President Obama flouted legal norms to implement Obamacare. Now Trump may go further.

http://www.vox.com/the-big-idea/2017/2/1/14463904/obamacare-executive-power-trump-law

This month, Kellyanne Conway, senior adviser to President Donald Trump, was asked whether the administration would refuse to enforce the Affordable Care Act’s individual mandate — the requirement that people get health insurance or pay a penalty. “He may,” she said, instantly sending a shiver of fear down the spines of health reform’s supporters. Without the mandate, insurance markets in many states will teeter; some will probably collapse.

Would it be legal for Trump to decline to enforce the mandate?

The short answer is no. The longer answer is more complicated, but it’s also instructive. At key points, President Barack Obama delayed aspects of the ACA in an effort to put health reform on a sound footing. The delays were classic examples of executive overreach; they never should have happened. The Republican-led House of Representatives even sued the president over them.

And now the shoe is on the other foot. With Trump in office, some of Obamacare’s fiercest critics seem almost giddy at the prospect that he might use the same weapon against the act. Pick your favorite tagline: payback is a bitch, what goes around comes around, “I learned it from watching you, Dad!”

What Trump has hinted at, however, would be a far greater overreach than Obama ever attempted. But Obamacare’s critics are unlikely to care. There’s an important lesson here about the accretion of executive power in the 21st century, how law is enforced outside the courts, and what presidential power might look like in an age of Trump.

Bloggingheads.TV on repeal and replace

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Earlier this week, Kevin Glass, director of policy at the Franklin Center and contributor at The Washington Examiner, invited me to chat on his Bloggingheads show about the future of the ACA. We touch on the scope and implications of Trump’s executive order, the Cassidy-Collins plan, and the difficult politics of repeal and (particularly) replace. We also spend a fair bit of time talking about the market uncertainty created by those politics, which threatens to undermine access to coverage in 2018, regardless of policy outcome.

Kevin Glass (Franklin Center for Government and Public Integrity) and Adrianna McIntyre (The Incidental Economist)

Premium support is back. What is it?

Premium support is back. What is it?

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Click to access premium-support.pdf

A number of Republican health care policy proposals that seemed out of favor in the Obama era are now being given new life. One of these involves Medicare, the government health insurance program primarily for older Americans, and is known as premium support.

Right now, the federal government subsidizes Medicare premiums — those of the traditional program, as well as private plan alternatives that participate in Medicare Advantage. The subsidies are established so that they grow at the rate of overall per enrollee Medicare spending. No matter what Medicare costs, older Americans can be sure that the government will cover a certain percentage of it. That’s the main thing that panics fiscal conservatives, because that costs the government more each year.

Premium support could quiet that fear. Subsidies would be calculated so they don’t grow as quickly, thus protecting the federal government (that is, taxpayers) from runaway spending. There are lots of variants, but there are really two principal ideas.

The surprising link between air pollution and Alzheimer’s disease

http://www.latimes.com/science/sciencenow/la-sci-sn-air-pollution-alzheimers-20170131-story.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=41764605&_hsenc=p2ANqtz-9DiZmgGHX54LqTpQGsAm4ohgFFyJHWy6ijRJ-3gxyi-aPS9QNViqc7K33BgIAVc43xoyt9TPB1HdtN7c-F__ONriUMMQ&_hsmi=41764605

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With environmental regulations expected to come under heavy fire from the Trump administration, new research offers powerful evidence of a link between air pollution and dementia risk.

For older women, breathing air that is heavily polluted by vehicle exhaust and other sources of fine particulates nearly doubles the likelihood of developing dementia, finds a study published Tuesday. And the cognitive effects of air pollution are dramatically more pronounced in women who carry a genetic variant, known as APOE-e4, which puts them at higher risk for developing Alzheimer’s disease.

In a nationwide study that tracked the cognitive health of women between the ages of 65 and 79 for 10 years, those who had the APOE-e4 variant were nearly three times more likely to develop dementia if they were exposed to high levels of air pollution than APOE-e4 carriers who were not.

Among carriers of that gene, older women exposed to heavy air pollution were close to four times likelier than those who breathed mostly clean air to develop “global cognitive decline” — a measurable loss of memory and reasoning skills short of dementia.

