many are calling for policy changes. Those changes include tightening up the rules around extra sign-up periods that insurers say people use to game the system, or to loosen up the rules around what an insurance plan must cover. ”



What If No One Sells In an Obamacare Marketplace?

Sarah Kliff: “There are at least three states that currently have just one health insurer planning to sell on their Obamacare marketplace in 2017: Alaska, Alabama, and Wyoming.”

“The health care law doesn’t have a backup plan if any of those states have their sole carriers drop out… A federal official told the Wall Street Journal he was “pretty confident” there would be no areas with zero carriers — but he also couldn’t rule out the possibility.”

“An Obamacare market with no sellers would leave thousands of enrollees unable to use tax subsidies to buy insurance coverage. And the government doesn’t have any particular legal power to cajole carriers into setting up shop in the markets they find undesirable. The most they can do, it turns out, is ask really nicely.”

Who Benefited Most from Obamacare?

New York Times: “The health care law was one of the most bitterly contested pieces of legislation in the country’s history. It remains controversial because of its costs to both taxpayers and insurance customers. The high premiums and high deductibles of many plans still make coverage a crushing financial burden for some families.”

“And the law is not close to achieving the goal of universal coverage, in part because 19 states have declined to expand their Medicaid programs for the poor, an option the Supreme Court granted them in a landmark 2012 case. Nevertheless, the Times’s analysis shows that by the end of that first full year, 2014, so many low-income people gained coverage that it halted the decades-long expansion of the gap between the haves and the have-nots in the American health insurance system, a striking change at a time when disparities between rich and poor are growing in many areas.”