Spring Is Here! Health Wonk Review

Welcome to the Spring edition of the Health Wonk Review. With condolences to our east-coast and Great Lakes friends who have been dealing with what probably seems like 47 straight months of winter. Maybe they can call it the “Spring is eventually coming” edition?

We’ve got a great round-up of health care articles in this HWR, with a little something for everyone.

At Health Care Renewal, Dr. Roy Poses shines a light on the fact that “the most ill-informed people in health care leadership seem to be running US government health-related agencies.” Poses details numerous examples of people running health care agencies in the Trump Administration, with little to no experience in health care. He clarifies that there has always been a trend towards having people with general management experience running organizations, rather than people with experience in that particular organization’s niche field. But he also points out that pre-Trump, it was also common to have people in health care leadership positions who had a background in health care.

At Xpostfactoid, Andrew Sprung digs into the potential ramifications of a ban on silver loading for the cost of cost-sharing reductions (CSR). The Trump Administration stopped reimbursing insurers for the cost of CSR last fall, but insurers still have to provide the benefits to eligible enrollees. So for 2018, insurers in most states added the cost of CSR to premiums, but generally only to silver plan premiums (since CSR benefits are only available on silver plans). That resulted in much larger premium subsidies in most states, since subsidies are tied to the cost of silver plans. But now there are rumblings at CMS about the possibility of requiring insurers to spread the cost of CSR across plans at all metal levels, which would leave millions of people worse off in terms of how much they pay for coverage.

At Balloon Juice, David Anderson also addresses the possibility that silver loading could be banned, but focuses on how that might affect the off-exchange market. Anderson’s position is that even if CMS requires insurers to add the cost of CSR to plans at all metal levels, it would be a stretch for them to prevent insurers from offering similar plans outside the exchange that don’t have the cost of CSR added in. So if broad loading is required, it would likely only apply to on-exchange plans. That would make the off-exchange market much more appealing to people who don’t qualify for premium subsidies, essentially splitting the on-exchange/off-exchange market so that virtually everyone who doesn’t qualify for premium subsidies shops off-exchange.

At ACA Signups, Charles Gaba has masterfully crunched a whole lot of numbers to figure out how much people are paying in extra health insurance premiums in every state this year due to the Trump Administration’s efforts to sabotage the ACA. The additional premiums are being fully borne by 6.5 million people who don’t get premium subsidies, but they’re also being paid by tax dollars that are used to fund premium subsidies to offset those higher premiums for almost 10 million people who are getting premium subsidies. If you buy your own coverage and you don’t get premium subsidies, check out the spreadsheet at the bottom of Gaba’s article to see how much extra you’re paying this year as a result of the Trump Administration’s efforts to undermine the ACA-compliant markets.

At InsureBlog, Hank Stern points out that some proponents of the direct primary care model seem to be ignoring the fact that most Americans simply do not have the cash to pay out-of-pocket for serious health issues. Although there are certainly problems with the current health insurance model, throwing the baby out with the bathwater is probably ill-advised, and a direct primary care model is not a panacea.

At Managed Care Matters, Joe Paduda notes that more than 900,000 aren’t working because of opioid use/addiction. His estimate is that about a quarter of those people are workers’ comp patients. Paduda also notes that if you’re under 50, you’re more likely to die from opioids than from any other cause. He calls on states to come up with solutions, which leads nicely into our next entry…

At Workers’ Comp Insider, Tom Lynch explains how the Ohio Bureau of Workers’ Compensation has been working to address the opioid epidemic for the last several years. The results are impressive in terms of the decline in the number of injured workers receiving opioids through the workers’ comp program, but Ohio still has the highest number of opioid deaths. That’s not something that workers’ comp changes can fully control though, since people get opioid prescriptions for plenty of non-work-related injuries. But the changes that the Ohio Bureau of Workers’ Compensation has implemented are clearly having an effect in terms of how work-related injuries are being treated.

At Health Business Group, David Williams analyzed a Kaiser Health News article (How a drugmaker turned the abortion pill into a rare-disease profit machineand found that it covered at least ten distinct — and important — health policy topics, ranging from abortion to drug pricing to conflicts of interest.

At HealthBlawg, David Harlow looks at mergers in the health care world, and the impact they could have on how primary care is delivered. Big horizontal mergers between the major players in the health insurance industry were blocked last year, on antitrust grounds. But what about a CVS-Aetna merger, or a Cigna-Express Scripts merger? These don’t decrease competition in the health insurance industry, but they do have the potential to change the relationship that insurers have with medical providers. Will they end up being approved without limits, or will the DOJ take action to limit potential negativate ramifications of such mergers? Stay tuned…

My own entry is a look at what’s going on with Medicaid in each state, including a summary of states to watch this year in terms of Medicaid expansion, work requirements, and other changes.

That’s it for this edition of the Health Wonk Review. Many thanks to all the outstanding health wonks who submitted entries! Jason Shafrin, aka the Healthcare Economist, will host next month’s HWR.

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.


  1. Wow – What a FANTASTIC job, Louise! Thanks so much for hosting, and for including our post.

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