Several Senate Republicans have proposed a plan that
offers three options for changing health care coverage
under the Affordable Care Act, also known as Obamacare.
One option allows states to continue using the existing
law. The other two options would change it in these ways:
http://khn.org/news/block-grants-medicaid-faq/
President Donald Trump’s administration made explicit this weekend its commitment to an old GOP strategy for managing Medicaid, the federal-state insurance plan that covers low-income people — turning control of the program to states and capping what the federal government spends on it each year.
It’s called “block granting.” Right now, Medicaid, which was expanded under the 2010 health law to insure more people, covers almost 75 million adults and children. Because it is an entitlement, everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs. Conservatives have long argued the program would be more efficient if states got a lump sum from the federal government and then managed the program as they saw fit. But others say that would mean less funding for the program —eventually translating into greater challenges in getting care for low-income people.
Block granting Medicaid is a centerpiece of health proposals supported by House Speaker Paul Ryan and Rep. Tom Price, Trump’s nominee to run the Department of Health and Human Services. This weekend, Trump adviser Kellyanne Conway emphasized the strategy as key to the administration’s health policy.
But what would this look like, and why is it so controversial? Let’s break down how this policy could play out, and its implications — both for government spending and for accessing care.
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20170123-story.html
Aetna claimed this summer that it was pulling out of all but four of the 15 states where it was providing Obamacare individual insurance because of a business decision — it was simply losing too much money on the Obamacare exchanges.
Now a federal judge has ruled that that was a rank falsehood. In fact, says Judge John D. Bates, Aetna made its decision at least partially in response to a federal antitrust lawsuit blocking its proposed $37-billion merger with Humana. Aetna threatened federal officials with the pullout before the lawsuit was filed, and followed through on its threat once it was filed. Bates made the observations in the course of a ruling he issued Monday blocking the merger.
Aetna executives had moved heaven and earth to conceal their decision-making process from the court, in part by discussing the matter on the phone rather than in emails, and by shielding what did get put in writing with the cloak of attorney-client privilege, a practice Bates found came close to “malfeasance.”
How to Inspire Teams to Pull Together Rather than Fall Apart
The future belongs to problem-finders who develop solutions. It’s not enough to simply find a problem. You have to solve it.
The difference between a complainer and a leader is passion for solutions.
Before pulling the plug on Obamacare, listen to health care providers
As President Trump and the Republican majority in Congress prepare to repeal Obamacare, they would be wise to listen to those who actually provide health care.
No one is better positioned to see how the health care system is working — and how it can be improved — than the doctors, nurses, and support staff on the front lines. Clinical professionals understand the strengths and weaknesses of the law because they’ve had to live and work within the requirements of the Affordable Care Act.
So they should have a say in its fate, or at least its replacement.
I spent more than a decade studying the implementation of health care changes in the United States (the world’s most privatized health care system) and the United Kingdom (the world’s most socialized health care system). The findings were eye-opening.
When change was imposed from above, without the input and engagement of health care workers, implementation was rarely successful. Recall the fee-for-service reimbursement programs in Medicare and private insurance that incentivized more care rather than better care. Ask providers about the time wasted on the phone with insurance companies, or the mind-boggling number of clicks needed to execute a simple function in their electronic health record systems.
Drug industry unveils massive new campaign to counter criticism
Under withering public criticism, the drug industry is doubling down on its arguments that the debate over drug prices is distorted, rolling out a multimillion-dollar ad campaign to repair its reputation and defend the value its medications provide.
The industry’s major lobbying group here, the Pharmaceutical Research and Manufacturers of America, unveiled the campaign on Monday. Officials said they would spend in the “high” tens of millions of dollars every year for the next four to five years, rehabilitating their image in the wake of former industry executive Martin Shkreli and the political backlash to rising prices.
“Less hoodie, more lab coats” is how PhRMA President and CEO Stephen Ubl described the advertising campaign in a briefing with reporters. (Shkreli, not missing an opportunity for publicity, responded with a hastily produced website detailing how double-digit price increases are hardly unique to companies outside PhRMA’s membership.)
The campaign, branded “GoBoldly,” sounds like a more aggressive version of the industry’s previous image-making campaign, “From Hopes to Cures.” It will emphasize that biopharmaceutical companies develop breakthrough medications that save lives and that they can be the answer to the problem of health care costs, rather than the cause.
The first television ad being released as part of the new campaign is being called “Do Not Go Gentle.” It blends Dylan Thomas’s famous poem with images of goggled scientists peering through microscopes and patients heading into treatment.
The PR campaign will be paired with a series of events intended to remake the public debate, from one about drug prices to one about medical breakthroughs and the value that novel medications provide by saving costs in the long run. The industry believes its preferred policies — value-based contracts and a modernized Food and Drug Administration — can fix the cost problem better than more direct price controls that drug makers view as their greatest threat.
“We have a great story to tell and we’re going to do a better job telling it,” Ubl said.
That is a promise, though, that industry officials have been making for more than a year. What Monday’s announcement made clear is that they are prepared to spend huge sums of money to fulfill it.
