Tuesday, March 31, 2015

Have House Republicans Cast Their First Vote for Obamacare?

Former Speaker of the U.S. Representatives Newt Gingrich said something last week that many feared, but few have been willing to admit: Republicans in Congress have no intention of repealing and replacing Obamacare with patient-centered health reform.

Faced with an interviewer who seemed to believe opposition to Obamacare is actually opposition to Barack Obama, and who suggested that after this president leaves office, opposition will soften, Mr. Gingrich accused his former colleagues of misrepresenting their commitment.

Now that we are in the twilight of the Obama presidency, and Republicans have majorities in both chambers of Congress, they should be able to put such charges to rest. Unfortunately, last week’s overwhelming bipartisan support in the House of Representatives for a deal to lock in Obamacare’s way of paying doctors sends a terrible signal.

Read the entire column at Forbes.

Access to Health Care Unchanged After Obamacare's First Year

The Centers for Disease Control and Prevention (CDC) has released early estimates of health insurance and access to health care for January through September 2014. The National Health Insurance Survey (NHIS) is (in my opinion) the most effective survey of health insurance, because it asks people three different but important questions: Are they uninsured at the time of the survey? Have they been uninsured for at least part of the year? Have they been uninsured for more than a year?

The proportion of long-term uninsured is about the same as it was circa 2000. The proportion of short-term uninsured has shrink a little in Obamacare’s first year. Further, this increase in government dependency has not lead to a change in access to health care.

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

Critics Pile on Flawed Medicare Doc Fix

The Boehner-Pelosi so-called Medicare “doc fix” is taking on water, despite (or because of?) overwhelming bipartisan support in the House of Representatives.

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

Monday, March 30, 2015

Budget Gimmicks Hide $213 Billion Cost of Medicare Doc Fix

The headline of the Congressional Budget Office’s (CBO) damning assessment of the fiscal damage done by H.R. 2 — the so-called Medicare doc fix negotiated secretly by House Speaker John Boehner and Minority Leader Nancy Pelosi — is that the deal will add $141 billion to the deficit over the next ten years.

Even this appalling outcome is sugarcoated. After unpacking the gimmicks underlying the estimate, the actual result is much worse.

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

Fraser Institute: Canadians Leave Canada for Medical Care

Canada’s government monopoly of health insurance leads to long waits, and an increasing number of Canadians have to leave the country to get care, according to The Fraser Institute:

In 2014, more than 52,000 Canadians received non-emergency medical treatment outside Canada.

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

Friday, March 27, 2015

Churn, Churn, Churn: Measuring the Cost of Fragmented Coverage

Low-income Americans face bewildering bureaucratic requirements when they try to obtain welfare benefits. One of the challenges is that they have to frequently re-apply for benefits because the state needs to know whether their incomes are still low enough form them to remain eligible. This moving in and out of benefits is called churn, and Dottie Rosenbaum of the left-wing Center for Budget and Policy Priorities has written an interesting paper discussing the challenges in measuring and understanding it.

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

Health Insurers Just Fine Under Obamacare

New research from the Commonwealth Fund, a pro-Obamacare think tank, shows that health insurers are doing just fine under Obamacare.

Well, the stock market has been telling us that for years. The report’s purpose is to cheer the rebates that insurers which made too much money paid to consumers. Obamacare regulates the Medical Loss Ratio (MLR). If an insurer does not spend enough premium on medical claims, it has to pay a rebate to its beneficiaries.

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

Honor Roll: 37 Voted Against the Budget Busting Medicare Doc Fix

"While I support an SGR replacement, I cannot vote in favor of a bill that costs more than $200 billion, while Congress only pays for $70 billion, leaving more than $130 billion to our children and grandchildren. We cannot continue to solve every problem by adding to the deficit,” Rep. Jim Bridenstine (R-Okla.) said in a statement.

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

With Medicare Doc Fix, House Republicans Move Left of Obama on Health Reform

The fallout from yesterday’s House vote to bind our children and grandchildren further into debt servitude to bail out an unreformed Medicare continues.

Before the vote, Chris Jacobs of America Next (Louisiana Governor Bobby Jindal’s think tank) warned that Medicare could not survive reform if the so-called “doc fix” passed. Writing after the unfortunate vote, Jacobs explains that House Republicans have actually moved left of Obama on Medigap reform.

