Healthcare Triage News: Health Care Reform, and the Issues We Face
As we approach the election this fall, it seems like the news media report on little else. Unfortunately, too little news coverage addresses health care reform. That’s wackadoo, because there is still so much to be done to improve the cost, quality, and access for patients within the US health care system.
So let’s talk about the major health policy issues we in the US face. This is Healthcare Triage News.
As we pass the 3-year anniversary of the opening of the insurance exchanges, most news seems to focus on the private insurance people can purchase there. In recent months, many have complained about private insurers exiting the exchanges, networks being narrowed, premiums rising, and competition dwindling out of existence.
But it’s important to remember that many, if not most, of the newly insured are part of the Medicaid expansion. As of today, 19 states have still refused to participate in that program. Some cite reports and news that Medicaid offers poor quality and little choice of providers. But most seem to cite the cost of Medicaid, claiming that its growing cost will eventually bankrupt states.
Such declarations only consider one side of the equation, though. In most ways, Medicaid offers an excellent return on investment. That’s the topic of this week’s Healthcare Triage.
http://khn.org/news/lack-of-medicaid-expansion-hurts-rural-hospitals-more-than-urban-facilities/
It isn’t news that in rural parts of the country, people have a harder time accessing good health care. But new evidence suggests opposition to a key part of the 2010 health overhaul could be adding to the gap.
The finding comes from a study published Wednesday in the journal Health Affairs, which analyzes how the states’ decisions on implementing the federal health law’s expansion of Medicaid, a federal-state insurance program for low-income people, may be influencing rural hospitals’ financial stability. Nineteen states opted not to join the expansion.
Rural hospitals have long argued they were hurt by the lack of Medicaid expansion, which leaves many of their patients without insurance coverage and strains the hospitals’ ability to better serve the public. The study suggests they have a point.
Specifically, the researchers, from the University of North Carolina Chapel Hill, found that rural hospitals saw an improved chance of turning a profit if they were in a state that expanded Medicaid — while in city-based hospitals, there was no improvement to overall profitability. Across the board, hospitals earned more if they were in a state where more people had coverage and saw declines in the level of uncompensated care they gave.
To put it another way: All hospitals generally fared better under the larger Medicaid program, but there’s more at stake for rural hospitals when the state expands coverage.
http://www.commonwealthfund.org/publications/case-studies/2016/oct/hennepin-health
This case study is one in an ongoing series examining programs that aim to improve outcomes and reduce costs of care for patients with complex needs, who account for a large share of U.S. health care spending.
http://www.gallup.com/poll/196193/uninsured-rate-new-low-third-quarter.aspx
In the third quarter of 2016, 10.9% of U.S. adults were without health insurance, representing a new low in Gallup’s and Healthways’ nearly nine years of trending the rate of uninsured. This is down from 11.9% in the fourth quarter of 2015, before the 2016 open enrollment period that allowed U.S. adults to obtain insurance through the government health insurance exchanges.
The uninsured rate has declined 6.2 percentage points from 17.1% in the fourth quarter of 2013, right before the Affordable Care Act’s requirement that Americans carry health insurance took effect in early 2014.
Results for the third quarter are based on approximately 44,000 interviews with U.S. adults aged 18 and older from July 1- Sept. 30, 2016, conducted as part of the Gallup-Healthways Well-Being Index. Gallup asks 500 U.S. adults each day whether they have health insurance, which, on an aggregated basis, allows for precise and ongoing measurement of the percentage of Americans with and without health insurance.
Despite the singular nature of this year’s presidential campaign, there is plenty of continuity with past elections when it comes to health care, argue David Blumenthal, M.D., and James A. Morone in their New England Journal of Medicine “Perspective.”
In “Past as Prologue—Presidential Politics and Health Policy,” Blumenthal, The Commonwealth Fund’s president, and Morone, director of Brown University’s Taubman Center for American Politics and Policy, discuss the “deep underlying political forces and historical experiences with health care politics and policy” that are reflected in the platforms of Hillary Clinton and Donald Trump.
The authors previously collaborated on the book The Heart of Power: Health and Politics in the Oval Office (University of California Press, 2009).
Today, Medicaid provides coverage to nearly 73 million people — kids, low-income working adults, seniors, and people with disabilities — making it the nation’s largest insurer.
In California, private hospitals pay an annual fee to the state that in turn helps bring in additional federal funds for Medi-Cal, the state’s health care program for low-income Californians. One in three Californians get their health care through Medi-Cal. The funds generated by the fee cover hospital services for Medi-Cal patients and health care for low-income children.
Hospitals originally approached the Legislature to create the “Hospital Quality Assurance Fee,” which state lawmakers enacted in 2009. This law is slated to expire in 2018. Proposition 52 would make the fee permanent and would make it tougher for the Legislature to use the money for other purposes.
The federal government matches state spending on health care for the poor, so the more California puts up for Medi-Cal, the more federal dollars it receives. The hospital fee boosts the state’s fund for Medi-Cal and thus attracts more federal money. Those dollars are then paid back to the hospitals to reimburse them for caring for their Medi-Cal patients.
Hospitals say the fee system is crucial to California’s medical safety net. They say they spend more to treat Medi-Cal patients than government reimbursement covers. The supplemental federal money hospitals get helps shrink their deficits. The estimated net benefit to hospitals in 2015-2016 was $3.5 billion.
Hospitals also contribute around $1 billion annually for children’s health care. This extra money acts like a handling fee that hospitals pay the state so the Legislature partners with them on Medi-Cal matching funds. Hospitals want to cement this law rather than have it re-upped every few years to avoid uncertainty and to make sure the amount of the extra fee for children’s health care doesn’t continue to increase, as it has in years past.
Proposition 52 requires a two-thirds vote in the state Legislature to end the program or to divert money from the hospital fee away from Medi-Cal. That’s something that lawmakers did in 2011, when they used approximately half a billion dollars for other purposes.
Snapshot of Where Hillary Clinton and Donald Trump Stand on Seven Health Care Issues
While health care has not been central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.
Hillary Clinton and Donald Trump have laid out different approaches to addressing these and other health care issues. Central among these is their position on the future of the ACA. Hillary Clinton would maintain the ACA, and many of her policy proposals would build on provisions already in place. Donald Trump, in contrast, would fully repeal the ACA, and although his policy proposals and positions do not offer a full replacement plan, they do reflect an approach based on free market principles.
See where the candidates stand on seven key health policy issues.
