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Category Archives: Uninsured
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How runaway healthcare costs are a threat to older adults — and what to do about it
Authors call for allowing Medicare to directly negotiate drug prices with manufacturers, which is currently prohibited by law.
Empowering Medicare to directly negotiate drug prices, accelerating the adoption of value-based care, using philanthropy as a catalyst for reform and expanding senior-specific models of care are among recommendations for reducing healthcare costs published in a new special report and supplement to the Winter 2019-20 edition of Generations, the journal of the American Society of Aging.
The report, “Older Adults and America’s Healthcare Cost Crisis,” includes a dozen articles by experts and leaders from healthcare, business, academia and philanthropy.
The authors examine the major drivers of the high cost of healthcare and its impact on patients, then offer solutions that can reduce costs and potentially improve the quality of care for older adults and society at large.
Topics include the employer’s role in reining in healthcare prices; the high cost of prescription drugs; investing in the social determinants of health; the value of home-based acute care; the need for oral health programs for older adults; value-based payment reform; and the geriatric emergency care movement.
WHAT’S THE IMPACT
In the report’s lead article, West Health President and CEO Shelley Lyford and Timothy Lash, chief strategy officer of West Health and president of the West Health Policy Center, called for allowing Medicare to directly negotiate drug prices with manufacturers, which is currently prohibited by law.
They write it “would be a game-changing lever that could force prescription drug manufacturers to bring down prices and lower costs for older Americans.” They also said it’s essential to quickly move from unfettered fee-for-service to value-based payment models, and that more transparency on price and quality is needed so consumers and other purchasers can make more informed decisions about care.
Among the other recommendations are for employers to demand greater price accountability from hospitals and health plans, and to take the lead in adopting value-based payment models.
Authors also call for establishing senior-specific models of care, including geriatric emergency departments, which may improve health outcomes and reduce hospital admissions, and senior dental centers, which can address what they call an epidemic of oral health problems among older adults.
They also support widespread use of home-based acute care, which they say increases the value of healthcare.
THE LARGER TREND
As spiraling U.S. healthcare costs dominate policy agendas at the state and federal level, older adults — the largest group of consumers of healthcare services — have a particularly high stake in solving the crisis. According to a 2019 West Health-Gallup poll, seniors withdrew an estimated $22 billion from long-term savings in the past year to pay for healthcare and an estimated 7.5 million were unable to pay for a prescribed medicine.
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California Health Policy Poll Released
Increases in Worry Over Health Care Costs and Skipping/ Postponing Treatment Due to Cost Over the Last Year |
| PERCENTAGE WHO SAY THEY ARE VERY OR SOMEWHAT WORRIED ABOUT… |
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The Supreme Court isn’t done with the ACA case yet. Here are the next steps.
The U.S. Supreme Court is scheduled to review the legal challenge to the Affordable Care Act on Feb. 21 to potentially weigh whether to take the case. However, legal expert Katie Keith from Georgetown University cautioned Healthcare Dive it’s common for the court to reschedule or relist cases for a later conference date.
Tuesday’s one-sentence order from the U.S. Supreme Court denying a request to fast-track the challenge to the Affordable Care Act is not the final word from the high court.
The justices will now decide whether to take up the legal case threatening to overturn the landmark law during their next term, which begins in October.
Essentially, the order returns the case to the typical review process as a group of blue states, led by California’s Democratic Attorney General Xavier Becerra, try to convince the Supreme Court it should hear the case at some point instead of letting it wind its way back through the lower courts.
“The court did not say we’re not reviewing this case at all,” MaryBeth Musumeci, an associate director at Kaiser Family Foundation and graduate of Harvard Law School, told Healthcare Dive.
The blue states sought to expedite the case, which would have resulted in a ruling before the presidential election in November. Some Democrats hoped that would pressure Republicans to come up with a replacement had the law been tossed, or more publicly defend efforts that would kill popular provisions like protections for pre-existing conditions.
The court refused to accelerate its review despite requests from hospitals, insurers, advocacy groups including AARP and a group of bipartisan economic scholars.
“It’s disappointing but it’s not altogether unsurprising. They typically don’t like to grant expedited review,” Katie Keith, a lawyer and health policy expert at Georgetown University, told Healthcare Dive.
Other legal experts warned against reading too much into Tuesday’s order and what it may mean for the case going forward.
“Expediting was always unlikely. It’s a big ask for little purpose here. I wouldn’t read anything else into it,” Jonathan Adler, a law professor at Case Western Reserve University, told Healthcare Dive.
Careful observers of the case should expect the justices to vote on whether to take it up by June at the latest, Keith said.
In the meantime, Tuesday’s order sets off another wave of briefs. First, the red states will try to convince the court of its position on whether the legal challenge should be heard in October. Expect that motion in the first few days of February, experts told Healthcare Dive.
Robert Henneke, the lawyer representing the individual plaintiffs, told Healthcare Dive his team will argue that the case is still premature for Supreme Court review. “The opinion from the Fifth Circuit was not a complete opinion,” Henneke said.
The appeals court in part affirmed a lower court’s decision, ruling that the individual mandate is unconstitutional because it can no longer be considered a tax. However, it sent the key question of whether the rest of the ACA can stand without the mandate back to the lower court for further analysis.
Becerra has argued that the lower court’s decision is wrong and, without a definitive ruling from the Supreme Court, the challenge only fuels doubt about the future of the ACA — credited with significantly reducing the ranks of the uninsured.
“The health and wellbeing of millions of our loved ones who rely on the ACA for healthcare is too important. We will do everything in our power to keep fighting for them,” Becerra said in a tweet following the order.
Nevertheless, Tuesday’s result likely thrusts the issue of the ACA back in the spotlight for another presidential campaign cycle.
Much of the healthcare debate among Democrats vying to take on President Donald Trump has revolved around a “Medicare for All” idea. One question now is, will Democrats shift to talk about rescuing the ACA, a law in place but remains in jeopardy?
The problem is the outcome is still uncertain, Stephanie Kennan, senior vice president of federal public affairs at McGuireWoods Consulting, told Healthcare Dive. However, it does give Democrats the opportunity to talk about what’s popular in the bill, noting protections for those with pre-existing conditions.
“It certainly gives them a springboard for them to talk about the things they could do to fix it,” Kennan said.
Despite Tuesday’s outcome, there will still be some Democratic contenders who will campaign for Medicare for All, Bill Jordan, chair of Alston and Bird’s healthcare litigation group, told Healthcare Dive. But this ruling gives Democrats another tool against Republicans, he said.
“As time has gone on, the Affordable Care Act has become more popular, not less popular,” Jordan said.
But he cautioned that anything can happen in the next election, which could entirely alter the political landscape and influence whether the case makes it back up to the Supreme Court if the justices pass this time.
We’re going to our primary care doctors less
Adults in the U.S. are visiting primary care doctors less often, according to a new study in the Annals of Internal Medicine, which could foreshadow worse health outcomes and higher costs.
By the numbers: The study focused on adults enrolled with a large commercial insurer.
- Between 2008 and 2016, visits to primary care physicians declined by 24.2%, and nearly half of adults didn’t visit one in any given year by the end of the time frame.
- Groups with the largest declines were young adults, adults without chronic conditions, and those living in the lowest-income areas.
Meanwhile, visits to alternative facilities like urgent care clinics increased by 46.9%.
The big picture: Primary care doctors are there to keep people healthy. The less often we go to them, the more likely we are to get or remain sick, which ultimately costs the health care system more money.
HENRY KOTULA 