Tuesday, June 30, 2015

Only 20 to 40 Cents of Each Medicaid Dollar Benefits Recipients

One of the problems with Medicaid is that it does not appear to improve recipients’ health (although the evidence can be described as mixed). The best evidence on Medicaid comes from Oregon, which ran a lottery to allow eligible people to enroll. This approximates a randomized clinical trial, the gold standard of clinical research and hard to achieve when examining the real world. Plenty of research indicates that the Oregon Medicaid did not improve health outcomes very much.

The original researchers continue to publish results, and have written a paper that might offer the best explanation why Medicaid does so little. Only 20 to 40 cents of Medicaid spending actually goes towards patients’ welfare.

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

Strict Antitrust Review for Health Insurers, Hospitals

As Obamacare accelerates the transformation of the U.S. health sector into a complex of regulated utilities, providers are concentrating into oligopolies. The Wall Street Journal reports that the U.S. Department of Justice will use “strict review” when considering mergers of health insurers, while the Federal Trade Commission will also review hospital mergers closely.

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

Monday, June 29, 2015

Obamacare and Employer-Based Benefits

Now that we have over one full year of ObamaCare under our belts, a mystery is unfolding: What is happening to employer-based benefits? Data from different sources convey widely different messages, but until we solve this mystery, it is difficult to predict the political future of President Obama’s troubled health reform law.

Read the entire op-ed at American Thinker.

41 Percent of Obamacare Silver Plans Have Small or X-Small Networks

New research sponsored by the pro-Obamacare Robert Wood Johnson Foundation confirms that Obamacare plans have limited access to physicians. The research defines a network as small if no more than 25 percent of physicians in an area are covered, and extra small if it covers less than 10 percent. The results:
  • The “narrowness” or size of a network can be quantified, and 41 percent of silver plan physician networks in the ACA marketplace are small or extra small.
  • While consumers are likely to select plans with low premiums, they are not fully aware of the characteristics of narrow networks.
  • Well-functioning narrow networks will survive only if their characteristics are communicated more clearly to consumers and they are regulated to ensure adequacy.
This paper is extremely well researched, especially given the obstacles facing the researchers.

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

Friday, June 26, 2015

SCOTUS Boosts Obamacare With Gay Marriage Ruling

I thought I knew everything about Obamacare until Charles Gaba pointed out that King v. Burwell was not the only Supreme Court decision to boost Obamacare. This morning’s decision on gay marriage may boost Obamacare enrollment numbers somewhat, because it will lead to more same-sex marriages this summer, which is an event that triggers special enrollment.

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

SCOTUS Saves Republicans in King v. Burwell

Health insurance veteran Bob Laszweski takes a contrarian approach to the Supreme Court upholding Obamacare tax credits in at least 34 states that did not establish their own exchanges. Instead of a loss for Obamacare opponents, Mr. Laszewski believers Republicans were saved from stealing defeat from the jaws of victory in King v. Burwell.

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

Health Insurers Consolidate on Business; Fragment on Policy

A few days ago, this blog discussed the wave of consolidation among health insurers. The two main deals discussed in the business press are Anthem’s bid for CIGNA and the likely takeover of Humana by a bigger insurer which wants to beef up its Medicare Advantage and/or Medicaid managed care business.

While this consolidation plays out, the policy world was surprised to see the largest insurer, UnitedHealth Group (UNH), pull out of AHIP, the health plans’ trade association. Both parties soft-pedalled the exit of the association’s largest member.

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

Thursday, June 25, 2015

King v. Burwell: Health Insurers Rally

Health insurers’ shares enjoyed a nice rally today, as the Supreme Court endorsed the tax credits they receive via Obamacare exchanges. On a day when the S&P inched up 0.30 percent, health plans jumped.

REad the entire entry at NCPA's Health Policy Blog.

Obamacare Beyond the Handouts

In the wake of the Supreme Court’s ruling, Holman Jenkin’s column from this morning’s Wall Street Journal is telling: "By one standard no government program can fail, and that’s the standard being applied to ObamaCare by its supporters: If a program exists and delivers benefits, the program is working."

I think Mr. Jenkins is too gentle on Obamacare.

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

King v. Burwell: The People, Not the Judges, Will Decide Obamacare

With a 6-3 decision, The Supreme Court upheld King v. Burwell, the lawsuit asserting tax credits paid to health insurers in at least 34 states using the federal health insurance exchanges are illegal.

