Category: Health Policy

Jan
19

What’s going on with health coverage for poor kids?

Posted by Joe Paduda on Friday, January 19th, 2018 | Comments

The current clustermess in DC around keeping the government funded is just bizarre.

What’s most bizarre is politicians are holding poor kids hostage, which is the only way to describe what is happening.

Republicans are refusing to consider legislation – requested by the President – to address DACA as part of the budget resolution. This is a core requirement for many Democrats, as is long-term funding for CHIP.

Background – CHIP has long been a bi-partisan program, championed by Sen Orrin Hatch R UT among other staunch conservatives. It provides insurance for poor kids and pregnant women, and has been funded for decades with nary a blip. Till now.  CHIP has been unfunded since October; most states are about to run out of residual funds, which would throw about 8 million poor kids and pregnant women off the program – and leave them with no insurance. 

This makes no sense.  If the Childrens’ Health Insurance Program is re-authorized for a decade, it SAVES $6 billion.  There is NO fiscal reason to NOT re-authorize CHIP, just a political one. The GOP is using the re-authorization in an attempt to force Democrats to support a budget proposal that is anathema to many Democrats – and more than a few Republicans as well.

It appears likely that we’ll be forced into a government shutdown over this, which will end up costing taxpayers a LOT more money than if the party in power had just passed a budget months ago as it was supposed to.  In case you aren’t as nerdy as your author, there have been four separate continuing resolutions to keep the government funding since Trump was inaugurated – and there are NO plans by the Senate Appropriations Committee to discuss a budget for this year – or next for that matter.

Moreover, the Committee, which is dominated by Republicans hasn’t even bothered to hold a vote on a budget over the last year.

If this stuff makes you nuts, well, it should.

What does this mean for you?

Be very thankful you aren’t a poor kid.  And really mad about what this idiots are doing to poor kids. 

Jan
8

Monday catch-up

Posted by Joe Paduda on Monday, January 8th, 2018 | Comments

Lots has been happening, here are a few items that caught my attention.

WCRI’s been diving deep into hospital reimbursement. This is an issue I’ve been tracking closely – and I’d suggest you should too. I see hospital/facility costs and utilization as a major cost driver; hear from Carol Telles in a webinar Thursday January 18 at 1 eastern.

As we’ve noted here previously, work comp payers would do well to pay close attention to facility reimbursement and utilization; expect work comp, auto, and other P&C lines to become even more attractive to hospitals seeking revenues and margins.

Healthcare spending inflation actually slowed significantly last year.  An analysis by Kaiser Health News indicates trend in 2016 was 4.3 percent, higher than the overall 2.8 percent inflation rate, but a 1.5 point drop from 2015’s rate.  Notably, drug cost inflation was just above 1 percent (although that’s a lot higher than the double-digit drop we’ve seen in workers’ comp).

Key point – this slowdown in the rate of growth occurred after ACA implementation.  Not surprising that costs went up; we insured millions more people, most of which had pent-up demand for services they couldn’t get or couldn’t afford.

While costs continue to grow, life expectancy declines. We have the most expensive healthcare in the world – by far – yet our life expectancy has dropped two years in a row. As a result, we rank 26th out of 37 developed countries for life expectancy.

Here’s why – we’re paying hundreds of billions for low-value care…

An excellent piece on how to make analytics actually work from Harvard Business Review.  Key points:

  • attach an ROI to the analytics unit itself
  • hire experts from OUTSIDE your industry…

Enjoy your week.

Dec
14

It’s not a tax bill, it’s a healthcare bill

Posted by Joe Paduda on Thursday, December 14th, 2017 | Comments

OK, a bit of hyperbole – but only a bit.