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

Thursday, March 26, 2015

The GOP's Proposed Budgets' Effect on Medicare and Medicaid

Sean Parnell of the Heartland Institute interviewed me for his podcast series on health policy:

Hear the entire podcast here.

How Conservatives Rationalize the Budget Busting Medicare Doc Fix

Opposition to the outrageous so-called Medicare doc fix bill, which will increase the deficit by $141 billion, is growing. Michael Cannon of the Cato Institute explains how this will “bust the budget.” My Forbes editor, Avik Roy, pleads that the Senate stop this monstrosity (which passed the House by a huge majority).

On the other hand, there are those unfortunate conservatives who endorsed the bill before the Congressional Budget Office (CBO) had announced what a budget buster it was. My friend Ryan Ellis of Americans for Tax Reform appreciates that the CBO score could give us a feeling of “whiplash”.

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

Wednesday, March 25, 2015

97 Percent of Medicare Doc Fix is Deficit Funded

Today’s Health Alert warned against the so-called Medicare doc fix that is being jammed through the Congress this week. The Health Alert was written and published before the Congressional Budget Office issued its estimate of the bill’s effect on the deficit.

Here it is:
Over the 2015–2025 period, CBO estimates, enacting H.R. 2 would increase both direct spending (by about $145 billion) and revenues (by about $4 billion), resulting in a $141 billion increase in federal budget deficits (see table on page 2). Although the legislation would affect direct spending and revenues, it would waive the pay-as-you-go procedures that otherwise apply.
Read the entire column at NCPA's Health Policy Blog.

Republicans Plant Their Flags on Health Reform

U.S. Senator Ted Cruz declaring his presidential candidacy at Liberty University (March 23): “Imagine health care reform that keeps government out of the way between you and your doctor and that makes health insurance personal and portable and affordable.”

House Budget Committee’s budget resolution (March 17): “Individuals should be able to own their insurance and have it follow them in and out of jobs throughout their career.”

Senate Budget Committee’s budget resolution (March 18): “By adopting this new budget, Republicans can repeal the President’s health law and the committees of jurisdiction can continue to work on plans to replace it.”

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

Kick the Medicare Doc Fix Down the Road

Congressional leaders from both parties have agreed on a long-term, so-called “doc fix” that claims to solve the problem of how the federal government pays doctors who treat Medicare patients.

Currently, Congress has a certain amount of money every year to pay doctors. The problem is the amount is not enough. If growth in Medicare’s payments to doctors were limited by the SGR, the payments would drop by about one-fifth, and they would stop seeing Medicare patients. So, at least once a year, Congress increases the payments for a few months. The latest patch (H.R. 4302) was passed in March 2014 and runs through March 31, 2015. It costs $15.8 billion.

This has happened 17 times since 1997. Congress has never allowed Medicare’s physician fees to drop. So, why not pass a long-term fix? This would finally free politicians from having to grub around every year finding money to pay doctors, and they could turn their attention to loftier matters.

Actually, there are plenty of reasons to be skeptical of any “doc fix”, and certainly this one.

Read the entire column at Forbes.

Tuesday, March 24, 2015

Obamacare is Driving Up Medicare Premiums

Obamacare includes a “health insurance providers fee” that is significantly increasing premiums. The fee is a fixed-dollar amount that is divvied up among insurers according to the amount of premium they write.

People who are really getting hit by this fee include Medicare Advantage beneficiaries who are enrolled in through retiree benefits. Because their former employers pay a share of their premium, the insurance fee has a disproportionate impact.

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

Monday, March 23, 2015

Congressional Budget Resolutions Shoot for the Sky; Miss Low-Hanging Fruit

The House Budget Committee and the Senate Budget Committee have passed budget resolutions that shoot for the sky with respect to health reform. Their proposals recommit the Republican majorities to patient-centered health reform and show a path forward for the next president. However, they do not harvest some low-hanging fruit offered by President Obama. Failure to do so might doom patient-centered health reform to the forever future.

