Tag Archives: Health Policy

Premium support is back. What is it?

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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

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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

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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

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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.”

Senate committee advances Price nomination without Dems present

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http://www.fiercehealthcare.com/healthcare/senate-committee-advances-price-nomination-without-dems-present?mkt_tok=eyJpIjoiTm1RM01HUTJORE15WVdRNSIsInQiOiJFd0pManZSb09vTTVCbXdwQThsTnBycFZvaEdvbmVBZUpFWU42RFlCNHpmNW81eG5vNzFGcFRWVjRodGZFRDhWTlQ1WG1OeU5CTklYaFdjSWN0OCtaWGRLU3laOU5NVGdQV3hYWE5PVUpTeXVtcnZnWFZcL040c241SnB6SytsMXYifQ%3D%3D&mrkid=959610&utm_medium=nl&utm_source=internal

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In an unprecedented, dramatic step, the Senate Finance Committee this morning suspended its rules and voted without Democrats present to send Tom Price’s nomination as head of the Department of Health and Human Services to the Senate floor.

The quickly scheduled meeting today took place less than 24 hours after Democrats managed to postpone a planned vote by boycotting the meeting. Under the committee rules, 13 members—including at least one Democrat—must be present for the vote.

Republicans were furious, calling the boycott “amazingly stupid” and “pathetic.” But Democrats said they wanted more information before they vote in light of a new report this week in The Wall Street Journal that Price received a special discounted offer to buy stock in a biomedical company, which contradicted his testimony during congressional hearings.

Rep. Price, R-Ga., an orthopedic surgeon, has served as a member of the House of Representatives for seven terms. But despite his ties to Congress and his medical background, President Donald Trump’s pick to lead HHS has been controversial from the beginning due to Price’s support for dismantling the Affordable Care Act.

But Democrats also raised ethical and conflict-of-interest concerns over reports of insider trading and purchase of thousands of dollars in stock in healthcare, pharmaceutical and biomedical companies while sponsoring legislation that could have influenced those companies’ shares.

The Senate Finance Committee’s ranking member, Sen. Ron Wyden (D-Ore.), said in a prepared statement Tuesday following the boycott that he “asked Congressman Price directly if he got an exclusive discount on stock in an Australian biomedical firm, and he said no. From the committee’s investigation to company documents to the company officials’ own words, the evidence tells a different story. It looks more and more like Congressman Price got special access to a special deal.”

Congress must act by March to stabilize individual markets, experts say during Senate hearing

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http://www.fiercehealthcare.com/payer/congress-must-act-by-march-to-stabilize-individual-markets-experts-say-at-senate-hearing?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTm1RM01HUTJORE15WVdRNSIsInQiOiJFd0pManZSb09vTTVCbXdwQThsTnBycFZvaEdvbmVBZUpFWU42RFlCNHpmNW81eG5vNzFGcFRWVjRodGZFRDhWTlQ1WG1OeU5CTklYaFdjSWN0OCtaWGRLU3laOU5NVGdQV3hYWE5PVUpTeXVtcnZnWFZcL040c241SnB6SytsMXYifQ%3D%3D

America’s Health Insurance Plans CEO Marilyn Tavenner testifies during Wednesday’s Senate hearing on the state of the individual marketplaces.

Expert witnesses warned lawmakers during a Senate hearing Wednesday that if they fail to ensure a stable transition while repealing and replacing the Affordable Care Act, they risk worsening the already unstable individual marketplaces.

“Insurance markets do not respond well to uncertainty,” Julie McPeak, Tennessee’s commissioner of commerce and insurance and president-elect of the National Association of Insurance Commissioners, testified at hearing held by the Senate Health, Education, Labor and Pensions Committee. “As you consider ACA reforms, it’s critical to remain transparent and to minimize surprises in our insurance system.”

For his part, Committee Chairman Sen. Lamar Alexander, R-Tenn., asked McPeak how quickly Congress needs to act in order to shore up the marketplaces enough for insurers to feel comfortable participating in 2018.

“I think you need to provide some indication to plans as quickly as possible, but March would be extremely helpful,” McPeak said, noting that insurance carriers have to file their rates by early spring. Janet Trautwein, CEO of the National Association of Health Underwriters, agreed, saying action is needed by late March at the latest.

“Right now, plans are trying to price for ‘18, and the uncertainty around cost-sharing subsidies and the tax credits would cause them to hesitate to price because we need to understand what the funding support is going to be, because that affects premiums,” America’s Health Insurance Plans President and CEO Marilyn Tavenner added.

Thus, she pointed to suggestions AHIP has previously made public, such as making full reinsurance payments for 2016, and continuing to provide premium subsidies and cost-sharing reductions through at least 2018. “Absence of this funding would further deteriorate an already unstable market and hurt the millions of consumers who depend on these programs for their coverage,” Tavenner said.

But that isn’t enough to ensure a stable and workable transition away from the ACA, Tavenner noted. Other necessary steps include recalibrating premium subsidies to encourage more young people to participate, federal risk pool funding and continuous coverage incentives.

 

Executive actions Trump could take to change the ACA

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Executive actions Trump could take to change the ACA

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The executive order President Trump signed on Friday does not have any immediate policy effect, but it does call attention to the wide range of administrative actions that a Trump administration could take to change the Affordable Care Act—all without legislation from Congress.

We’ve compiled a list of those actions. It’s not exhaustive; there is a lot more a Trump administration could do. Nor do we mean to suggest that these actions would be legal. Declining to enforce the individual mandate, in particular, would be problematic, although the Trump administration might seek cover from dubious enforcement decisions made by the Obama administration (like the “like it, keep it” fix and employer mandate delays).