Here’s how the Trump Tax Bill will affect healthcare…

  1. Immediate $25 billion cut in Medicare spending followed by a total of $400 million over the next nine years
    This has to happen under “PAYGO” rules which require offsets in spending when revenues are cut (as will happen under the Trump Tax).  Medicare is NOT AN ENTITLEMENT, it is an EARNED benefit. Starting January 1, 2018, doctors, hospitals, and pharma are going to take the hit as Medicare will stop paying for some care delivered by doctors.
  2. 13 million (+/-) more people will lose health insurance
    If you can sign up AFTER you get sick, why would you pay premiums until you need insurance? The bill ends enforcement of the mandate, but insurers are still REQUIRED to take all comers. So, many younger and healthier people will not sign up, and when they don’t the “pool” of insured people will get older, less healthier, and therefore more expensive to insure.
  3. Individual health insurance premiums will go up about 10%
    So, Insurance companies will raise premiums by about 10% as healthcare costs for the older, less healthy population will go up.
  4. Drive insurers out of the individual and small group markets
    See above…
  5. Reduce drug development for “orphan” diseases
    Today pharma gets a major tax break for developing treatments for orphan diseases, such as cystic fibrosis, epilepsy, muscular dystrophy and Angelman syndrome. It appears that tax break goes away – and this will greatly reduce R&D. The tax credit has been cited as responsible for treatments for about 350 diseases; there are around 7000 in total.  Here’s one pretty amazing success story that will likely not be repeated due to the end of the tax credit.

With fewer people covered by insurance, and higher rates for those that are, we’re likely to see more insurers drop out of more markets.

The greatest impact will be seen several years down the road, when the overly-optimistic growth projections prove to be just that. Already, experts predict the Trump Tax Bill will add over a trillion dollars to our national debt. When that happens, there are going to be calls for massive cuts to ALL services – including Social Security, Medicare, and Medicaid.

What does this mean for you?

I’m thinking Medicaid for all by 2027.

 

Nov
10

Friday catch-up

Posted by Joe Paduda on Friday, November 10th, 2017 | Comments

Here’s a few things I missed this week – and a big thank you to you, loyal reader.

First, thank you to all the folks who reached out publicly and privately to offer condolences on my political campaign and thank me for running. I deeply appreciate each and every one of you, and cannot thank you enough.

It’s Veteran’s Day (observed) today – thanks to all of you who have served.

Okay, here’s the big news of the week…

The death of “Obamacare” was announced prematurely; ACA signups are breaking records.

Enrollment is well ahead of any previous year, as in more than 50% higher in the first few days of the month. There are likely several factors driving enrollment:

  • grassroots organizations like Get America Covered, the Indivisible ACA Signup Project are doing a great job despite the Administration’s efforts to kneecap enrollment efforts (thanks Charles Gaba)
  • Costs for bronze plans for millions of Americans are actually very affordable; while the coverage is thin the cost is almost nil, making it an obvious “no brainer”
  • Loss aversion – as I’ve noted here before, people hate losing something more than they like getting something, so Trump’s continual blathering about the death of “Obamacare” is likely reminding many that they better sign up now.

I hate Purdue Pharma

And I don’t use that word lightly.

A very well-researched and written piece in the New Yorker about Purdue Pharma and the family that gave us the opioid crisis is required reading. If you want to know why 60,000 friends, family members, and neighbors died of drug overdoses last year, here is the answer.

China is a major drug supplier

And it’s unbelievably easy to get illicit drugs sent here from China.

Why large employers are buying healthcare directly

Because the outcomes are much more consistent and much better, costs are lower, and there’s a LOT of crappy medical care out there. There’s a movement among smart buyers to STRONGLY encourage their insureds to use specific providers for specific conditions, and that movement is going to explode.

Here’s a key takeaway:

While nearly all of the 450 spine patients who presented to one of the participating centers had been recommended for surgery by providers in their home markets, only 62% of the patients were found to be suitable candidates for surgery by the COE [center of excellence] sites. Instead of unnecessary surgery, activity-based therapies, pain injections, physical therapy, or weight loss were recommended by our providers.

Vacation is next week – I won’t be posting.

Enjoy the weekend!

