Medicaid on the Oregon Trail

A few days ago, I wrote an article suggesting that an effective post-Obamacare reform would be difficult to bring about as long as anti-Obamacare reformers (especially yours truly) stuck to the simple argument that being on Medicaid is as bad (or even worse) than being uninsured. The reason is that the Medicaid beneficiary does not sign up for a national health plan called Medicaid. Instead, he is increasingly likely to sign up for a managed-care plan that contracts with the state to provide Medicaid benefits.

Readers retorted that the nail in Medicaid’s coffin was driven by the Oregon Medicaid experiment, a randomized, controlled trial (sometimes described as “gold standard” which it could not have been, because it was not double blinded). This blog has agreed that the Oregon Medicaid experiment demonstrated the ineffectiveness of Oregon’s Medicaid expansion. However, I am not sure that leads to a general theory of Medicaid’s overall ineffectiveness.

Read the entire column at NCPA's Health Policy Blog.

Obamacare Kills Jobs

Many health-policy analysts, lulled into complacency by the fact that employer-based health benefits have not vanished in a puff of smoke in Obamacare’s first year, insist that the federal healthcare takeover is not to blame for the continuing poor recovery in employment. Their arguments are superficially appealing, but they ignore the big picture.

Read the entire column in The Daily Caller.

Ed Gillespie's Health Reform Plan A Big Step In The Right Direction

Ed Gillespie, the Republican candidate for the U.S. Senate from Virginia has proposed a substantive plan to reform U.S. health care. The Washington Post called it “the most sensible GOP alternative.” An economic consulting firm estimates the plan, which was developed by the 2017 Project, would reduce the federal deficit by $1.3 trillion over 10 years.

There is significant overlap between the 2017 Project’s proposal and the NCPA’s: They both rely on individual tax credits for individually-purchased insurance as a building block for a new, consumer-driven health system.

Read the entire column at NCPA's Health Reform Blog.

Industry's User Fees Fail To Improve FDA's Approvals of Medical Devices

In June 2012, I wrote an analysis of the effect of user fees, paid by the medical-device industry, on the Food and Drug Administration’s behavior with respect to approving new medical devices. My conclusion: The FDA had sucked up the dollars without increasing its productivity.

New research, commissioned by the California Healthcare Institute, a trade association, confirms that the industry’s user fees are disappearing into a black hole. Despite putting a positive spin on the behavior of the regulator, which has a choke-hold on the industry’s ability to launch new products, the evidence indicates that the millions of dollars that the industry has paid to the FDA have not improved its performance.

Read the entire column at NCPA's Health Policy Blog.

Naturalized Citizens Are Second-Class Citizens Under Obamacare

I suppose many will typify this as just another Obamacare glitch, but Obamacare exchanges will treat naturalized citizens as second-class citizens for 2015 open enrollment.

Read the entire column at NCPA's Health Policy Blog.

92 Percent of Nurses Dissatisfied With Electronic Health Records

Although we have frequently discussed physicians’ dissatisfaction with electronic health records, doctors are not the only victims of the federal government’s $30 billion adventure in underwriting poor IT investments. Nurses are even more disappointed in EHRs than doctors are, according to a new survey by Black Book Market Research.

Read the entire column at NCPA's Health Policy Blog.

Free of Obamacare Taxes, The Future of Health Care Is Digital

A handful of recent reports indicate that capital, overall, is seeking to exit the healthcare industries burdened by Obamacare’s excise taxes and annual fees. With one outstanding exception – digital health – much of health care is seeing consolidation through mergers and acquisitions. As for fresh capital, venture funding remains shriveled from its 2007 high.

Read the entire column at Forbes.

Is Medicaid-Associated Overuse of Emergency Departments Just A Temporary Surge?

Research from the UCLA Center for Health Policy Research suggests that increasing Medicaid dependency does not result in a secular increase in use of hospitals’ emergency departments (EDs). Rather, the jump in ED use is just pent-up demand being satisfied, which then drops off.

Sure, the people who sign up for Medicaid will consume a lot of medical care and then drop off. But they will also drop out of Medicaid until they need it again. Meanwhile, eligible people who become sick will sign up next month. It never stops.

