Fall may have arrived, but here in the shadows of the Rocky Mountains, we’re still having beautiful summer-like days. We’ve got a few yellow leaves here and there, but the pictures in this edition of the Health Wonk Review are mostly from years gone by, because we’re enjoying a particularly green September at the moment. We’ve got a great line-up of health wonkery for your perusal today, so pull up a chair and a cup of something delicious, and join us…
Ethics – when the lines get blurry
At Health Care Renewal, Dr. Roy Poses always shines the spotlight on unethical, corrupt, or questionable aspects of our healthcare system, and lately he’s been calling attention to the revolving door for executives between government and the private sector. His most recent example is Dr. Thomas Insel, who currently heads the National Institute of Mental Health and is moving to Google Life Sciences in November. As Poses succinctly describes the situation: “So Dr Insel clearly helped steer current US government mental health care research and policy towards its current course. Now he is going directly, not with any sort of delay or waiting period, to a commercial firm poised to take advantage of the current direction of US mental health care research and policy.” Are there conflicts of interest here? It’s certainly in the grey area, although the revolving door has become so commonplace that many people don’t even question it anymore. Poses notes that true healthcare reform would close the revolving door, permanently.
The ACA has reformed many aspects of our health insurance system, and a lot of new regulations are part of the picture. Of course schemes have sprung up that try to circumvent the rules. At InsureBlog, Hank Stern dug into the details of a “Classic 105” plan that purports to take money out of employees’ checks, “somehow ‘make it tax free’ and refund most of it back through some vague ‘loan’ that [the employees] apparently don’t have to pay back.” Doesn’t sound especially legit, and that’s exactly the conclusion Stern came to after investigating the details and running the whole thing past a series of experts. You know what they say about things that sound too good to be true…
Repeal and replace: 5+ years and going strong
At Health Affairs Blog, we have an excellent piece from John McDonough and Max Fletcher of the Harvard TH Chan School of Public Health. McDonough and Fletcher tackle the issue of what Republicans would do to replace Obamacare. If Republicans win the presidency as well as a majority in the House and Senate next fall, there are very pertinent questions about what they would do with regards to healthcare reform. Unfortunately, while several proposals have been advanced, none of them are anywhere near as comprehensive as the ACA; they would uniformly result in reduced access to health insurance and healthcare, particularly for lower-income Americans. McDonough and Fletcher provide a detailed analysis of eight proposals that have been put forward since 2012, and find them all lacking to some degree. For the most part, the replacement proposals call for a reduction in the amount of financial assistance available to help people pay premiums and out-of-pocket costs, and most of them would take us back to the days when people with pre-existing conditions had one option for coverage: the state-run high risk pool. And most of the proposals would eliminate Medicaid expansion, with no clear consensus on how they would replace it.
At healthinsurance.org, Charles Gaba also takes on the vast field of Republican presidential candidates and their desire to repeal the ACA. But Gaba points out that it might be beneficial for those candidates to actually shop on the exchanges for themselves and see how many private options are available to them – in some cases, there are more than a hundred different choices. And of course, those are private health insurance plans, which tend to be favored by the GOP. In many areas, the exchanges offer a vast array of options from which consumers can choose – and of course, subsidies are available to make coverage affordable for low and middle-income Americans.
2016 premiums – what should we expect?
Curious about what’s going on with individual health insurance rates for 2016? The Kaiser Family Foundation has been tracking the change in benchmark (second-lowest-cost silver) plans and lowest-cost silver plans in 12 states and DC, and Andrew Sprung has published an excellent summary of the data, including astute commentary, at xpostfactoid. Sprung notes that while changes in benchmark premiums are important, as are weighted average premium changes across the whole market, neither one accounts for enrollees’ ability to shop around during open enrollment. Because the ACA did away with medical underwriting in the individual market, people are free to switch plans during open enrollment, and carriers have seen significant market share volatility over the last two years. I have no doubt that there will be more shifting around of market share during the upcoming open enrollment period, and am curious to see how much actual premiums change in 2016, once we’ve accounted for plan changes.
