Welcome to the Health Wonk Review! The ten-year anniversary of our first blog post here at the Colorado Health Insurance Insider was earlier this month. I didn’t notice it at the time, but as I read through the entries for this edition of the Health Wonk Review, I was struck by how many changes we’ve witnessed in the health wonk-o-sphere over the last decade (and indeed, for a few years before that, when we were firmly in the health insurance world, but not yet writing about it on the interwebs).
We hosted our first Health Wonk Review in 2007, when healthcare reform discussions were already heated in some places (like here in Colorado, with our Blue Ribbon Commission), and were starting to ramp up on the national stage as well, with then-Senator Barack Obama calling for universal health care, and incorporating it into his campaign platform in his bid for the White House.
We’ve come a long way, but there’s still a long way to go. We’re certainly still a long way from universal coverage, and the individual market — where our clients get their coverage — is struggling to stabilize itself after the last few years of upheaval.
The articles in this edition of the Health Wonk Review have a little something for everyone, and highlight the fact that heathcare reform is still very much a work in progress. Let’s take a look…
At healthinsurance.org, Harold Pollack calls out the fact that good news about the ACA is often buried in the media, largely due to the fact that the majority of the good news has been for people who are poor and/or sick.
Julie Ferguson, writing at Workers’ Comp Insider, calls attention to the exploitation of immigrant workers (although, just as good news about poor/sick people is unlikely to grab big headlines, so is news of immigrants being exploited). Julie notes that not only are they more likely to face unsafe working conditions that result in serious injuries, they’re also less likely to have workers’ comp or health insurance to cover the resulting medical bills, thanks to the prevalence of designating these workers as independent contractors.
Roy Poses, writing at Health Care Renewal, reminds us to be wary of health care corporations that claim to be acting in the public’s best interest. If they’re for-profit, publically-traded companies, they are almost certainly acting first and foremost in shareholders’ best interest, and that might conflict greatly with what’s actually in the public’s best interest. Poses highlights two recent incidents, both involving pharmaceutical companies: Insys Therapeutics, Inc. attempting to defeat marijuana legalization “to protect the safety” of Arizona’s children, while also developing synthetic THC. And Pfizer rallying against proposals to regulate the price of drugs, claiming that it would be a step towards single-payer healthcare, and that consumers wouldn’t want that. Except it seems more likely that Pfizer wouldn’t want that.
All over the country, first responders, community leaders, and consumer advocates are fighting the opioid epidemic. But the opioid industry is lobbying hard to block efforts to reduce opioid prescriptions. Joe Paduda has an article at Managed Care Matters, calling out the opioid industry. Although opioids are essential medication in some cases, there’s no justification for the industry not getting behind efforts to curb the epidemic that’s ravaging some areas of the country right now. But when you see how this lines up with Roy Poses’ article, I suppose there is…
Spiraling Prescription Costs
At The Medical Care Blog, Lisa Lines addresses the Medicare Part D “doughnut hole” and the ACA’s progress towards closing the gap. She notes that while the gap is certainly closing and some seniors are seeing a reduction in out-of-pocket medication costs as a result, there’s still a problem: After enrollees get out of the doughnut hole and move into the “catastrophic” level, they still have to pay 5 percent of the cost of their medications. For specialty drugs, which can be thousands of dollars per month, that can still add up to a significant amount of out-of-pocket charges. And there’s no upper cap on the total out-of-pocket spending a Part D enrollee can incur.
Theodore T. Lee, Abbe Gluck, and Gregory Curfman, writing at Health Affairs, dig into the history of the ban on allowing CMS to negotiate with pharmaceutical companies to set prescription drug prices for Medicare Part D. And they note that although a large majority of the American public supports repealing the ban, it’s not likely to happen anytime soon. They also note that even if the ban were repealed, it might not do much good, and might end up stifling innovation in pharmaceutical research and development. A lot to digest in this one, and a very important read, given how much this topic gets batted around in political debates and backyard health wonk discussions.