Nov
3

GOP budget’s impact on healthcare

Posted by Joe Paduda on Friday, November 3rd, 2017 | Comments

The budget resolution that Republicans are basing their budget on would cut $1.8 trillion from healthcare, mostly from Medicaid over the next decade.

The impact of this on healthcare would be akin to Harvey hitting Houston. 

We will leave aside Republicans’ wildly optimistic economic growth projections and Congress’ elimination of scoring by the CBO – but you shouldn’t. (from former Reagan and Bush economic adviser Bruce Bartlett, discussing GOP growth projections... “[it’s] wishful thinking.  So is most Republican rhetoric around tax cutting.  In reality, there’s no evidence that a tax cut now would spur growth.”

Instead, the plan would cut Medicaid funding by 30 percent over the next ten years and slash Medicare by another half-trillion dollars.

This is a massive cut, one substantially larger than those proposed in either of the GOP’s failed ACA repeal bills.

There are NO details on how these cuts would be made or which providers and beneficiaries would lose what. This is classic Washington; they don’t want to highlight any specifics because the lobbyists will flood their offices.

Without those details, it is clear that doctors, hospitals, clinics and therapists would all face massive cuts in Medicaid reimbursement, and millions of families and kids would lose coverage. 

If something like this becomes law;

  • doctors and hospitals are going to jack up prices and increase utilization for privately-insured patients,
  • insurance markets will be thrown into disarray as the budget blueprint slashes ACA subsidies, and
  • the health status of millions of kids will decline.

What does this mean for you?

IF something like this passes – which I believe is highly doubtful – the US healthcare “system” will be hugely disrupted, with major implications for employment, private insurance costs, and workers’ comp.

Sep
26

Susan Collins saves the GOP

Posted by Joe Paduda on Tuesday, September 26th, 2017 | Comments

With her announcement that she won’t vote for the Graham-Cassidy bill, Sen. Susan Collins (R ME) has ended GOP efforts to kill the ACA.

She also saved her party from the disaster that would befall it if the bill had become law.

here’s why.

  • millions of core Republicans would have lost health insurance coverage,
  • states that went for Trump in the presidential election would have lost billions in federal funds,
  • many of the people covered in the individual market in Trump states have pre-existing conditions; Cassidy-Graham would have allowed insurers to drastically limit their coverage
  • Key GOP states such as Arkansas and Kentucky would lose billions in Medicaid dollars over the long term

This doesn’t mean future efforts won’t seek to slash coverage for kids via cutbacks in the Child Health Insurance program (CHIP), limits on Medicaid, or thru budget machinations. But these will be much lower-impact, subtler moves that won’t be as potentially devastating to the Republican brand as Cassidy-Graham. CG would have shown core supporters the GOP’s “solution” to the healthcare mess was far worse than the current one.

So, what now?

Nothing much is going to happen with healthcare in Congress for some time.  That’s too bad, as ACA needs fixing – namely:

This would go a long way to giving certainty to insurers, certainty that would lower premiums and stabilize markets.

What does this mean?

While the result may be a failure to deliver on a core campaign promise, what’s really happened is the GOP didn’t do deeper and broader damage to itself.

 

 

Jun
16

Why are Senate Republicans hiding their health care bill?

Posted by Joe Paduda on Friday, June 16th, 2017 | Comments

OK, let’s set aside the partisanship to objectively consider that question.

Senate Republicans are writing a bill in secret that would:

  • change one-sixth of our economy,
  • cause at least 20 million Americans to lose health insurance,
  • eliminate thousands of jobs in healthcare, and 
  • significantly change the insurance many of the rest of us have.

Many Republican Senators have yet to see the bill. HHS Secretary Tom Price has not seen the bill. The President has not seen the bill. The Wall Street Journal is upset with the process. The Conservative Review reports Orrin Hatch (UT), the second-highest ranking Republican Senator hasn’t seen the bill.