The majority admits the law is sloppy. Nevertheless, relying on the so-called Chevron doctrine, the Supreme Court decided the administration is free to continue to spend billions of taxpayers’ dollars in tax credits that are not clearly authorized in the statute. This is a dangerous notion. When the president and Congress have the same policy objective, it encourages them to write a law as ambiguously as possible, so that the President can bend the law this way and that way without interference.

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

How Congress And President Obama Can Win After King v. Burwell

A congressional response to King v. Burwell will be successful if President Obama signs a bill making at least one permanent change to the law that removes at least one of Obamacare’s harmful effects.

This proposal contains reforms in six buckets, which can be adopted independently or comprehensively:

  • Reforming Obamacare tax credits for premiums to reduce disincentives for beneficiaries to work more hours and increase their incomes.
  • Combine Obamacare tax credits and cost sharing subsidies so beneficiaries can decide themselves how much to pay directly for health goods and services versus how much to pay in premium to health insurers.
  • Allow beneficiaries to buy health insurance from brokers or agents, instead of the broken exchanges, and receive tax credits through the IRS directly.
  • Remove federal mandates on health insurance, such as age bands and mandated benefits, which increase cost.
  • Remove the mandates on individuals and employers to purchase government-compliant health insurance.
  • Combine these reforms with reforms unrelated to King v. Burwell or even Obamacare itself, in order to increase the likelihood of winning the president’s signature.

Read the entire special publication at the National Center for Policy Analysis.

Wednesday, June 24, 2015

GDP: Health Spending 43 Percent of Increase in Personal Consumption

Where is your money going? Increasingly, the answer is health care. This morning’s third estimate of first quarter Gross Domestic Product (GDP) was not as awful as previously estimated – a real decline of 0.2 percent, not 0.7 percent.

The overall drop of $7 billion was driven by a decline in exports and nonresidential structures. Personal consumption expenditures increased by $58.3 billion. However, $48.1 billion of that was services, of which $24.2 billion was health care. Almost half the quarterly increase in personal consumption was health care.

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

King v. Burwell: Fix Obamacare's Job-Killing Tax Credits

You read that headline right: It is not only those who pay Obamacare taxes who suffer, but those who receive them. That’s because the tax credits are calculated so perversely that people who receive them actually get punished for working more hours. In the wake of the Supreme Court’s forthcoming decision on King v. Burwell, which will determine whether tax credits paid in at least 34 states are legal, fixing this should be a priority for Congress and President Obama.

Read the entire column at Forbes.

Employer Benefit Plans' Subsidy of Obamacare Increased

The administration has just increased the amount it will play plans under one of the “3 R’s” of Obamacare. Reinsurance, risk corridors, and risk adjustment are three mechanisms the administration uses to protect insurers from losing money in Obamacare.

Last year, I focused my efforts on limiting risk corridors, which exposed taxpayers to a potentially unlimited liability. This had a largely successful legislative result in Congress. Now, reinsurance has become a problem. As Ed Haislmaier of The Heritage Foundation has explained, reinsurance taxes all plans, including those covering the employer-based group market, to reduce risk in Obamacare.

Well, the administration collected more money than it expected from this tax.

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

Medical Device Excise Tax Repeal? Not So Fast!

As discussed a few days ago, the House of Representatives has voted to repeal Obamacare’s medical device excise tax. The tax itself, obviously, is harmful. However, putting this at the top of the “to do” list for the repeal effort is a curious priority.

Some conservatives are turning against the notion of repealing the tax on its own.

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

Veterans' Health Waiting Lists Up 50 Percent One Year After Scandal Exposed

Unfortunately, our predictive abilities at NCPA’s Health Policy Blog appear to be holding up pretty well. Last July, I wrote that giving billions of dollars to the Veterans Health Administration to “fix” the problems of long waiting lists for treatment would be viewed by the VHA bureaucrats as a “reward,” and they would react accordingly.

That is exactly what has happened.

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

Monday, June 22, 2015

Repealing Obamacare Would Grow Economy

I have asked, and the Congressional Budget Office has answered.

I have been urging the CBO to do a comprehensive estimate of all the effects of the Affordable Care Act, effectively for the first time since 2012. It did so last week. The main take-away is that “repealing the ACA would increase GDP by about 0.7 percent in the 2021–2025 period, mostly because provisions of the law that are expected to reduce the supply of labor would be repealed.”