The Current State of Health Care Reform
At Xpostfactoid, Andrew Sprung has a very thoughtful ten-point analysis of the current state of the individual market, and what steps could be taken (if we had a magic wand that could get through political gridlock) to stabilize it. That article juxtaposes nicely with this one, highlighting the fact that Congressional Republicans gravitate towards privatized solutions (like continuing to rely on private health insurers under the ACA’s reforms), but that the private insurers cannot make a profit in the current individual market without Congress stepping in to remedy some of the issues with the law.
The ACA did a lot to reform our health care system over the last several years, but it didn’t do much of anything about surprise medical bills when patient go to in-network hospitals but are treated by doctors and other providers who don’t participate in the same networks as the hospital. This issue has been largely left to the states, and only a few have made significant progress so far. But California is on the cusp of enacting the strongest consumer protections in the nation to prevent surprise out-of-network bills. If signed by Governor Brown (he’s expected to do so by the end of the month), AB 72 will ensure that patients are only responsible for in-network charges if they go to an in-network hospital, regardless of the network contracts of the providers who work in the hospital. The state already protects consumers from surprise out-of-network bills in emergency situations, but AB 72 would extend this protection to non-emergency situations too. At Health Access California, Anthony Wright explains the details. Other states should follow California’s lead on this.
Jason Shafrin, otherwise known as The Healthcare Economist, is also the Director of Research at the Innovation and Value Initiative. Jason shares an excerpt from a recent Health Affairs piece that calls for innovation in healthcare pricing, and notes that the Innovation and Value Initiative is leading the way in this effort.
InsureBlog’s Hank Stern has a post about the three-month grace period for people who are receiving premium subsidies through the exchanges and get behind on their portion of the premiums (here’s more on how the grace period works). U.S. News & World Reports ran a story recently about the negative impact the grace period has had for insurers. Quite a few insurers have decided to exit the exchanges at the end of 2016, and the grace period is likely a factor for some of them. InsureBlog writer Pat Paule was interviewed for the article, and explains how the grace period can turn into a loophole.
Writing at Balloon Juice, Richard Mayhew gives us an update on the risk corridor situation, and what an early settlement would mean for insurers of varying sizes (you can read more about the current risk corridor situation at ACA Signups, if you’re curious). It’s no surprise to anyone that there’s no new money for the risk corridor program based on 2015 numbers. And although CMS will eventually make carriers whole again, but in many cases (all the CO-OPs that closed last year or are closing this year, for example), all that will be left is the creditors who still need to be paid. For big insurers, it doesn’t matter whether they get the risk corridor money now, or a year from now, and it didn’t really matter that they didn’t get most of what they were supposed to get last fall. For smaller insurers, however, the timing is crucial, and an early settlement could be the key to keeping the doors open.
If you’re not already familiar with Balloon Juice, I highly recommend it. Another example of Richard’s astute analysis of the healthcare reform scene is his article about 1332 waivers and how states could design their exchanges to prevent “silver spamming” and thus take advantage of additional federal dollars to fund a 1332 waiver program.
At ACA Signups, Charles Gaba is another must-read health wonk. He wrote a piece for healthinsurance.org advocating for the elimination the off-exchange enrollment pathway, and putting the whole individual market on-exchange. Shortly after that, Senator Lamar Alexander (R, Tennessee) introduced legislation that would make subsidies available off-exchange, essentially tackling the problem from the opposite perspective. Charles summed up Sen. Alexander’s proposal to push more enrollees outside the exchange, and highlighted some concerns he has about that approach.
At Health Business Blog, David Williams shares a podcast with Dr Joshua Newman, GM for Healthcare at Salesforce, in which they discuss telehealth and Salesforce’s Health Cloud. They address return on investment, mobile technology, patient engagement, and what sets Health Cloud apart from other telehealth systems.
My own entry for this edition is all about the election, and how healthcare reform could be influenced by the outcomes all across the country. Early voting starts on Friday in Minnesota, Saturday in Michigan, and Vermont on Sunday. And over the next few weeks, early voting options will become available in most of the country. Get out and vote!
That’s it for this edition of the Health Wonk Review. Thank you to all the writers who submitted entries!