Senate Majority Leader McConnell has crafted a process to repeal-and-replace ACA that:

  • eliminates Senate requirements for debate,
  • doesn’t allow members of his own party or any Senate committee to review the bill before it hits the floor, and
  • avoids an accurate assessment by the Congressional Budget Office.

When ACA was passed back in 2009, there was:

  • 25 days of open public debate on the floor of the Senate
  • 13 days of open committee hearings
  • consideration of hundreds of amendments
  • months of meetings of the Gang of Six – three Republican and three Democratic Senators

Then-Minority Leader McConnell had this to say about ACA’s passage in 2009:

“This massive piece of legislation that seeks to restructure one-sixth of our economy is being written behind closed doors, without input from anyone, in an effort to jam it past not only the Senate but the American people…”

What does this mean for you?

Are you OK with this?

May
9

Trump de-funds Drug Policy Office…WTF!

Posted by Joe Paduda on Tuesday, May 9th, 2017 | Comments

President Trump’s budget proposal kills the Office of National Drug Control Policy.

I cannot fathom how any responsible public servant could do this.

In the midst of a horrific opioid epidemic, where we need every possible tool to slow down the death train, he de-funds ONDCP? 

30,000 dead people, thousands of devastated communities, huge societal costs, dead moms and kids and drug-addicted newborns, fentanyl and elephant tranquilizers coming in from China and he de-funds ONDCP?!

ONDCP is the lead agency setting NATIONAL DRUG CONTROL POLICY.  This isn’t some obscure, useless federal agency – these people set POLICY – what the feds do, don’t do, how they work together, what they focus on, where they target their efforts.

Without ONDCP, there is no coherent, cohesive policy; we’ll have a bunch of federal, state, and local organizations tripping over each other, duplicating efforts in some areas while completely missing or ignoring others.

And don’t tell me this is just a wish list – this shows where the President’s heart is, where his priorities are and are not.

This is real, folks. I’ve made no secret of my fear of the Trump administration, I just cannot believe even Trump would do this.

Thank goodness this is too awful for some of his fellow Republicans. 

What does this mean for you?

I don’t even want to think about it.

 

Apr
5

Republicans channelling Monty Python

Posted by Joe Paduda on Wednesday, April 5th, 2017 | Comments

Why the President and Congressional Republicans are still trying to do healthcare legislation is truly a puzzle. Unhappy with their initial effort to completely blow up the insurance markets (and their political future), they’ve re-engaged in a pointless effort that is destined to fail – and wound themselves in the process.

Pointless because every concession to win votes from the Freedom Caucus guys costs votes from those slightly more moderate.  So, it’s a zero-sum game – win an arch-conservative’s support, lose a less-conservative vote.

perhaps they’re thinking the initial AHCA no-vote debacle wasn’t much of a concern…

To be fair, in the disastrous AHCA non-vote they ONLY lost one of their arms.  This time they’re looking to lose more appendages.  This is one of those “if you don’t laugh you’ll cry” moments, because ACA does need significant improvement, but – at least for now – improvements are being ignored as politics prevail.

There are a lot of reasons this is political suicide…

The President and Republican candidates committed to keeping coverage for pre-existing conditions.  The plan being discussed today would gut this entirely, leaving over a quarter of us without coverage for pre-ex.  Ignore claims to the contrary; the combination of changes to what’s covered (essential health benefits) and removal of restrictions on premiums would mean anyone in the individual or small group markets would be subject to medical underwriting (absent state regulations to the contrary).

A close friend and lifelong Republican (including experience working on Capitol Hill) emailed me this morning about this latest “reform the reform” effort using language that would peel the paint off a battleship.

Most Americans now believe the GOP “owns” health reform.  A just-published Gallup poll finds 61% of respondents said “any problems with the law moving forward are the responsibility of Trump and Republicans in Congress…”

Interestingly, ACA is now polling higher than ever, at 55% approval. That’s up 13 points since the election…

I think the Freedom Caucus guys understand their ideological purity means millions of Americans will lose insurance coverage – and thus healthcare. 