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

Shrink Obamacare's Costs By Removing Rule Driving Up Young People's Premiums

The Supreme Court will soon decide King v. Burwell, the case that will determine whether tax credits being paid in at least 34 states without their own exchanges are legal. If the Supreme Court makes the administration follow the letter of the law, billions of dollars of federal tax credits will continue to flow to 16 states, but not the rest. This will result in a political crisis giving Congress and President Obama the opportunity to fix the worst aspects of Obamacare.

Here is one suggestion: Remove Obamacare’s rule forbidding accurate premiums by age. The difference in rates between young adults and older ones can be no greater than three to one. The actuarial consensus is that average health spending for 63-year-olds is five times that of 22-year-olds. However, instead of reducing premiums for older applicants, the rule dramatically increases premiums for younger ones.

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

Obamacare and Employer-Based Benefits

Now that we have over one full year of ObamaCare under our belts, a mystery is unfolding: What is happening to employer-based benefits? Data from different sources convey widely different messages, but until we solve this mystery, it is difficult to predict the political future of President Obama’s troubled health reform law.

The puzzle is obscured by the media’s focus on topline figures, which indicate significant increases in the number of insured people, including millions added to Medicaid, the joint state-federal program for low-income households.

Read the entire op-ed at American Thinker.

Friday, June 19, 2015

Top Health Insurance Expert: Republican Response to King v. Burwell Will Fail

Forbes colleague and insurance industry veteran Robert Laszewski has reviewed Congressional Republicans’ potential responses to a victory in King v. Burwell, the lawsuit that could upset Obamacare’s tax credits, and found them deeply wanting.

With respect to the House Republican proposal to give (what are effectively) block grants of Obamacare money to states:
I have no earthly idea how a state might opt out and build a brand new health insurance system in just a few months—and do it for what might only be two years!
With respect to Senator Johnson’s proposal (which I previously discussed), he is equally dismissivw.

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

King v. Burwell Video Comments



This week's NCPA video has about one minute from me on the Obamacare King v. Burwell lawsuit.

Health Spending Up, Up, and Away

The Quarterly Services Survey (QSS) is Census Bureau report that we should be watching to see how health costs are climbing. This blog last looked at it in September 2014. Fortunately, Dr. Drew Altman, CEO of the Kaiser Family Foundation has been keeping a close eye on it. His conclusion: Health spending is growing faster again.

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


U.S. Busts 243 Providers for $713 Million Medicare, Medicaid Fraud

This blog does not often congratulate the Obama administration. However, it has been relatively successful at prosecuting Medicare fraud through old-fashioned, gum-shoe type investigations.
From yesterday’s news:
In Miami, the owners of a mental-health treatment center allegedly billed Medicare for tens of millions of dollars’ worth of intensive therapy that actually involved just moving people to different locations. Some of them had dementia so severe that they couldn’t even communicate.
And in Michigan, another physician allegedly prescribed unnecessary narcotic painkillers in return for the use of his patients’ IDs to generate additional false billings. When they tried to escape the scheme, authorities say, he threatened to cut off the medications, to which his patients were addicted. (Lenny Bernstein & Sari Horwitz, “Government arrests 243 in largest crackdown on health-care fraud,” Washington Post, June 18, 2015)
Read the entire entry at NCPA's Health Policy Blog.

Medicare's Sustainable Growth Rate Was Not Entirely Bad

Supported by health-care interests, Medicare beneficiaries, and an overwhelming bipartisan consensus in Congress, President Obama has signed a law that will change how Medicare pays doctors — for the worse. Critics note the law will dramatically increase federal control of medicine and add $141 billion in deficits through 2025, a violation of Republican and Democratic pledges made since 2010.

The old system, called the Sustainable Growth Rate, was hardly perfect. In fact, in over a decade of working in health policy, I have never heard one person say anything good about it. Now that it is dead, it is time to give the SGR a fitting eulogy — to bury it, but also, for once, to praise it. Whatever its flaws, the SGR was this nation’s only attempt to connect the cost of an entitlement to our ability to afford it.

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

Thursday, June 18, 2015

Obamacare's Shrinking Revenues: Medical Device Excise Tax

The House of Representatives voted today to repeal Obamacare’s medical device excise tax, the 2.3 percent tax levied on medical devices sold in the U.S. The tax is certainly harmful. Whether it deserves the highest priority is another question.

The bill was scored by the Congressional Budget Office (CBO), which determined that it will increase the deficit by over $24 billion in the next 10 years. We seldom see explicit budget scores of individual Obamacare taxes. This score overlaps the original 2010 CBO score for four years, 2016 through 2019. Comparing the two scores shows how much the taxes estimated revenues have shrunk – 36 percent, from $12.7 billion to $8.1 billion over the period.

