The Winner of the Republican Debate? Obamacare.

Sarah Kliff: Last night, Republican candidates “mentioned Obamacare exactly six times during the first debate. Only two candidate, Scott Walker and Ted Cruz, have even uttered the Republican rallying cry: “Repeal Obamacare.” The near-complete absence of Obama’s health overhaul is remarkable.”

“The rhetorical shift shows a fundamental change in the calculus of Obamacare: It’s one thing to talk about dismantling a theoretical law. It’s another to take away insurance that tens of millions of Americans now receive. And that’s exactly where Republicans are in 2016. So while Obamacare has barely made it onto the stage, it might just be the biggest winner of the debate season so far.”

“Now Obamacare has an army: More than 10 million Americans get coverage through the health law’s marketplaces and millions more through Obamacare’s Medicaid expansion. America’s uninsured rate has tumbled since the last time Republican presidential candidates took to a debate stage.”

“Democrats, meanwhile, will likely be more enthusiastic to discuss Obamacare than ever. In 2010, the party largely shied away from the health law after weathering bruising debates in Congress over “death panels” and abortion.”

Census Report: Uninsured Rate Drops ‘Sharply’

Washington Post: “The proportion of Americans who lack health insurance took a big dip last year, with nearly 9 million people gaining coverage since 2013, according to federal figures announced Wednesday morning.”

The new Census figures “are the most solid evidence to date of the impact that the Affordable Care Act has had since its main coverage provisions took effect in 2014. They show that the share of people across the country who were uninsured throughout the year fell from 13.3 percent in 2013 to 10.4 percent last year.”

“Among the different sources of insurance, the biggest increase last year was among what the Census calls ‘direct purchase’ – people buying health policies on their own. That includes, though is not limited to, people buying health plans through the new federal and state insurance marketplaces created under the federal health care law. The share of coverage that was directly purchased increased by 3.2 last year to account for nearly 15 percent of those with health insurance.”

Large Majority Wants to Avoid Shutdown Over Planned Parenthood

The Hill: “A huge majority wants Congress to keep the government open, regardless of whether that means providing funding to Planned Parenthood, according to a CNN/ORC poll released Monday.”

“The poll finds that 71 percent of adults say it is more important for Congress to approve a spending bill to keep the government open, compared to 22 percent who say it is more important to eliminate all federal funds for Planned Parenthood.”

The Nation’s Healthcare Checkup

Kaiser Family Foundation 9/10/15 newsletter: “A new brief on the Peterson-Kaiser Health System Tracker finds that the quality of the U.S. health system is improving in many areas, but comparable countries continue to outperform the United States on key measures.”

Findings include:

  • The U.S. health system has improved on a wide variety of quality measures, including mortality amenable to health care; the number of hospital-acquired infections; and the percentage of children receiving all recommended doses of vaccines.
  • The U.S. has worsened on other measures, including health-related quality of life.
  • The U.S. outperforms countries of comparable wealth on some measures … but, on a large number of measures, comparable countries outperform the U.S., including life expectancy at birth; cost-related barriers to health care access; … and burden of disease, which takes into account years of life lost due to premature death and years of life lost to poor health or disability.

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Planned Parenthood Myths

Sarah Kliff in Vox: “A stat is adding fuel to the defund Planned Parenthood movement on Capitol Hill: The group receives over a half billion in federal funding every year … The problem? Planned Parenthood doesn’t receive half a billion in federal funds. A review of the organization’s income suggests it’s only a fraction of that.”

“The likely source of this myth is a Planned Parenthood report that states it receives just over $500 million in public funds, which include grants from the federal government, states, and local governments. That’s a significant distinction. If conservatives on Capitol Hill want to slash the group’s federal funding, they will have a hard time finding the half a billion.”

“The most recent Planned Parenthood annual report “shows that about 41 percent of the organization’s budget comes from government grants and reimbursements … If you translate that graph into dollar figures, as this table does, the half-billion figure turns up.”

Vast Majority Support EPA Limits on Smog

The Hill: “Nearly three-quarters of United States voters want the Environmental Protection Agency to put further limits on the ozone pollution that causes smog, a new poll found.”

“The survey was commissioned by the American Lung Association, which supports the EPA’s proposed ozone rule, and found that 73 percent of voters favor stricter ozone limits.”

“The poll is meant to show support for the EPA’s efforts, proposed in November, to restrict the allowable levels of ozone in the air to between 65 and 70 parts per billion, from the current 75 parts per billion.”

Which Health Costs Are the Greatest Burden?

Drew Altman: “In our August polling, we asked which health costs people with health coverage find to be the greatest burden. As the chart below shows, deductibles led a closely bunched list, followed by premium payments, drug costs and doctor visits. Deductibles have been rising steadily each year, especially for people who work for smaller employers, as insurance has gradually been moving from more to less comprehensive, with more ‘skin in the game’ for consumers.

