Seven healthcare questions the candidates aren’t answering

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/seven-healthcare-questions-candidates-aren-t-answering?cfcache=true

Hillary Clinton is quick to tout that she will defend the Affordable Care Act (ACA) and build on it to slow the growth of out-of-pocket healthcare costs while Donald Trump vows to repeal the ACA and have a series of reforms ready for implementation that follow free-market principles.

But when taking a closer look at their proposals, Clinton and Trump are keeping mum about some healthcare issues, and that’s raising some critical questions. Managed Healthcare Executive asked industry experts to comment on what topics presidential candidates are being quiet about, and why they suspect they’re not talking about them.

5 health and medicine issues to watch for at the Democratic convention

5 health and medicine issues to watch for at the Democratic convention

Hillary Clinton led a health care reform effort in the 1990s, promoted medical research as a senator, and has been bashing price-hiking drug companies on the campaign trail and in TV ads.

So there’s every reason to expect her to make health care a major theme when she accepts the Democratic presidential nomination in Philadelphia on Thursday night. What she says about the future of medical research, public health, and the uninsured will give a valuable preview of what her priorities would be — and how far she’s willing to go to co-opt the ideas of her defeated rival, Bernie Sanders.

Here are the five biggest things to watch in health and medicine:

Five Health Issues Presidential Candidates Aren’t Talking About — But Should Be

http://khn.org/news/five-health-issues-presidential-candidates-arent-talking-about-but-should-be/

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References to the Affordable Care Act — sometimes called Obamacare — have been a regular feature of the current presidential campaign season.

For months, Republican candidates have pledged to repeal it, while Democrat Hillary Clinton wants to build on it and Democrat Bernie Sanders wants to replace it with a government-funded “Medicare for All” program.

But much of the policy discussion stops there. Yet the nation in the next few years faces many important decisions about health care — most of which have little to do with the controversial federal health law. Here are five issues candidates should be discussing, but largely are not:

Cleveland Clinic CEO: Affordable Care Act is here to stay

http://www.fiercehealthcare.com/finance/cleveland-clinic-ceo-aca-appears-mostly-safe?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTm1VMU5HUmlOakEzTWpVMyIsInQiOiI5XC9mUGloUlREa3Rtam9UaXdnaG0zeXZlWitYYVRuR3R3eFAzMDc1WWFURHlZMVBcL005SG42T2IwY2FhOFY0MFJDYzFHSGpDTmRQVkVqWXE3TTRORFEyNlpBdDFUR2k2N3RaNXNBdkh0NXJnPSJ9

capitol building above treescapitol building above trees

The Republican National Convention pulled up stakes after it concluded yesterday, but a visitor to the convention floor says that the Affordable Care Act is here to stay.

In an interview with CBS This Morning, Cleveland Clinic Chief Executive Officer Toby Cosgrove, M.D., said that it was unlikely that the ACA would be uprooted, even if Republican Donald J. Drumpf is elected President and there are GOP majorities in both houses of Congress.

“I don’t think you will see something now six years into the process totally dismantled,” Cosgrove said, adding that the healthcare reform law has led to insurance coverage for 20 million more Americans. Cosgrove suggested that it was more likely that the ACA would undergo continuing improvements such as “more wellness activities.”

Nondiscrimination And Chronic Conditions — The Final Section 1557 Regulation

http://healthaffairs.org/blog/2016/07/20/nondiscrimination-and-chronic-conditions-the-final-section-1557-regulation/

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Before the Affordable Care Act (ACA), those with serious or chronic health conditions were often denied health insurance coverage or paid high prices for substandard plans with coverage exclusions. Many went uninsured and untreated. For them, the ACA’s new coverage opportunities and protections against discriminatory practices by health insurers serve as an essential lifeline.

Under the ACA, insurers can no longer charge higher premiums or deny coverage for people with pre-existing conditions. However, some insurers have tried to circumvent ACA protections by designing benefits that discourage enrollment by persons with significant health needs.

NHeLP and The AIDS Institute filed a landmark complaint with the Department of Health and Human Services’ Office for Civil Rights after four Florida insurers placed all HIV medicines, including generic drugs, on the highest cost sharing tiers. Researchers found that this practice—called “adverse tiering”—is widespread. A New England Journal of Medicine study found that one-in-four insurers placed all drugs to treat HIV in the highest tiers. Another study in Journal of the American Medical Association found that up to 15 percent of plans in the federal marketplace lack in-network physicians for at least one specialty, making access to care significantly more expensive for those with specialized care needs.