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

Obamacare Payments to Health Insurers Wildly Inaccrate

The Office of the Inspector General of the U.S. Department of Health & Human Services has concluded that the administration has no clue if the billions of dollars it is paying to health insurers as Obamacare tax credits and coast-sharing subsidies are accurate:
We determined that CMS’s internal controls (i.e., processes put in place to prevent or detect any possible substantial errors) for calculating and authorizing financial assistance payments were not effective.
Read the entire entry at NCPA's Health Policy Blog.

King v. Burwell Round Up

King v. Burwell, the case that challenges the administration’s illegal payments of billions of dollars of tax credits in at least 34 states without state-established exchanges, may be decided this morning or no later than June 29 (or so I learn from legal blogs).

NCPA has a list of responsible responses to King v. Burwell, that should be acceptable to both Congress and the President. Yesterday’s Health Alert described one of them. Of course, we are not the only ones. Here’s what some others have to say about it.

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

Wednesday, June 17, 2015

Producer Prices: Health Goods and Services Lag

Last Friday’s Producer Price Index showed a jump from April to May of 0.5 percent (seasonally adjusted). When I last looked at the PPI, it looked like prices of health goods and services were outpacing other producer prices.

The latest data show them lagging. Although, looking at year-on-year data, pharmaceutical products, hospitals, and nursing homes have had relatively high price increases. Price inflation for health insurance has been moderate, according to the PPI.

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

King v. Burwell: Give Obamacare Benefits to Patients, Not Health Insurers

he Supreme Court is expected announce its decision on King v. Burwell soon. The case hinges on whether Obamacare tax credits can be paid in states that did not establish their own exchanges. If the plaintiffs win, health insurers will lose tax credits that allow them to offer artificially low premiums to Obamacare beneficiaries. About seven million people will suddenly be asked to pay full premiums for their plans. To be blunt, they will freak out, and many will drop out of Obamacare, putting the president’s signature achievement in jeopardy.

This gives Congress the opportunity to present the president with reform. Here is one suggestion: Every single penny of Obamacare’s federal spending on health benefits goes to insurers. Not one penny goes to beneficiaries themselves. How about giving that money to beneficiaries directly, and allowing them to decide how much to spend on medical care directly, instead of premiums to health insurers?

Read the entire column at Forbes.

Obama’s Former Health IT Czar Raises $35 Million for New Venture

Bow-tied and charismatic, Dr. Farzad Mostashari, who led the Office of the National Coordinator of Health IT (ONC) from April 2009 to October 2013, has raised a total of $35 million from leading venture capitalists for his new business, Aledade. Aledade’s senior management includes veterans of athenaHealth and Practice Fusion, both firms which I admire for their entrepreneurship and relative (although not perfect) independence from government.

Like those firms, Aledade will provide its Electronic Health Records to independently practicing physicians. Aledade claims its uniqueness lies in an EHR that will ensure doctors’ win the Accountable Care Organization game.

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

Tuesday, June 16, 2015

PA, DE To Identify As State-Based Exchanges

There seems to be a trend in the United States of people formerly identifiable as a person with one set of easily recognized characteristics deciding that they “identify” as having another set of characteristics.

This is also happening with Obamacare exchanges. The Supreme Court will soon announce its decision in King v. Burwell, resolving the question of whether Obamacare tax credits can be paid in states using the federal exchange (healthcare.gov) or only states with their own exchanges. Some states with federal exchanges are trying to “identify” them as state exchanges.

Pennsylvania is one. Delaware is too, but it is called a State Partnership Marketplace. These State Partnership Marketplaces are not defined in the Affordable Care Act. The law defines clear blue sky between state and federal exchanges, and that tax credits can only flow through state exchanges. This difference was supposed to create the incentive for states to establish exchanges. It did not work.

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

Lament for Medicare's Sustainable Growth Rate

Supported by health-care interests, Medicare beneficiaries, and an overwhelming bipartisan consensus in Congress, President Obama has signed a law that will change how Medicare pays doctors — for the worse. Critics note the law will dramatically increase federal control of medicine and add $141 billion in deficits through 2025, a violation of Republican and Democratic pledges made since 2010.

The old system, called the Sustainable Growth Rate, was hardly perfect. In fact, in over a decade of working in health policy, I have never heard one person say anything good about it. Now that it is dead, it is time to give the SGR a fitting eulogy — to bury it, but also, for once, to praise it. Whatever its flaws, the SGR was this nation's only attempt to connect the cost of an entitlement to our ability to afford it.