“Drug spending represents just 10% of overall health spending.  But the number of transactions people have with the health system is much larger for drugs than for physician visits or hospital stays or other services — and the cost is very immediate and tangible. Concern about drug prices is best understood as the tip of the iceberg of a larger concern consumers have about out-of-pocket costs.  It’s an example of a basic rule of health policy: Experts think more about national and government spending for health while people focus more on health care as a pocketbook issue.”

Obamacare Enrollment Remains on Track

The Hill: “The Obama administration said Tuesday that 9.9 million people have ObamaCare coverage, a slight drop from the previous count of 10.2 million.”

“The new data are for people who have paid their premiums as of June 30, marking a drop-off from the number enrolled through March 31.”

“Both figures are down from the 11.7 million who signed up in the enrollment period this year, but a decline was expected from that figure, as not all of those people paid their premiums. The administration said it expects some further fluctuation as factors like gaining employer-based coverage or getting married could effect how many people need ObamaCare coverage.”

“The administration points out that the new figure is still higher than the administration’s stated goal of 9.1 million sign-ups this year.”

“California also edged past Florida for the title of state with the most sign-ups, at around 1.4 million and 1.3 million respectively.”

Is Breast Cancer Overtreatment a Problem?

A report in the scientific journal Health Affairs estimates that the U.S. spends $4 billion a year “on unnecessary medical costs due to mammograms that generate false alarms, and on treatment of certain breast tumors unlikely to cause problems,” the AP reports.

The study “breaks the cost down as follows: $2.8 billion resulting from false-positive mammograms and another $1.2 billion attributed to breast cancer overdiagnosis. That’s the treatment of tumors that grow slowly or not at all, and are unlikely to develop into life-threatening disease during a woman’s lifetime.”

“Breast cancer is the second most common cause of death from cancer among American women, claiming nearly 41,000 lives a year. Annual mammograms starting at age 40 have long been considered standard for preventive care, because cancer is easier to treat if detected early. But recently there’s been disagreement about regular screening for women in their 40s. It parallels the medical debate about the pros and cons of prostate cancer screening for men.”

However, the Breast Cancer Research Foundation notes that while mammograms “are not perfect tests, BCRF’s scientific leadership… join the large majority of the scientific community in recommending that women of average risk take current screening guidelines—including annual mammograms starting at age 40—seriously.”

Fewer Americans Forego Medical Care

Washington Post: “During the first three months of the year, just 1 in 20 Americans said they did not get medical care they needed because they could not afford it, according to the U.S. Centers for Disease Control and Prevention.”

“The findings, from the federal National Health Interview Survey, show that 4.4 percent of people interviewed from January through March said they had skipped medical care in the previous year because of its cost — the lowest percentage in 16 years.”

“The survey, conducted with people of all ages, does not explain the reason why fewer people are avoiding treatment because of its cost, but the improvement coincides with two big changes: Health insurance has become more common under the Affordable Care Act as government exchanges began nearly two years ago to sell private insurance policies for people who cannot get coverage through a job and as Medicaid for low-income people expanded in some states. At the same time, the economy has been recovering from the Great Recession of 2008-09, so more people are working.”

A Win for Public Health: Smoking Rate at a New Low

Jonathan Cohn: “New survey data, which the U.S. Centers for Disease Control and Prevention released Tuesday morning, suggests that just 15.2 percent of American adults are now using cigarettes on a regular basis. That smoking rate is nearly 2 percentage points lower than what the same survey reported for calendar year 2014. ”

“This year’s reduction is part of a long-term trend that dates back at least 50 years, to when the surgeon general published a landmark report identifying smoking as a health hazard. Since that time, officials and public health advocates have been waging the policy equivalent of a full-court press against smoking.”

“Of course, some portion of the people who no longer smoke cigarettes have probably switched to using electronic cigarettes, the health effects of which remain the subject of intense debate even among scholars and anti-smoking activists.”


The Problem With the GOP’s Interstate Obamacare Alternative

Margot Sanger-Katz: “The idea of developing a more national market for health insurance has become a major part of Republican health reform orthodoxy … Aside from repealing Obamacare, allowing insurers to sell their products across state lines appears to be the most popular health reform idea among the G.O.P. candidates.”

“The trouble with the idea is that varying or numerous state regulations aren’t the main reason insurance markets tend to be uncompetitive. Selling insurance in a new region or state takes more than just getting a license and including all the locally required benefits. It also involves setting up favorable contracts with doctors and hospitals so that your customers will be able to access health care. Establishing those networks of health care providers can be hard for new market entrants.”

“’The barriers to entry are not truly regulatory, they are financial and they are network,’ said Sabrina Corlette, the director of the Georgetown University Health Policy Institute.”

“Critics of the across-state-lines plan worry about negative consequences of letting insurers shop for the state regulator of their choice … Insurers may end up congregating in whatever state offers the most lenient regulations. That could mean that customers who get sick could be harmed because there are few comprehensive policies available, or because consumer protections are weak when things go wrong.”