​The ACA is the ultimate survivor

​https://newsatjama.jama.com/2017/11/20/jama-forum-the-health-care-law-that-continues-to-escape-death/

The Affordable Care Act has survived more assassination attempts than Fidel Castro — and it’s still kicking. The Kaiser Family Foundation’s Larry Levitt has a piece in the JAMA Forum laying out the argument that the ACA “continues to escape death.”

  • Levitt’s piece is mostly focused on the Senate’s repeal-and-replace efforts and the Trump administration’s implementation decisions — cutting off payments for cost-sharing subsidies and dramatically scaling back enrollment outreach.
  • “If these efforts were intended to make the marketplace implode, they may, in fact, be backfiring,” Levitt says, citing the weird abundance of plans with $0 monthly premiums and enrollment totals that are beating some experts’ expectations.

This is just the latest chapter. The ACA has been a fixture of public debate since 2009, and it has never veered far from death’s door. In that time, it has survived:

  • Any number of make-or-break moments during the legislative debate
  • Two potentially disastrous Supreme Court challenges
  • The Republican waves of 2010 and 2014, and the countless repeal votes that followed
  • A slew of self-inflicted wounds, from provisions that proved unworkable to the hot mess that was the HealthCare.gov launch.

Between the lines: The ACA has definitely taken some hits — it’s not as strong its drafters might have hoped on the day it passed. But congressional Republicans’ failure to repeal it, and President Trump backing into a massive increase in its subsidies, are just the latest signs of the law’s surprising durability.

Until Congress repeals the individual mandate, anyway…

 

Puerto Rico’s Dire Health-Care Crisis

https://www.theatlantic.com/politics/archive/2017/10/puerto-ricos-health-care-crisis-is-just-beginning/544210/

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It’s been two months since Hurricane Maria hit Puerto Rico, but nearly 10 percent of the island’s 3.4 million residents still don’t have access to clean, safe water. Half of the electric grid is still out of service, which has made it difficult to safely store food or medicines that need to be refrigerated. The outages have also left many residents vulnerable to heat exposure; temperatures remain in the high 80s on the island.

There’s also growing concern that Puerto Rico’s Medicaid program — which covers nearly half of Puerto Ricans — will soon run out of money to pay doctors and hospitals. The territory’s governor has asked the Trump administration to waive Puerto Rico’s share of Medicaid costs, and some Democratic senators have made similar appeals.

 

 

Health Care Price Growth Plummets To Lowest Rate In Almost Two Years

https://altarum.org/about/news-and-events/health-care-price-growth-plummets-to-lowest-rate-in-almost-two-years

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Fueled by health policy uncertainty and structural health sector changes, health care price growth in August rose by only 1.2% compared to a year earlier. This is the lowest health price growth rate recorded in almost 2 years, and just slightly above the all-time low, according to Altarum’s latest Health Sector Economic Indicators Briefs. Contributing to overall slow price growth is a historically low Medical Consumer Price Index growth rate, a possible signal of relief for health care consumers with substantial out-of-pocket expenditures.

Despite an upward revision to recent estimates, health spending growth in August 2017 was only a modest 4.3% higher than a year earlier. Per Charles Roehrig, founding director of Altarum’s Center for Sustainable Health Spending, this moderation in spending growth is in response to a leveling-off in insurance coverage.

Health care job growth also remained modest, with 22,500 new jobs added in September 2017, slightly less than the 2017 average of 25,000. “Slower growth in health care utilization is reflected in slower growth in health jobs, particularly in the hospital sector,” said Roehrig. “This relatively good news should be tempered by a serious look at whether even this moderate growth is sustainable in the longer term.”

Health Care Spending

In August, the health share of gross domestic project (GDP) fell to 18.0%, but spending at an annual rate was 4.3% higher than August 2016, exceeding $3.5 trillion. Spending growth in August 2017 increased in all major categories, led by home health care at 6.5%. Hospital spending continues to grow slowly, at a 2.3% rate.

Health Care Employment

Hospitals added 4,500 jobs and ambulatory care settings added an above-average 24,700 jobs in August, but these gains were offset by the loss of 6,700 jobs in nursing and residential care. Slow hospital job growth in 2017 is a primary force behind the health sector growing at about three-quarters the pace of 2015 and 2016.

Health Care Prices

The 12-month moving average of the Health Care Price Index (HCPI) fell to 1.8% growth after being at 1.9% for 6 straight months, dousing any expectations of a return to a 2.0% growth rate range in the near term. Year-over-year hospital price growth fell to from 1.5% to 1.3%, and physician and clinical services price growth fell one-tenth to 0.5%. Annual drug price growth fell to a 2.7% rate, its lowest reading since growing by 2.4% in December 2015.

Fitch affirms ‘AA-‘ on Virtua Health’s revenue bonds

https://www.beckershospitalreview.com/finance/fitch-affirms-aa-on-virtua-health-s-revenue-bonds.html

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Fitch Ratings affirmed its “AA-” rating on Marlton, N.J.-based Virtua Health’s revenue bonds, affecting a total of $605 million of debt.

The affirmation is a result of several factors, including the health system’s solid liquidity growth, strong market position, favorable operating margins, sizable clinical platform and moderate debt burden.

The outlook is stable.