And it certainly does not address the problem that Medicaid provides poor access to physicians. If it did, the newly covered would not have had to flood hospitals’ emergency departments.

Read the entire article at NCPA's Health Policy Blog.

Australia Will Raise $5 Billion By Privatizing Its Biggest Health Insurer

Australia’s federal government is about to raise almost $5 billion by privatizing its largest health insurer:

Australia has been shrinking the role of government in health care. Although a national single-payer scheme was established in 1975, the federal government re-introduced private choice within a few years. Indeed, Medibank Private is the descendant of the original single-payer plan, Medibank.

Read the entire article at NCPA's Health Policy Blog

Health Spending Grew 18 Percent Faster Than GDP In 12 Months

According to the Altarum Institute, health spending rose 4.9 percent in the twelve months through August 2014. In the twelve months to July, it rose 5.1 percent, 18 percent more than the 4.3 percent growth in Gross Domestic Product (GDP).

Read the entire article at NCPA's Health Policy Blog.

Price Transparency: Organizations to Watch

George Washington University’s Master of Public Health program has complied a nice list of fourteen “organizations to watch” because they are moving the ball on price transparency. The woman who wrote the article, Emily Newhook, sent an email to NCPA bringing it to our attention.

Unfortunately, we can hardly ever make time and space to profile lists compiled by other parties, but I decided to give this one a boost for a number of reasons.

Read the entire article at NCPA's Health Policy Blog.

Mars and Venus on Medicaid

Avalere Health estimates that 75 percent of Medicaid dependents will be enrolled in MCOs by 2015, up from 63 percent in 2012. The Kaiser Family Foundation anticipates that a “sharpened focus on high-cost/high-need beneficiaries” will lead states to enroll more of the sickest Medicaid dependents into private plans.

If done properly, this should improve outcomes for those patients. Medicaid managed care blurs the line between the Medicaid “ghetto” and private choice. When the opportunity for post-Obamacare health reform arises, Medicaid managed care's success will make patient-centered reforms to the whole system easier to bring about.

Read the entire column at Forbes.

The Case For Drugstore Clinics

In The Atlantic, Richard Gunderman, MD, PhD, has delivered “The Case Against Drugstore Clinics“. It is a weak case.

Read the entire column at NCPA's Health Policy Blog.

After Almost One Year, Some Medicaid Applicants Still Not Enrolled

Well, there is progress. In June, we discussed the three million people who were funneled into Medicaid by Obamacare’s exchanges, but had still not been enrolled. As of October, the backlog is down to a few hundred thousand.

Read the entire column at NCPA's Health Policy Blog.

A Business Group Reacts Strangely To The Rise Of Private Health Exchanges

This blog has discussed the rise of private exchanges for health benefits, describing them as “getting ready for individual health insurance to be the standard.” A private exchange allows an employer to make a defined contribution to employees’ health benefits, which they can use to choose one of many policies within the exchange.

The strangest news is the reaction of the National Business Coalition on Health to its own survey of employers:

In a departure from other industry polls, employers said they plan to reject private exchanges as a way to control rising health care costs, according to a new survey of more than 330 employers…

In fact, the survey reports that 32 percent are considering moving to one within three to five years, up from 5 percent today. Describing growth of over 600 percent as a “plan to reject” is surely inaccurate.

Read the entire column at NCPA's Health Policy Blog.

Adverse Selection Got Worse As Obamacare's Open Enrollment Progressed

New data from Express Scripts, a leading pharmacy-benefits manager (PBM) indicates that adverse selection in Obamacare exchanges actually got worse as open enrollment reached its hard finish in mid-April.

However, the later sign-ups look to be in much worse shape with respect to very expensive conditions that are not so widespread:

Exchange enrollees fill 59% more prescriptions for specialty medications than other insured individuals. This disparity is especially pronounced in Exchange enrollees ages 18 to 34, who fill twice as many specialty medications as similarly aged individuals in traditional health plans.
Nearly 3 out of 5 specialty prescriptions filled by Exchange members are for HIV medication.

The younger adults are even sicker, versus their peers, than the middle-aged ones.

Read the entire column at NCPA's Health Policy Blog.