And when they do, every mother, father, aunt, uncle, and grandparent will be incensed beyond measure that their wife/husband/child/grandchild won’t get the care they need.

How that is a winning proposition escapes me, but good for the Freedom Caucus for standing up for what they believe in.

Of course, you need to have legs if you want to stand.

 

UPDATE – looks like the Freedom guys and their Republican opponents can’t agree on what the White House said the new bill would include.  Either that or the WH folks told the two parties different things.

Apr
4

Trump, Immigration, and Healthcare providers

Posted by Joe Paduda on Tuesday, April 4th, 2017 | Comments

Today MCM is honored to bring you a guest post authored by the Sedgwick Institute’s Rick Victor, PhD.  Rick is the former CEO of the Workers’ Compensation Research Institute, and a colleague and friend as well.

The post begins below; emphasis was added by MCM.

Trump Immigration Rhetoric and Actions

Risk Higher WC Costs and Slower Return to Work

The Trump immigration actions and rhetoric will significantly worsen the doctor shortage. The Association of American Medical Colleges (AAMC) reports a deficit of 8200 primary care doctors in 2016. It predicts a shortage of nearly 95,000 doctors by 2025. As of 2010, 27% of US physicians were foreign born – 230,000 physicians. Fortunately for US patients, that number has increased each year. Given the large number of baby-boomer physicians who will retire in the next decade, we increasingly rely for our care on foreign born doctors.

The Trump travel ban, rhetoric and recent actions to detain and deport immigrants are creating direct impediments to immigration of needed medical personnel, and a hostile environment for many healthcare workers who consider immigrating to the US for training or jobs. It is in our self-interest to encourage the best and brightest come to the US rather than embracing public policies and rhetoric that repel them.

Seven thousand US physicians were born in the six countries covered by the Trump travel ban. These doctors provide 14 million patient-visits each year. Especially affected are patients in Michigan (1.2 million visits), Ohio (880,000 visits), Pennsylvania (700,000 visits) and West Virginia (210,000). In areas with current doctor shortages, the doctors born in these 6 countries provide 2.3 million patient-visits each year. [The Immigrant Doctors Project used US government data to create a map showing the adverse effects on each local area in the US https://immigrantdoctors.org/.

The negative impact of the Trump travel ban on our healthcare system is much broader than this. First, the rhetoric and initial actions have created substantial uncertainty (and inhospitality) for immigrants from many countries, not just the six listed in the travel ban. The best and the brightest of these have many options other than the US.

Second, both those currently working and training in the US and those considering immigration for training and/or better living conditions are also affected. For those currently training in the US, they wonder if they leave the US to visit family, will they be allowed to returned. When their training is completed, will they be allowed to stay? For those considering training or relocating to the US, they are making a multi-year commitment – mid-course disruption would be very costly to them. The uncertainty created by the recent rhetoric and government actions make the decision to come to the US an increasingly risky one.

Third, we rely heavily on non-physician healthcare workers – 1 in 6 of US healthcare workers are foreign born (nearly 2 million). Forty percent of foreign born healthcare workers are from Asia and the Middle East.

Each year, the US healthcare system depends heavily on immigration to meet the growing demand for healthcare services in the US. Between 2006 and 2010, the number of foreign born US healthcare workers grew from 1.5 million to 1.8 million – adding 300,000 new immigrant healthcare workers.

The US healthcare system relies heavily on foreign born doctors and other healthcare workers. Each year, its reliance grows. The demands on our healthcare system are growing substantially with the aging of the population. Current doctor shortages are predicted to growth dramatically, even if the past patterns of immigration continue. The Trump rhetoric and actions on immigration will impair the flow of healthcare workers immigrating to the US. We will all be worse off as wait times grow and access to needed services becomes more difficult.

Foreign born doctors have choices about where they work. Opponents of single payer models of healthcare financing often cite the longer wait times for patients in single payer systems like Canada and Britain. How ironic if US immigration policies end up reducing wait times in Canada while increasing our wait times.