When it comes to crunching the numbers for the 2016 rate changes, I haven’t seen anyone doing more extensive work than Charles Gaba. He’s been tracking the data all summer at ACAsingups, using proposed rate changes and then final rates as they’ve been approved over the last several weeks (some states final rates won’t be released until mid-late October). At this point, he’s combined all of the hard data available in every state, as well as educated guesses for the missing numbers, and he’s projecting a weighted average rate increase of 11% to 15% for 2016, nationwide. But he stresses the fact that those numbers only hold true if nobody shops around. Consumers in many areas will be able to secure much lower rate hikes – or even rate decreases – by shopping around.
Get sick on a Tuesday, but make sure you’ve got money
If you got to pick and choose the day of the week that you’re admitted to the hospital, your best bet would be a Tuesday, Wednesday, or a Thursday. Brad Flansbaum, writing at The Hospital Leader, explains a recent study that compared mortality rates based on the day of the week a patient is admitted to the hospital. Most hospitals have reduced staffing on the weekends, and unfortunately, patients admitted on Saturday and Sunday have an increased risk of death, by 10% and 15% respectively.
Bernie Sanders’ presidential campaign has shone a spotlight on the income inequality problem we have in the US – it’s certainly a pervasive problem, with far-ranging impacts. Jason Shafrin, aka the Healthcare Economist, highlights another gulf between the financial haves and have-nots: Our average life expectancy has grown over the years, but virtually all of the increase has been for the wealthiest 60% of the population. For the bottom two quintiles, the chance of reaching age 85 is virtually identical for people born in 1960 as it was for people born in 1930.
Ever-evolving healthcare IT
David Harlow, writing at Flow Health, explains the nuances of lifetime medical records. Who owns them? Who controls them? How do we want that to work going forward? Harlow notes that with modern technology, it’s possible to put the patient in control of their own lifetime medical records – including which providers and family members have access – while still centralizing them. He describes a system that Flow Health has established to provide patients with control over their lifetime medical records in a way that should be workable and useful to most patients.
While we’re on the subject of IT and healthcare, Peggy Salvatore’s post at Health System Ed explains the new “wide-ranging, ambitious and forward-looking” Federal Health IT Strategic Plan: 2015-2020. The plan is described as “one that puts the person at the center” and incorporates the tremendous advances in healthcare IT that we’ve seen over the past few years. The new plan’s mission includes the “… use of technology and health information that is accessible when and where it matters most.”
The more you know…
At Managed Care Matters, Joe Paduda has a great summary of current workers’ comp spending (not counting self-insured workers’ comp programs, which account for about a quarter of benefits). The takeaway? In 2013, workers’ comp spending on healthcare came to $31.5 billion. But things get a bit murky when you start to break it down into separate categories of spending.
At Workers’ Comp Insider, Julie Ferguson explains that OSHA can stop by a workplace for an inspection at any time, unannounced. She provides us with a list of Dos and Don’ts for when the OSHA inspector stops by – in general, being honest and polite will get you a long way. Violations may be found, but the whole point of the inspection is to discover those problems and get them fixed as quickly as possible; trying to hide them benefits nobody, particularly your employees who may be injured as result of the safety violations.
At the Population Health Blog, Jaan Sidorov discusses the merits of having physicians on the governing boards of health care organizations, noting that research indicates such a move is beneficial both in terms of financial health of the organization as well as medical outcomes for patients. Intuitively, this makes sense. If your business involves providing and/or financing healthcare, at least some members of your governing body should be healthcare providers.
At Health Access Blog, Anthony Wright digs into the US census data that confirmed a dramatic drop in the uninsured rate in the US last year. Numerous smaller surveys had also shown the uninsured rate to be dropping sharply, but the census data makes it official – and it’s based on data that was collected last year, which means the uninsured number is almost certainly even lower now. Wright notes that California used to have the 7th highest uninsured rate, and has dropped to 20th now – considerably progress in the first year. But there is still much work to be done, although California has a significant population of undocumented immigrants, who are not currently eligible to purchase coverage at all or enroll in Medi-Cal (but California lawmakers just passed a bill that would allow undocumented immigrant children to enroll in Medi-Cal if eligible based on income, without regard for immigration status – the bill has not yet been signed by the Governor).
That’s it for the fall colors edition of the Health Wonk Review – we hope you’ve enjoyed this collection of posts, and learned something new. Joe Paduda will be hosting the next edition at Managed Care Matters on October 8, so mark your calendars.