Ironies Abound: Walmart Workers Who Lose Their Benefits Can Buy Obamacare Policies At Walmart!

Walmart stands out as the poster child of Obamacare’s perverse consequences. Last week, the giant retailer announced that it is dropping benefits for workers who put in fewer than thirty hours per week, which is the definition of part-time according to Obamacare. This will affect about 30,000 U.S. workers. For the remaining “associates” still eligible for benefits, their premiums will jump 19 percent, from $18.40 to $21.90 per pay period. Project 2017′s Jeff Anderson has dug up an embarrassing letter published by Walmart in 2009, which championed Obamacare:

Read the entire column at NCPA's Health Policy Blog.

5 Myths About Cancer Care

Leading health economists Dana P. Goldman and Tomas Philipson challenge five myths about cancer care. To the right we have an infographic that explains them very clearly.

The most economically interesting one is the fourth. This appears to challenge the notion that we should be skeptical about paying high prices for therapies that might buy only a short time of good life. (In health-economics, we use terms like Quality-Adjusted Life Year [QALY] and Disability-Adjusted Life Expectancy [DALE].)

Read the entire column at NCPA's Health Policy Blog.

Hospital Administrative Costs Higher In U.S. Than Other Countries

The Commonwealth Fund has sponsored yet another study that concludes that the U.S. health system is less efficient than others. This time, the measurement is specifically hospitals’ administrative costs. As always, it recommends single-payer, government monopoly as the solution.

Readers of this blog know that I am not about to defend hospitals’ bloated administrative costs. However, the Commonwealth Fund’s scholars go way off-base when it comes to capital costs.

Read the entire column at NCPA's Health Policy Blog.

Lawmakers Should Ask The FDA, Not Manufacturers, Why Generic Drug Prices Are Skyrocketing

U.S. Representative Elijah Cummings and U.S. Senator Bernie Sanders have asked 14 manufacturers of generic drugs why prices for some of their products have multiplied hundreds or thousands of times in the last few years:

• Albuterol Sulfate, used to treat asthma and other lung conditions, increased 4,014% for a bottle of 100 2 mg tablets.
• Doxycycline Hyclate, an antibiotic used to treat a variety of infections, increased 8,281% for a bottle of 500 100 mg tablets.
• Glycopyrrolate, used to prevent irregular heartbeats during surgery, increased 2,728% for a box of 10 0.2 mg/mL, 20 mL vials.

It’s a fair question, but it does not look like the line of inquiry is on the right track

Read the entire column at NCPA's Health Policy Blog.

Obamacare's War On Women Reduces Employment By 4 Million Equivalent Full-Time Workers

Casey Mulligan of the University of Chicago has just released a study examining Obamacare’s impact on employment. Mulligan has also written a damning op-ed explaining how Obamacare discriminates against women workers.

Read the entire column at NCPA's Health Policy Blog.

Hospitals Profit From Drug Discount Program For Poor Americans

A new study by Drs. Rena M. Conti and Peter B. Bach makes a valuable contribution to the growing body of evidence on the harm being done by a federal program that Congress designed to increase poor people’s access to prescription drugs, but has been perverted by hospitals to pad their bottom line.

Read the entire column at Forbes.

California's Prop 45 Support Dropping For Good Reason

Proposition 45, a ballot initiative that would give California's Insurance Commissioner, Dave Jones, power to determine insurance rates for millions of Californians, looked like a winner last summer. A Field poll conducted in June and July showed 69 percent in favor versus only 16 percent opposed. However, in August and September, the numbers dropped to 41 percent to 26 percent in the Field poll, and 48 percent to 38 percent according to the Public Policy Institute of California.

As more voters tune in, they realize that giving more power to politicians to determine health-insurance premiums is a losing proposition.

Read the entire article in the Orange Country Register.

Administration Plans To Make Insurer "Bailout" Payments Illegally

Informed observers believe that the U.S. Department of Health & Human Services (HHS) will make “bailout” payments to health insurers under Obamacare’s risk-corridor program, despite a growing body of legal opinion that such payments would be illegal. As previously discussed at this blog, both the Government Accountability Office and the Congressional Research Service have held that the Administration needs Congress to appropriate funds in order to make risk-corridor payments.