While scientists have long tallied the health costs of air pollution in asthma, lung disease and cardiovascular disease, the impact of air pollutants on brain health has only begun to come to light. This study gleans new insights into how, and how powerfully, a key component of urban smog scrambles the aging brain.

Published Tuesday in the journal Translational Psychiatry, the research looks at a large population of American women, at lab mice, and at brain tissue in petri dishes to establish a link between serious cognitive decline and the very fine particles of pollution emitted by motor vehicles, power plants and the burning of biomass products such as wood.

All three of these biomedical research methods suggest that exposure to high levels of fine air pollutants increases both dementia’s classic behavioral signs of disorientation and memory loss as well as its less obvious hallmarks. These include amyloid beta protein clumps in the brain and the die-off of cells in the brain’s hippocampus, a key center for memory formation.

 

Why we should listen to Martin Shkreli

Why we should listen to Martin Shkreli

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The public already knows that the medicines we make can be enormously valuable. They just think we charge too much for them, and it is hard to find a good argument that we aren’t doing that. Take Sovaldi — Gilead launched a cure for the scourge of hepatitis C, something everyone wanted, priced it at what the market couldn’t refuse, and then faced the inevitable backlash.

In good years, innovation in the pharmaceutical industry amounts to 30 to 40 new products. Yet we’re charging the world for the 50,000 candidates that it took us to get to those 30 or 40. And that ratio is unlikely to change for as long as the market will bear the increasing cost. Unfortunately, there are signs that the market and public opinion have changed, and the lobbyists have chosen to ignore them.

The answer to fixing the pharmaceutical industry’s reputation doesn’t lie in vilifying Shkreli. He just supersized its business model, one that the lobbyists are defending at all costs.

Instead, we must choose to be different. We need to regain our ethical core and to be, once again, known as ethical pharma. And that’s where we need real leadership.

Hospital leaders support keeping many elements of ACA

http://www.revenuecycleinsights.com/news/hospital-leaders-support-keeping-many-elements-aca?mkt_tok=eyJpIjoiWWpCaU1USXhZbVEzWkRCaiIsInQiOiJURzlCeG5tb05KNjN5QU9UMGIrVFBoZkxiS3Q2WHdPZDZRNXJ0TFQzemdXdVwvS3pPa3UrcWNOQTVxanpaVW5mMFFoUzk4OXc0ejg2dSs2SkRGWHErZDlqUjlhd1dTQit3c2VBaXdGSDdPK1IzQXEwdWNNaWt6YjFRQ2xyR3JZNloifQ%3D%3D

An overwhelming majority of hospital C-suite and pharmacy executives support preserving the protections in the Affordable Care Act (ACA) for patients with preexisting conditions, according to a post-election survey.

Member-based healthcare performance improvement company Vizient conducted the survey to assess how member hospitals were reacting to the planned repeal of the ACA by the Trump administration and Republican leaders in Congress. Vizient also asked executives about their top concerns for the future as well as their priorities for 2017.

Nearly 90 percent of C-suite leaders (89.5 percent) and 96 percent of hospital pharmacy executives surveyed said the ACA’s protections for patients with preexisting conditions should be kept in place.

Other findings from the survey show:

  • 68 percent of hospital C-suite leaders and 35 percent of hospital pharmacy executives want to keep incentives for expanding Medicaid coverage
  • 56 percent of hospital executives and 46 percent of hospital pharmacy leaders want to continue subsidies to help consumers pay for insurance
  • 52 percent of hospital C-suite leaders and 39 percent of pharmacy executives want to continue value-based reimbursements.

The top three priorities for all executives this year were 1) reducing clinical variation across care delivery 2) migrating toward value-based models, and 3) the integration of existing technology systems, Vizient said.

“In reviewing the survey results, central themes come through: uncertainty and concerns about financial viability,” Byron Jobe, president and chief administrative officer for Vizient, said in a statement. “There are many open questions about the future of the ACA, and what a repeal and replacement strategy could look like. As Congress wrestles with these decisions, it’s important to ensure reimbursement levels are enough to allow hospitals to continue their mission of caring for patients in their communities. Equally important, hospitals must quickly gain a clear understanding of where health policy is heading so they can begin to prepare.”