March 26, 2024

The Looming Election Year Debate Over The Affordable Care Act

This article captures the big divide between advocates and detractors of the Affordable Care Act (ACA). Good links to various studies.

Proponents say that over 21 million are enrolled in the Exchanges and a total of about 45 million gained coverage including Medicaid expansion.  Opponents argue costs have been huge — 36,798 per additional private insurance enrollee and 20,739 per additional non-group enrollee.  This is well above original estimates. Further, critics say insurers have benefited disproportionately.

Here is my Republican defense of the ACA – as strange as that sounds.

  • Yes we could look at reining in the rich benefit, but upfront coverage even at these costs will ultimately save dollars.
  • At least some of the costs have been caused by poor policy actions that have driven costs under the Obama and Trump administrations.
  • With 45M gaining coverage and tens of millions helped by pre-existing condition rules and the ability to stay on parents’ coverage until age 26, this law is going nowhere.  Reform it – do not repeal it. Opponents have failed to recommend anything that promotes quality coverage.

I also am dubious of the study that says 3 in 4 (73%) U.S. adults “report that in one way or another the healthcare system is failing to meeting their needs.”  Other surveys would suggest general contentment with their coverage and insurer.

#healthcare #healthcarereform #aca #obamacare #exchanges #medicaid 

Link to Article

Latest Inflation Cap List Under Medicare Drug Pricing Law Out

The Department of Health and Human Services announced its latest list of drugs that have exceeded inflation thresholds. For April 1 to June 30, 41 drugs have been added.  This will lead to rebates or penalties from the drug makers and lower cost-sharing for consumers in Medicare. About 750,000 enrollees will benefit. They could save up to $3,575 per average dose.

Press release: https://www.hhs.gov/about/news/2024/03/26/hhs-announces-savings-41-prescription-drugs-thanks-inflation-rebates-from-biden-harris-administrations-lower-cost-prescription-drug-law.html

Additional article: https://www.managedhealthcareexecutive.com/view/cms-estimates-savings-for-patients-from-medicare-inflation-rebates

#ira #drugpricing #brandrugmakers

Link to Article

Respected Non-Profit Researcher Finds Non-Profit Hospitals Not Living Up To Charity Mission

Respected non-profit researcher Lown Institute finds that hospitals are getting more in tax breaks than they are giving back in charity care.  The American Hospital Association (AHA) of course attacks the study (their MO), but it does not change the facts that about 80% of nonprofit hospitals, (over 1,900 of 2,425 hospitals) received more in tax break benefits than the support provided to communities. Hospitals spent just 3.9% of their budget on community support in 2021 – ranging from less than 1% at some facilities to nearly 9% at others. Lown says some hospitals pocketed hundreds of millions of dollars more in tax breaks than chairty care. The combined gap was $25.7 billion in 2021.

Lown recommends some sensible reforms, including establishing minimum thresholds for hospital community benefit spending (sensitive to regional profiles), additional reporting, and better enforcement and financial penalties.

Lown has provided a great public service here. Congress is right to be concerned and looking at reforms.

Additional article: https://www.modernhealthcare.com/finance/hospital-charity-care-tax-breaks-lown-institute

(Some articles may require a subscription.)

#hosptials #charitycare

Link to Article

Colorado Getting Into Drug Pricing As Well

In addition to the new federal Medicare drug pricing law, Colorado has passed a provision seeking to set upper limits on drugs as well.  This state law applies across lines of business. Brand drug maker Amgen is suing in federal district court arguing the state law violates the constitution in a number of ways. The Colorado board is determining whether it will set an upper payment limit on Enbrel after the governing board determined the drug was unaffordable under the state law.

Kudos to Colorado and let it be a trailblazer in other states.  The National Academy of State Health Policy seems to have advised on proper drafting of laws in this regard.

Let me add that this is an example of another multinational drug maker (although based in the U.S.) trying to dictate policy in the U.S. – this time at the state level.

Additional article: https://coloradosun.com/2024/03/25/amgen-lawsuit-enbrel-pdab/

(Some articles may require a subscription.)

#drugpricing #ira #co #branddrugmakers

Link to Article

Interesting Article On Theories On Kate Middleton’s Cancer

This is an interesting article on Kate Middleton and what her preventive chemo may be all about and why it is important. In general, I don’t believe that we should be prying into others’ private lives, but the media coverage has been so big.  This article takes a rather dispassionate approach to the issue.  We pray for both the Princess and King as they battle the great scourge of cancer. The hope is that both cancers were caught early and they will continue to live long and happy lives.

#cancercare #healthcare #prevention

Link to Article

Does Lower Insulin Cost-Sharing Boost Compliance And Usage?

A new study finds that, while people save when insulin prices are lowered, it does not necessarily boost usage of insulin.  The study admits that other studies may have different conclusions and differences could be related to lines of business as well.  It does state that those with Health Savings Account-related insurance saw major financial relief.

In general, the financial relief is good and I like the idea that we are constantly evaluating the policy impacts of various changes in policy.

#insulin #drugpricing #ira

Link to Article

Biden Goes On Healthcare Offensive In North Carolina

President Biden travelled to North Carolina and went on the offensive on healthcare.  He celebrated the 14th anniversary of the Affordable Care Act (ACA) and attacked proposals from the House Republican Study Committee (RSC) on Medicare and Medicaid reform.  Among the proposals, includes a block grant for Medicaid and a subsidy concept for Medicare. 

I believe we have to have a healthy debate on the status of entitlements and discuss reasonable changes.  I do not agree with everything in the RSC proposals, but the debate is healthy,.  Except for taxes and the Medicare drug price negotiations (the latter a good thing), Biden has proposed no meaningful reforms. I applaud the president’s position on coverage in general.

One last point: We may not need to make radical changes to any entitlement program if we engaged in true healthcare reform — tackled price throughout the system, emphasized prevention care management, and ensured affordable universal access. Overall costs would come down.

#healthcarereform #aca #obamacare #exchanges #medicaid #medicare

Link to Article

KFF’s Drew Altman On Medicaid Reform

A good article by Kaiser Family Foundation President and CEO Drew Altman on proposals to block grant or create a per capita cap program for Medicaid. It concludes that the truth is really in the final details of any proposed bill. In general, block grants and per capita caps would likely reduce spending over the long term from the baseline entitlement program. 

I happen to believe that a per capita cap reform is where we need to go.  I think it needs to be very flexible to recognize various demographic, inflation, aging, economic and other trends. But the article is a good one and is necessary.

#medicaid #healthcarereform

Link to Article

— Marc S. Ryan

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