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

Obamacare Beneficiaries 2.5 Times More Likely to Have HIV/AIDS Than Commercially Insured

One of our themes is that Obamacare causes health plans to attract the healthy and shun the sick. However, they do not succeed, according to a report by Prime Therapeutics, a pharmacy-benefit manager.

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

Saturday, March 21, 2015

The "Next Frintier"? Health Plans Covering Yoga?

When a leading benefits consultant writes an article in the Harvard Business Review recommending that health plans should cover yoga, it should be glaringly apparent that we have perverse incentives in U.S. health benefits:

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

Friday, March 20, 2015

Organ Donation and Imminent Death

This blog occasionally discusses organ donation. Over the years, there has been increasing government control over organ transplantation. It is not an area where supply and demand can meet in the normal economic sense, because there is a fixed supply of organs that is not adequate to satisfy demand. Many libertarians have proposed that anybody who wants to sell one of his organs should be free to do so. (Currently, we are not.)

Joshua Mezrich and Joseph Scalea, two organ-transplant physicians, make the case in The Atlantic that we should not have to wait until bran death to donate organs.

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

Government and the Private Sector - The Case of eHealth

Obamacare’s exchanges are the DMV of American health care – frustrating for consumers and completely unnecessary. In a column for, NCPA CEO Allen West and I point out that this is hardly unique to Obamacare.

Decades ago, the government seized the commanding heights of mortgage lending, leading to recurring housing crises. The Obama Administration has also expelled financial institutions from student loans. That monopoly won’t end well, either.

Read the entire column at

Wednesday, March 18, 2015

eHealth, Inc.: Obamacare's Biggest Winner Becomes Its Biggest Victim

For years now, Wall Street has cheered as Obamacare fuelled the stock prices of corporations in the healthcare industry. One of them was  eHealth, Inc. (NASDAQ: EHTH), an online health-insurance broker that was founded in 1997.

Obamacare is only its second year of enrollment, but Uncle Sam has already sidelined eHealth, which has announced that it will lay off 15 percent of its workforce and take a restructuring charge of up to $4.7 million dollars. This announcement followed horrific fourth quarter earnings.

Read the entire column at Forbes.

400 Percent Cost Difference to Treat Prostate Disease

UCLA researchers have for the first time described cost across an entire care process for a common condition called benign prostate hyperplasia (BPH) using time-driven activity-based costing. They found a 400 percent discrepancy between the least and most expensive ways to treat the condition. (UCLA Health)
Why does this persist?

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

Obamacare is Expensive and Difficult or Impossible to Afford

Obamacare is crushing agents and brokers, according to industry sources:
Amid the national debate over raising the federal minimum wage to $10 per hour, Scott Leavitt of Boise says he and his fellow advisors have been enrolling clients in their state’s health insurance exchange for an hourly wage that works out to about $4.50 – and sometimes even less. (Susan Rupe, InsuranceNewsNet)
And that is just the advisors.

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

Health Wonk Review: Spring Forward Edition

The latest Health Wonk Review (“Spring Forward Edition”) curated by Professor Brad Wright is posted at HealthWorks Collective. There are a lot of items about King vs. Burwell, the case against Obamacare’s subsidies to insurers in states that do not have their own exchanges

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

Monday, March 16, 2015

Health Goods Prices Rise, Other Prices Fall

Last Friday’s release of the Producer Price Index  for February confirms that prices for health goods and services are rising at a much higher rate than other producer prices, most of which are declining significantly.

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

Obamacare’s Second Open Season: Average Premium Up 23 percent – After Subsidies

With enrollment data through February 22, the administration finally declared Obamacare’s second enrollment season closed and released its report on the results. (Although, people who have to pay Obamacare’s mandate/penalty/fine/tax as a result of information disclosed in their 2014 tax returns will have a special open enrollment in April).

Obamacare’s supporters cheered that enrollment hit 11.7 million people, exceeding the low-ball estimate of 9.1 million the administration made last November. Lost in the enthusiasm for Obamacare’s new high-water mark are a few uncomfortable facts.

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

Saturday, March 14, 2015

One Family's Obamacare Nightmare

One of this blog’s consistent themes is that Obamacare incentivizes insurers to attract the healthy and shun the sick. Pattie Curran is a North Carolina mother of two children born with a rare bone-marrow dysfunction. She reported her experience in the Washington Times.