Whether and which actions a Trump HHS chooses to pursue will depend on the administration’s willingness to gamble the stability—already quite fragile, in some states—of the individual market. And it will depend, too, on what Congress is willing to do through legislation. If Congress wipes out the individual mandate, for example, there’d be no need to change the rules governing hardship exemptions.

In search of sweet spots in public policy

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In search of sweet spots in public policy

Increasing government spending improves educational outcomes and doesn’t enhance them at all.  Augmenting incarceration rates reduces crime and increases it. Raising the minimum wage will increase unemployment and not affect it in the slightest.  These statements are neither Zen koans nor political doublespeak, but summaries of policy research findings that are not as contradictory as they at first may sound. All of them stem from a reality that is frequently forgotten in political discourse: In many public policy areas there exists a “sweet spot” in which pursuing a certain approach does maximal good, and beyond which further increments make less difference, no difference, or even make things worse.

For a range of political, tribal and emotional reasons, sweet spots are always going to be underappreciated in political debates, when tend to be dominated by shouting matches between proponents of simplistic positions that do not change in light of current circumstances, e.g., “More money for health care!”, “Lower taxes now!”, “Tough on crime!”, “Mass incarceration has failed!”. But a sophisticated policy maker, journalist, researcher or voter should recognize that there are few absolutes in public policy.  Very often the policy change that worked at a different point in the curve will no longer yield a benefit or even be counterproductive of further pursued. Our political life is usually characterized by the search for simple answers, but good governance depends on the search for sweet spots.

The health care production function

 

More families with employer-sponsored insurance are needing public assistance

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http://www.academyhealth.org/blog/2017-01/more-families-employer-sponsored-insurance-are-needing-public-assistance

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As employer-sponsored insurance becomes more expensive for children, public programs are picking up the slack.

The Medicaid Expansion, which was responsible for a large part of the reduction in uninsurance in the United States over the last few years, was mostly aimed at adults. This is because Medicaid has traditionally covered nearly all children in poverty for some time. The CHIP program has bolstered that coverage, so that uninsurance in children fell steadily in the 1990’s and well into the 21st century.

The passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) assured that CHIP coverage would continue for some time. But even before that, trouble was brewing with respect to the coverage of children. These troubles were not in the Medicaid  program, though. Issues were arising in the employer-sponsored insurance market.

As I’ve written about in many posts here before, the cost of employer-sponsored insurance has been rising quite steadily for some time. Further, the out-of-pocket costs for such insurance have also been increasing. Deductibles, co-pays, and co-insurance – not to mention premiums – can put the cost of insurance out of reach for many employees even when it is “offered” as a benefit from their job. The costs of insurance have outpaced both income and wages for more than a decade, meaning that more and more must come out of employee’s pockets if they want to maintain coverage for themselves and their children.

 

Ex-Obamacare Chief Warns Trump’s Already Weakening The Health Care System

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http://www.huffingtonpost.com/entry/ex-obamacare-chief-warns-trumps-already-weakening-the-health-care-system_us_588bca30e4b0b065cbbc071b?utm_source=&utm_medium=email&utm_campaign=5982

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Andy Slavitt helped save Obamacare once already. He’s hoping he can do it again.

Until Inauguration Day, Slavitt had been acting administrator of the Centers for Medicare and Medicaid Services since March 2015. That agency oversees the two health programs in its name along with the Children’s Health Insurance Program and the Affordable Care Act’s health insurance exchanges. CMS, as it’s known, manages benefits for 140 million people and its $1 trillion budget is bigger than the Pentagon’s.

In the short time since Slavitt left federal service, he’s already seeing signs that President Donald Trump and the GOP Congress are dealing damage to the health care system before even repealing the Affordable Care Act. And health care executives are telling him the same thing, Slavitt said.

The Affordable Care Act first entered Slavitt’s life in the fall of 2013, when he helped lead the effort to salvage HealthCare.gov, the federal insurance exchange website, after its disastrous launch. From there, Slavitt left his position as group executive president of Optum, a unit of UnitedHealth Group, to join CMS as a senior official. President Barack Obama nominated Slavitt for the top job in July 2015 but the Senate never held a vote on him.

Now Slavitt is out of government, but he’s not abandoning the fight over the Affordable Care Act. In an interview with The Huffington Post, he argued that Trump is already undermining the law and threatening coverage for millions ― in spite of his repeated promises to ensure that all Americans would have health care under his policies.

“I take the new president at his word. He said he wants to expand coverage. He said he wants the coverage to be high-quality. He said he wants it to be affordable to Americans who have trouble affording health care,” Slavitt said. “Those are the right goals, and I think the president should start out with those goals. Now, the actions that we’ve seen so far don’t support those goals.”

Specifically, Slavitt cited the executive order Trump issued the day of his inauguration, which instructs federal agencies to “take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.”

The White House subsequently signaled this could include halting enforcement of the law’s individual mandate that most Americans obtain health coverage.

Executive actions such as these, and like the Trump administration halting television advertising for the sign-up period that ends Tuesday, threaten to destabilize the health insurance market, Slavitt. These moves signal to health insurers that enrollment will be lower this year than it could have been, and that fewer of the healthy consumers needed to offset the costs of the sick will buy coverage. Without the mandate’s tax penalty for being uninsured, some consumers will opt against buying insurance.

“It increases premiums, it will send people out of the market,” Slavitt said. “Those actions that we’ve seen haven’t gotten us on the track that we would hope and that we need to be on in a bipartisan fashion, and so I’d hope that they’re quickly corrected.”