This is an issue on which NCPA has exerted significant influence. I testified to the House Committee on Oversight and Government Reform on June 18, and NCPA has published that testimony as an Issue Brief.

Read the entire column at NCPA's Health Policy Blog.

"Open Payments" Website Missing $1 Billion

Just yesterday, we discussed the federal government’s intrusive and mischievous Open Payments website, where payments for consulting and similar services provided by doctors to pharmaceutical and medical-device makers are publicized.

Well, less than a week after launching the database, the federal government has disclosed more errors, adding up to about $1 billion:

Read the entire column at NCPA's Health Policy Blog.

Federal IT Standards Pushed Back Yet Again

Sometimes deadlines just slip. The federal government’s deadline for providers certifying “Meaningful Use Stage 2″ in order to get federal funding for their electronic health records (EHRs) has just been bumped yet again.

Read the entire column at NCPA's Health Policy Blog.

Where Are The "Open Payments" From Government?

Well, now we know how much pharmaceutical companies and medical-device makers pay doctors for consulting and similar services. Paul Keckley aptly summarizes last week’s data dump from the Centers for Medicare & Medicare Services (CMS).

Read the entire article at NCPA's Health Policy Blog.

Half of Doctors Give Obamacare D or F

The Physicians Foundation and Merritt Hawkins (a physician recruiting firm) have just published their biennial physicians’ survey. The survey interviews over twenty thousand physicians in all fifty states and multiple specialties.

Read the entire column at NCPA's Health Policy Blog.

Medicare Advantage: Telemonitoring Cuts Admissions 44 Percent; ROI $3.30 per dollar

Geisinger Health Plan has conducted a study of elderly patients enrolled in Medicare Advantage who were treated for congestive health failure.

The key policy take-away is that these patients were members of Geisinger’s Medicare Advantage plan, which frees both patients and providers from Medicare’s bizarre, Soviet-style, price-fixing schedules. It would be very challenging to execute this innovation in the traditional Medicare program, because only very few types of facilities can claim reimbursement for telehealth.

Read the entire column at NCPA's Health Policy Blog.

Hiring In Health Care Finally Slows Down

Fast-paced hiring in health care, which I previously discussed with respect to the jobs report for August, seems to have tempered in September. The case I’ve been making over the last few months is that healthcare providers have been adding workers faster than the rest of the economy. In September, that turned.

Read the entire column at NCPA's Health Policy Blog.

Reporting Changes In Uninsured Due To Obamacare: Government Agencies Can Be Clearer

One of the themes of this blog is that the number of uninsured Americans is not decreasing as quickly or surely as Obamacare’s supporters would have us believe. Part of the problem estimating this is a confusing series of releases from federal agencies, which has led to inconsistent interpretation by scholars.

Last month, the Centers for Disease Control and Prevention (CDC) released the results of the National Health Insurance Survey (NHIS), which I discussed under the headline “Number of Uninsured Americans Aged 18-64 Down 2 Percentage Points.” What this was referring to was that the percentage of residents in that age group who were uninsured at the time of the interview had dropped from 20.4 percent in 2013 to 18.4 percent in the first quarter of 2014. That’s about 3.8 million people.

However, the proportion who were uninsured for at least part of the last year barely budged from 24.4 percent to 24.3 percent, and the proportion who were uninsured for more than a year dropped by 1.7 percentage points, from 15.7 percent to 14 percent. That’s about 3.2 million people. Obviously, the last group is a subset of the second group. The first group is also a subset of the second group, but it is not clear how to connect the first group and the third group.

It's a big difference, with big policy implications:

Read the entire column at NCPA's Health Policy Blog.

Obamacare Veteran Sues Obamacare To Disclose Premiums

Here’s one from the “you can’t make this up” files:

The Department of Health and Human Services is in the spotlight for claims it is violating the Affordable Care Act.
The lawsuit was filed by Mehri & Skalet attorney Jay Angoff, who used to oversee ACA implementation for HHS. Filed on behalf of a Missouri consumer advocacy group, the suit claims the federal agency is not following through on its obligation to make rate filings for 2015 publicly available in time for the public to comment on them.