Read the entire op-ed at RealClearPolicy.

Friday, June 12, 2015

King v. Burwell: How Important is Obamacare's Individual Mandate

Later this month, the Supreme Court will likely announce its decision on King v. Burwell, the lawsuit which asserts tax credits currently being paid to health insurers in 34 to 37 states that use the federal health insurance exchange are illegal. If the Supreme Court stops these tax credits, over six million people will be required to pay the full premiums for their Obamacare policies. This will cause a crisis, which will demand a response by Congress and the president.

Now that both chambers of Congress have Republican majorities, any legislative response will surely include eliminating the individual mandate, the most unpopular feature of the law. Victory for King would make Obamacare policies in most of the country “unaffordable” and thereby relieve 11.1 million people of the individual mandate. Any “fix” that re-imposes the mandate would be political kryptonite for this Congress.

Read the entire column at Forbes.

Thursday, June 11, 2015

Obamacare Beneficiaries Skip Care

Kaiser Health News covers an issue we’ve discussed: Obamacare beneficiaries are skipping care because they cannot afford it.

Here’s something to think about: Every penny of the billions of dollars taxpayers are paying to underwrite Obamacare goes to health insurers, either as premium tax credits via exchanges or cost-sharing subsidies for low-income households. Not one penny goes to the beneficiaries directly, so they can decide themselves which health goods and services to pay for.

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

Electronic Health Records: Doctors, Hospitals "Literally Terrified"

In a hearing on Meaningful Use Stage 3, interoperability and patient access to data, Sen. Lamar Alexander (R-Tenn.) cut right to the heart of the problem:
“To put it bluntly, physicians and hospitals have said to me that they are literally terrified of the next implementation stage … because of the complexity and because of the fines that will be levied,” he said. (Katie Dvorak, FierceHealthIT, June 10, 2015)
Read the entire entry at NCPA's Health Policy Blog.

Trans-Pacific Partnership: Intellectual Property Rights Not Strong Enough

A few days ago, I discussed my concern that intellectual property rights for pharmaceutical innovators would not be strong enough in the Trans-Pacific Partnership agreement for which President Obama seeks Trade Promotion Authority.

Well, they won’t be strong enough, according to information leaked from the negotiations.

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

Wednesday, June 10, 2015

Render Unto Caesar: Obama Preaches to Catholic Health Association

Yesterday, President Obama made a speech on healthcare to the Catholic Health Association’s meeting in Washington, DC, where the CHA celebrated its 100th anniversary. The president recycled his campaign speech, making many claims about the cost of care, medical bankruptcy, and uninsurance, all of which we have debunked countless times in this blog.

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

Doctor Who Billed Medicare Over $16 Million Explains it on YouTube

Last year, I had a very rare opportunity to congratulate the Obama Administration for its decision to release Medicare’s physician payment data for public scrutiny. It followed up quickly with a data dump of hospital claims.

I also anticipated that this would lead the physicians with the highest spending to justify their claims to the citizens at large. Last week, the Administration released the 2013 physician file, which is causing a this to happen. Here is one high-cost specialist explaining his practice on YouTube.

Read the entire entry: at NCPA's Health Policy Blog.

Calorie Counts on Menus Don't Work

Obamacare mandates that chain restaurants post calorie counts on menu boards. This is an example of “nudging.” Wouldn’t it be great if America’s obesity epidemic could be solved by just ensuring people are better informed about how many calories are in those French fries?

Well, the evidence is in, and calorie counts are ineffective. Dr. Aaron Carroll tells the story at his always informative and engaging Healthcare Triage YouTube channel.

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

Tuesday, June 9, 2015

Trans-Pacific Partnership: Will Intellectual Property Rights Be Strong Enough?

Having passed the Senate, it is now up to the House of Representatives to decide whether to give President Obama Trade Promotion Authority (TPA, or “fast track”) to negotiate the Trans-Pacific Partnership.

Most Congressional Republicans who support TPA also advocate strong intellectual property rights. However, one concern with TPA is that it is uncertain the President will negotiate strong intellectual property rights in the TPP. What will these Republicans do if the final version of the TPP does not have adequate protection for investment in intellectual property?

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

More Price Transparency Problems

Writing in Health Affairs, Ge Bai and Gerard F. Anderson have highlighted the fifty U.S. hospitals with the most “extreme markups” from what Medicare pays to their list prices (from the hospital chargemaster). The paper is written up by Olga Khazan in The Atlantic:
The study found that, on average, the 50 hospitals with the highest markups charged people 10 times more than what it cost them to provide the treatments in 2012.
Read the entire entry at NCPA's Health Policy Blog.