The Department of Health and Human Services (HHS) recently finalized regulations for the cornerstone non-discrimination provision of the ACA — Section 1557. For the first time, the provision applies civil rights protections against discrimination on the basis of race, ethnicity, national origin, sex, age, and disability specifically to health programs and activities administered by or receiving federal funding.

Health advocates and patient advocacy organizations lauded the final regulations for Section 1557, which expressly prohibit insurers from employing plan benefit designs or marketing practices that discriminate.

Hospitals oppose potential rebirth of ‘public option’ coverage

http://www.fiercehealthcare.com/finance/hospitals-chafe-against-potential-rebirth-public-option-coverage?mkt_tok=eyJpIjoiTXpVMk1HRm1NRE5pWW1JMSIsInQiOiIrM3BwTVBRRXorTzl3NjQxOWNPOUh1UUxUT0ZcL2xNTGdleWQzKzRFRzIwZzhHYTg2T0c3TWlZV1BjUEsxd0JBRmNJaGk0WU9NMTRvWmFyZndPVit2SzZmUDFxM1dWSm1OV2l4Rnd1YlBMWTQ9In0%3D&mrkid=959610&utm_medium=nl&utm_source=internal

Pillar of building etched with the word insurance

Under pressure from onetime rival Bernie Sanders and the liberal wing of her party, Hillary Clinton has pushed for a “public option” form of coverage in the state and federal health insurance exchanges.

The decision is considered to be a middle ground option away from Sanders’ primary campaign push for single-payer coverage. The proposal was recently endorsed by President Barack Obama.

However, the public option has drawn fire from the hospital sector, which fears it would depress the payments it receives to provide care. As a result, the American Hospital Association and the Federation of American Hospitals reached out last week to the Democratic Platform Drafting Committee.

Reflections on 17 Years in California Health Policy

http://www.chcf.org/articles/2016/07/reflections-17-years?_cldee=aGVucnlrb3R1bGFAeWFob28uY29t

California Health Care Foundation - Health Care That Works for All Californians

California’s individual health insurance marketplace today bears little resemblance to that of the mid-2000s. Since 2014 Californians have been able to purchase individual coverage without regard to their medical history. They can switch plans and carriers during annual open enrollment periods. Consumers face strong incentives to obtain coverage: They incur tax penalties if they remain uninsured, and all who are lawfully present and meet income standards are eligible for subsidies through Covered California. As a result, a greater share of Californians is now covered through the individual market than is uninsured (14% versus 11%, according to one national survey). While affordability concerns remain, early data show that Californians who bought insurance through the individual market spent significantly less than those buying before the ACA. And the percentage of Californians with individual coverage spending more than 10% of their household income on health care costs also went down.

Health plans that attract the working uninsured

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/health-plans-attract-working-uninsured?cfcache=true

Baby-Hand-Holding

http://files.kff.org/attachment/supplemental-tables-the-uninsured-a-primer-key-facts-about-health-insurance-and-the-uninsured-in-the-era-of-health-reform

 

Americans’ Experiences with ACA Marketplace Coverage: Affordability and Provider Network Satisfaction

http://www.commonwealthfund.org/publications/issue-briefs/2016/jul/affordability-and-network-satisfaction

For people with low and moderate incomes, the Affordable Care Act’s tax credits have made premium costs roughly comparable to those paid by people with job-based health insurance. For those with higher incomes, the tax credits phase out, meaning that adults in marketplace plans on average have higher premium costs than those in employer plans. The law’s cost-sharing reductions are reducing deductibles. Lower-income adults in marketplace plans were less likely than higher-income adults to report having deductibles of $1,000 or more. Majorities of new marketplace enrollees and those who have changed plans since they initially obtained marketplace coverage are satisfied with the doctors participating in their plans. Overall, the majority of marketplace enrollees expressed confidence in their ability to afford care if they were to become seriously ill. This issue brief explores these and other findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016.

Mr. Trump, Here’s Some Health Policy Advice — From a Physician

http://www.medpagetoday.com/Blogs/KevinMD/57318?xid=fb_o_

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Free-market healthcare won’t last long in modern society, says Saurabh Jha, MD