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

Friday, March 13, 2015

Unconnected Medical Devices Harm Patients

The federal government’s dominance of health information Technology (HIT) has been most apparent, and most harmful, in electronic health records (EHRs). However, the hand of government must lie heavily in other parts of health care, too.

An example is medical devices hooked up to patients at the hospital. Remarkably, these devices do not talk to each other, requiring nurses to waste time transcribing data from one device to another. This is confirmed in a survey of 500 nurses commissioned by the West Health Institute.

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

Wednesday, March 11, 2015

Let Medicare Patients Decide Which ACO to Join

One of the reasons people rebelled against Obamacare was that it financed the growth of government-run health care through drastic cuts to Medicare. According to the Congressional Budget Office (CBO), Medicare spending will see a $455 billion cut over the next decade, which would finance almost half of Obamacare spending.

One loudly trumpeted tool to cut costs in Medicare is the Accountable Care Organization (ACO). Unfortunately, ACOs are underwhelming and soon likely to fall off the radar screen

Read the entire column at Forbes.

Obamacare's Shrinking Costs Should Bring Tax Cuts

The Congressional Budget Office’s March budget baseline updates its estimates of costs and insurance coverage due to Obamacare. The March baseline estimates that the gross cost of Obamacare’s subsidies and Medicaid spending for the years 2016 through 2025 will be $1.7 trillion, $286 billion less than it had estimated in the January baseline.

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

Tuesday, March 10, 2015

The Patent Trolls Are Coming To Medical Technology

“Patent trolls” (more neutrally labelled “patent-assertion entities”) are a big problem for software patents. In the House of Representatives, Representative Darrell Issa has promised to carry last year’s Innovation Act, which would reform patent litigation to keep a lid on allegedly out-of-control lawsuits targeting software That might change, according to a new report by Jay Nuttall of Steptoe & Johnson, LLP, who explains that “the patent trolls are coming to medtech.”

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

Monday, March 9, 2015

Here's What Electronic Health Record Interoperability Looks Like (Not)

NCPA recently released an Issue Brief questioning the federal government’s dominance of health information technology, especially electronic health records (EHRs). Our conclusion came from the failure of the federal government to bring about so-called interoperability between EHRs. Jonathan Bush, CEO of Athenahealth, a provider of EHRs, illustrates how appalling this failure has been:

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

FDA Approves First Biosimilar, Still No Guidance on Names

The Food and Drug Administration has approved the first biosimilar therapy in the U.S.

There is a rough – but very imperfect – parallel between biosimilars and generic drugs, which now make up the vast majority of prescriptions filled in the U.S. The innovative biotech industry long argued that it was harder to make a generic biologic therapy than a generic drug, because the former is made from living sources, not just molecules.

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

VHA Sitting on Results of 140 Investigations

We recently noted that the government’s own watchdog has noted that the Veterans Health Administration is at high risk for fraud, waste, and abuse. Unfortunately, the public has little ability to see the evidence. USA Today has discovered that  the Veterans Health Administration has not been very forthcoming about the department’s shortcomings:

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

Friday, March 6, 2015

Weak Health Jobs Growth; Mostly in Hospitals, Physicians' Offices

Today’s employment report, cheered as positive, had a grey lining for health workers. January’s report showed a big boost in health jobs, but that reversed itself in February.

Total nonfarm payroll increased by 295,000 from January, but only 24,000 (fewer than 8 percent of the total) were health jobs. And 9,000 of those jobs were in hospitals. Physicians’ offices saw 7,000 jobs, but employment in other health facilities grew only slightly or shrank.

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

Galluping Away with the Uninsured

Gallup has released a teaser for its quarterly update of health-insurance coverage. Although the polling firm released only one datum (that the rate of uninsured fell to 12.3 percent in the first quarter from 12.9 percent in the fourth quarter of 2014) this was enough for President Obama to send forth a victory tweet.