Accountable Care Organizations Hate Medicare's ACO Final Rule

Last Thursday, the Centers for Medicare & Medicaid Services published the final rule for Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs). At almost 600 pages, it differs in many ways from the proposed rule issued last December:

ACOs themselves are criticizing the rule quite harshly.

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

88 Percent of Nurses Use Smartphones at Work

According to market intelligence firm InCrowd, almost all nurses use smartphones on the job. THey own them, and their employers do not cover the costs.

I’m all in favor of information technology, but might this not pose a risk to privacy? I had understood most hospitals had very strict policies on BYOD (Bring Your Own Device).

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

Monday, June 8, 2015

Employer-Based Benefits Steady in Obamacare's Second Year

Urban Institute researchers have published new research supporting the thesis that Obamacare has not harmed either offers or uptake of employer-based health benefits. This corroborates the case I recently made, although there is contrary evidence.

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

King v. Burwell Update

The range of possible political reactions to the forthcoming King v. Burwell decision, in which the Supreme Court will decide whether tax credits paid to insurers in 34 to 37 states, remains uncertain.

Sarah Ferris of The Hill reports that states are prepared to “zero in” on an “Obamacare rescue plan” if the Supreme Court turns off the spigot.

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

Friday, June 5, 2015

Still No Transparency in Medical Pricing

Entrepreneur David Williams has good insight into the limits of Health Savings Accounts as tools of consumer empowerment, discussing a consumer who did his darndest to find a good deal on a CT scan, finally settling on the $475.53 price at Coolidge Corner Imaging. But the bill he got later was for $1,273.02 — more than twice as much — from a hospital he had no idea was connected to the imaging center.

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

Milliman: Heath Costs Rising Again

The latest annual edition of the Milliman Medical Index (which estimates “the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization”) suggests that last year’s moderate rate of growth was idiosyncratically low.

Last year’s 5.4% growth rate was the lowest in the history of the Index. This year, the growth rate has climbed to 6.3 percent – exactly the same as 2013.

Milliman also concludes that the “Cadillac tax” is fast approaching, especially for workers at smaller firms.

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

Health Jobs Doubled Growth in May

This morning’s employment report was greeted as good news, with 280,000 jobs added in May. Health hiring doubled its April pace, adding 47,000 jobs (versus only 22,000 in the previous report), comprising about one of six nonfarm jobs. At a seasonally adjusted growth rate of 0.31 percent, health jobs are still growing faster than non-health jobs (0.18 percent)

Job growth continues to be concentrated in ambulatory settings, while nursing and residential care facilities added few jobs.

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

Doctors, Hospitals, Medical Groups Demand EHR Rule Delay

Electronic Health Records (EHRs) continue to take on water. The American Medical Association and the Medical Group Management Association adding their voices to the demands to delay the Stage 3 Meaningful Use rule.

I discussed the stage 3 rule when it was published. The response of these professional groups is stunning: They were all happy to take the almost $30 billion the government handed out to induce them to install Electronic Health Records.

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

Thursday, June 4, 2015

Republican Study Committee Reintroduces Health Reform Bill

The RSC has re-introduced its American Health Care Reform Act, previously introduced in September 2013.

Most importantly, it eliminates the current exclusion from taxable income of employer-based benefits as well as Obamacare’s tax credits paid through exchanges. In exchange, it offers a standard deduction of $7,500 for individuals or $20,500 for a family that buys qualifying health insurance.

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

Dynamic Scoring Drops Obamacare Repeal Cost

Keith Hall, new Director of the Congressional Budget Office, has said that dynamic budget scoring would reduce the estimated cost of repealing Obamacare.

Among other things, Mr. Hall is surely referring to two issues: The taxes on businesses (e.g. medical device excise tax, “Cadillac” tax on employer benefits, employer mandate to offer government-compliant benefits) and the taxes on individuals that cause less work (2.5 million fewer jobs, according to CBO).

CBO’s new commitment to dynamic scoring is good news.

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

Local Governments Must Disclose Retire Liabilities Properly

U.S. state and local governments will have to report billions of dollars in health-care liabilities on their balance sheets under an accounting change aimed at improving disclosure of retiree benefits.
As a result of rules approved Tuesday by the Governmental Accounting Standards Board, municipalities and states will have to record the cost of health insurance and other benefits besides pensions in financial statements, the board said in a statement. Such costs are currently disclosed only in footnotes. (Darrell Preston, BloombergBusiness, June 2, 2015)
This great news is the result of years of grinding out the issue.