Get it? Mr Angoff “used to oversee ACA implementation for HHS.” He used to run Obamacare. Now, he’s running against it. Here’s why;

Read the entire column at NCPA's Health Policy Blog or the Independent Institute's Beacon blog.

Veterans Wait 3 Months For Primary-Care Appointment Vs. 3 Days For Private Patients

I have noted with dismay that the U.S. government is trying to fix the Veterans Health Administration scandal over wait times by throwing more money at a fundamentally broken system.

Jonathan Bush, CEO of athenaHealth, a leading provider of cloud-base electronic health records (EHR’s) has researched his firm’s database to arrive at a shocking conclusion: Patients wait three days, on average, for a primary-care appointment. And that was for well patients: Sick patients got in in one day.

Read the entire column at NCPA's Health Policy Blog.

States' Right-To Try Laws Have A "Strange" Allure

Writing in JAMA: Journal of the American Medical Association, Patricia J. Zettler, JD, and Henry T. Greely, JD, both of Stanford University, criticize the “strange allure” of states’ laws that recognize patients’ “right to try” new medicines before the Food and Drug Administration (FDA) approves them.

These laws should help patients get access to medicines that the FDA forbids. However, these lawyers point out that the FDA’s power may overwhelm these laws.

Read the entire column at NCPA's Health Policy Blog.

Medicare Advantage: Mend It; Don't End It

Medicare Advantage is one area of U.S. healthcare policy that’s not a complete disaster. It’s not surprising that the Obama administration revealed in September that enrollment in the program is at an all-time high.

Medicare Advantage enables older Americans to choose a health plan from an array of private insurers. If not for this option, nearly 16 million people would be stuck in the traditional Medicare Part A (physician) and Part B (hospital) plans, where the federal government determines how much to pay providers according to bureaucratic formulae.

It needs to be reformed, but not replace.

Read the entire column at The Daily Caller.

U.S. Infant Mortality Still Lags Other Developed Countries

There’s more bad news for the U.S. on the infant mortality front: The U.S. ranks last of 26 countries in infant mortality: 6.1 per 1,000 live births, versus 2.5 in Sweden, according to a new study by the Centers for Disease Control and Prevention (CDC).

Regrettably, other evidence points to large racial disparities in the U.S., with black babies doing especially poorly. Nevertheless, even if we exclude black babies, white, Hispanic, and Asian U.S. babies appear to do worse than in other countries.

Read the entire article at NCPA's Health Policy Blog.

Are Insurers Bailing In To Obamacare?

Obamacare’s supporters cheered a report by the U.S. Department of Health & Human Services, which claimed, based on preliminary evidence, that more insurers will participate in Obamacare exchanges next year:

This is evidence, according to the media, that Obamacare is here to stay. There is no doubt that insurers are heavily invested in the success of Obamacare. They certainly want the subsidies that flow as tax credits via the exchanges.

Nevertheless, I don’t think that means that Obamacare is a done deal, for at least three reasons.

Read the entire column at NCPA's Health Policy Blog.

GAO Says Congress Can Stop Obamacare's Bailout of Health Insurers

Yesterday, the General Counsel of the U.S. Government Accountability Office (GAO) supported the requirement that the Administration needs appropriations to bail out insurers who lose money in Obamacare exchanges in 2015, via risk corridors:

HHS stated that it intends to begin collections and payments under section 1342 in FY 2015. However, as discussed above, for funds to be available for this purpose in FY 2015, the CMS PM appropriation for FY 2015 must include language similar to the language included in the CMS PM appropriation for FY 2014.

This is a very positive development towards protecting taxpayers’ from the unlimited liability to which Obamacare exposes us by protecting insurers’ income statements from losses in Obamacare exchanges.

Read the entire column at NCPA's Health Policy Blog.

60 Percent of Commercial In-Network Payments Are "Value-Oriented". Does It Matter?

The Catalyst for Payment Reform has released this year’s Scorecard for Payment Reform, which reports a dramatic increase in employer-based provider contracts that are “value-oriented”. “The 2014 Scorecard shows a 29 percentage point increase over 2013, when just 11 percent of payments were value-oriented.” However, the details seem to deflate the potential for this transformation.

Read the entire column at NCPA's Health Policy Blog.