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

Safety-Net Hospitals Profit Under Obamacare

Guess what? Those safety-net hospitals in states that did not expand Medicaid, which were pleading that they would go bust unless that welfare program grew, are doing just fine:

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

Thursday, March 5, 2015

Senate Dems: Get Pregnant, Then Get Health Insurance

While everyone else is wondering whether the Supreme Court will replace Obamacare in 37 states with the actual Affordable Care Act as written, some Democratic U.S. Senators are urging women to dive deeper into Obamacare’s perverse incentives by encouraging them to delay getting health insurance until after they become pregnant.

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

A Grand Bargain for Intellectual Property in International Trade Deals?

Bloomberg View columnist Caroline Freund has proposed a thoughtful grand bargain for brand-name pharmaceutical firms’ data exclusivity in international trade deals.

Unfortunately, the column confuses two related but different issues: Patent protection and data exclusivity. The former is available to anyone who invents a better mousetrap. It is an important type of intellectual property (IP), and the U.S. leads the world in protecting inventors’ IP.

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

Obamacare Versus the Affordable Care Act: Which Will Win?

In March 2010, Congress passed, and President Obama signed, the Patient Protection and Affordable Care Act (ACA). The ACA was never implemented as written. The ACA authorizes subsidies to health insurers operating in state-established exchanges, but not the federal exchange. Some 37 states opted not to establish their own exchanges. Nevertheless, the Administration has been paying subsidies to insurers in those 37 states.

Yesterday, the Supreme Court heard oral arguments in King vs. Burwell. At stake is the Administration's payment of subsidies to health insurers operating in states which use the federal exchange.

On March 4, the Supreme Court heard oral arguments in King vs. Burwell, which could eliminate the illegal subsidies. A decision to uphold the ACA, as written, will surely cause millions of people to stop paying premiums. Many assert that this will cause an immediate crisis that Congress and the President will have to resolve immediately. This is an overly dramatic reading of events.

Read the entire column at Forbes.

Tuesday, March 3, 2015

Reduce Drug Prices by Solving Pharmaceutical R&D Crisis

A new NCPA study concludes that Congress must act to reduce the regulatory burden on pharmaceutical research and development.

Read more at NCPA's Health Policy Blog.

The Kline-Ryan-Upton Republican Off-Ramp from Obamacare

Tomorrow is the day the Supreme Court hears oral arguments in King vs. Burwell, and all the talk is about what Congress will do if the Supreme Court directs the Administration to obey the law by not paying subsidies in the majority of states, which have declined to establish their own Obamacare exchanges and defaulted to the federal one.

The Wall Street Journal ran an op-ed (available by subscription) by John Kline, Paul Ryan, and Fred Upton, who chair committees of jurisdiction in the House of Representatives that will be tasked with proposing a Congressional response to this decision. Here’s what they write:
Let people buy insurance across state lines. Stop frivolous lawsuits by enacting medical-liability reform. Let small businesses band together so they get a fair deal from insurance companies.
There's a lot more, but these three items are unexciting.

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

Obamacare Subsidies Made Up One Fifth of Government Transfer Payments in January

January’s Personal Income and Outlays report from the Bureau of Economic Analysis shows how significant Obamacare’s subsidies are in the scheme of government transfer payments to households, accounting for 21 percent of the increase in government transfer payments in January:
Personal current transfer receipts increased $24.8 billion in January, compared with an increase of $13.8 billion in December. The January estimates of current transfer receipts reflected several special factors…… Other government social benefits to persons was boosted $5.3 billion, primarily reflecting health insurance premium subsidies paid in the form of tax credits to enrollees of the Affordable Care Act exchanges.
Read the entire column at NCPA's Health Policy Blog.

The Fall of Government Unions and Slowing Health Costs

An op-ed in the Wall Street Journal about a recent legal decision on retiree health benefits shines the light on is a reason for optimism about the slow growth in health spending.

As readers know, I look pretty closely at the economic data from various government agencies, and they are starting to show an uptick in health spending and prices. However, a recent Supreme Court decision weakens the power of government unions to demand exorbitant retiree health benefits, according to Robert C. Pozen and Ronald J. Gilson.

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

Monday, March 2, 2015

Health Technology Forum: DC March 11 - Third Speaker Announced. Join Us!

The Health Technology Forum: DC Meetup will meet on March 11 in Washington, DC. We have three great speakers announced already and more will be announced in the next few days.

More info and RSVP here.