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

Medicaid Paid $9.6 Million For Dead Patients

From the statement of Seto Bagdoyan, Director, Forensic Audits and Investigative Service (June 2, 2015):

Approximately 8,600 beneficiaries received benefits worth about $18.3 million concurrently in two or more states –- even though federal regulations do not permit beneficiaries to have payments made on their behalf by two or more states concurrently.

…… our work raises concerns about whether payments made on behalf of certain beneficiaries were appropriate, including the following:

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

Wednesday, June 3, 2015

Many Congressional Republicans Opposing Obamacare Have Conflict of Interest

Many representatives and senators are benefiting from an illegal payment of public monies the administration is using to prop up Obamacare. When the Affordable Care Act was being debated, one sticking point was that politicians were proposing to impose an unpopular health insurance “reform” on vulnerable citizens while leaving their own generous health benefits untouched. Members of Congress and their staff have long been covered by the same health plan that unionized federal public servants enjoy.

So, politicians of both parties collaborated with the administration to “fix” this, and the Office of Personnel Management (which is the federal government’s HR department) unilaterally decided in August 2013 to change the law and pay these subsidies to politicians’ and staffers’ exchange plans. The politicians and staff are then able to get health insurance through a Small Business Health Options Program (SHOP) exchange. Did you catch that? Congress is defined as a “small business” by its own administrative bureaucracy!

Read the entire op-ed at The Hill.

More on Obamacare's Double Digit Rate Hikes

Yesterday, I pointed out that this blog would have room for nothing else if we discussed every local newspaper’s coverage of how Obamacare’s outrageous 2016 rate hikes were going to hit their community. Well, the House Speaker John Boehner’s office collected and summarized many of the articles, from the Wall Street Journal to the Wichita Eagle; from the New York Times to the Fayetteville Observer.

Insurance expert Bob Laszewski corroborates my conclusion from yesterday: It is surprising that insurers are asking for such “eye-popping” premium hikes while they still have taxpayers’ protection from losses via Obamacare’s risk corridors and reinsurance.

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

13 Percent of Obamacare 2015 Sing Ups Dropped Out A Month Later

The Administration released data on the status of enrollees in second open enrollment, which ended on February 22 (give or take a few days, depending on the state):
About 11.7 million Americans selected plans through the Health Insurance Marketplaces as of February 22, the end of the “in-line” special enrollment period for 2015 Open Enrollment for individual market coverage. On March 31, 2015, about 10.2 million consumers had “effectuated” coverage which means those individuals paid for Marketplace coverage and still have an active policy in the applicable month.
That’s a 13 percent drop-out rate within five weeks. Actually, I am happy to see if it those people got employer-based coverage, which has explained most growth in coverage over the last few years.

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

Medicare Accountable Care Organizations Cut Spending Two Thirds of One Percent

The Center for American Progress, a very pro-Obamacare organization, has published a study summarizing results of one of Obamacare’s most hyped tools to wring savings out of Medicare:
We first calculated overall savings by the Pioneer ACOs, finding that they reduced overall spending by 0.67 percent compared with the target amount of spending in the model’s second year.
Underwhelming, to say the least, don’t you agree?

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

Net Neutrality Versus Your Health

(A version of this Health Alert, which is co-authored by Roslyn Layton, was published by iHealthBeat. Roslyn Layton is a PhD fellow at Aalborg University’s Center for Communication, Media & Information Studies and vice president of Strand Consult.)

The Federal Communications Commission’s recent decision to regulate the Internet with the same law that was created for “Ma Bell” before World War II has plenty of implications for the health innovation economy. The era of “permission-less innovation” may be coming to an end as the FCC will scrutinize telemedicine applications and other broadband-enabled health care services because they involve connectivity. If Congress can act quickly to rein in the FCC, a disaster can be averted.

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

Tuesday, June 2, 2015

Hip Replacements in L.A.: $12,457 to $17,609

A short drive in the Los Angeles area can yield big differences in price for knee or hip replacement surgery. 
New Medicare data show that Inglewood’s Centinela Hospital Medical Center billed the federal program $237,063, on average, for joint replacement surgery in 2013.
That was the highest charge nationwide. And it’s six times what Kaiser Permanente billed Medicare eight miles away at its West L.A. hospital. Kaiser billed $39,059, on average, and Medicare paid $12,457. 
The federal program also paid a fraction of Centinela’s bill — an average of $17,609 for these procedures. (Chad Terhune & Sandra Poindexter, “Price of a common surgery varies from $39,000 to $237,000 in L.A.,” Los Angeles Times, June 2, 2015)

Okay, hospital bills are silly. We already know that. Let me point out two things.

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

Obamacare's Double Digit 2016 Rate Hikes

In Missouri, Coventry has asked for a 23 percent Obamacare rate hike next year:
Insurance brokers had considered the health plans sold by the Maryland-based insurer to be among the cheapest with the most extensive provider networks available to Missouri consumers.
But Coventry’s strategy appears to have caught up with it, and the insurer is now asking federal regulators to approve an average rate increase of 23 percent for plans sold in the St. Louis area. (Jordan Shapiro, “Coventry Health Care seeks double-digit price hike for health plans,” St. Louis Post-Dispatch, June 2, 2015)
But, hey, if I posted every article about eye-popping rate hikes in Obamacare exchanges next year, we’d have room for nothing else on this blog for the next few weeks. So, I’ll leave it to my Forbes colleague and Obamacare fan, Bruce Japsen, to roll up the whole story.

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

The Human Face of Medicaid's Poverty Trap

NCPA has long recommended a universal, refundable tax credit to replace welfare programs that impose effectively high marginal income tax rates on their dependents. A story from Chicago shows the human cost of Medicaid’s poverty trap.

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

Drug Shortages Getting Worse

According to the Wall Street Journal, the shortage of critical cancer drugs is getting worse. The U.S. government’s measures to mitigate this problem have failed because it has ignored NCPA’s conclusion that shortages result from too much, not too little control over the market for these drugs.

The government keeps tightening the screws on manufacturers, and the shortages keep growing. See Devon Herrick’s testimony to the U.S. Senate in 2011 and my own study published in 2012.

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

Monday, June 1, 2015

Paying for Mammograms: We're Thinking About it All Wrong

The third rail of American health policy is women’s health care.  The U.S. Department of Labor states that women make 80 percent of health care decisions for their families, although this appears to be derived from folklore rather than scholarly research. Nevertheless, any politician knows that the way to drive up polling numbers among women is to dial up the rhetoric on health care.

Back in 1996, Hillary Clinton, bitter after the defeat of HillaryCare, campaigned against “drive-by deliveries,” demanding that a federal law should be passed mandating that health insurers pay for mothers to stay in hospital for at least 48 hours after delivery. The campaign succeeded quickly: The Newborns’ and Mothers’ Health Protection Act passed that year, and took effect in 1998. It mandated a 48-hour stay (or 96 hours for Caesarian section). Although, doctors are free to discharge their patients earlier.

More recently, controversy arose when the Affordable Care Act was being debated, because it was being jammed through Congress just as women were struggling with a 2009 decision by the US Preventive Services Task Force to change its guidelines recommending annual mammograms. The new guidelines recommended screening starting at 50 years, not 40 (as previously recommended).

Needless to say, this upset many people. The American Cancer Society maintained its recommendation that preventive screening start at 40, as did the Mayo Clinic. Politicians took note, and made an exception in Obamacare for mammograms, such that the 2009 USPSTF revision was ignored when it came to Obamacare’s “free” preventive care.

Read the entire column at Forbes.

Health Construction Spending Lags

In response to some comments about the role of health facilities construction in the economy, I’ve decided to add a few lines about today’s construction spending report from the U.S. Census Bureau.

Year on year, total construction spending increased by 4.8 percent through April, to just over one trillion dollars, of which about 40 billion dollars (four percent) was health facilities construction. Health construction spending grew only 2.6 percent, much less than all construction and the 9.2 percent growth in nonresidential non-health construction.

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

Health Insurance Consolidation Begins With A Bang

Just last Thursday, I wrote about the forthcoming consolidation in U.S. health insurance. My thesis was that only large, centralized, politically powerful insurers could continue to thrive.

With perfect timing, Humana, Inc., announced on Friday that it was putting itself on the block, and the shares rallied about twenty percent. They continue to climb today.

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

Obamacare Patients Had Lower Drug Spending Than Patients in Employer Plans

A scholarly study of data from America’s largest pharmacy benefits manager concludes that Obamacare beneficiaries had lower drug spending than people in employer-based plans.

These are startling findings, and even contrary to earlier releases from Express Scripts itself. It does not seem consistent with emerging evidence that insurers are jacking up their Obamacare rates for 2016 because of higher than expected claims experience.

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