Throughout 2017, nearly every week has seemed like a very big deal for health care reform. But this week is especially noteworthy, with bipartisan efforts to stabilize the individual insurance markets (cough… fund CSRs… cough), along with not one, but two major pieces of legislation unveiled on Wednesday: Senator Sanders’ single-payer bill (which garnered 16 co-sponsors, up from zero when he introduced single-payer legislation in 2015), and Senators Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson’s ACA repeal/replace bill. To say it’s a whirlwind in the health care reform sphere would be a bit of an understatement.
And yet, there is more to healthcare and healthcare reform than the merry-go-round of federal legislation, as evidenced by the wide range of topics covered by our health wonks in this edition. But to get things started, let’s take a look at an article inspired by Sanders’ single-payer bill:
David Williams, at Health Business Blog, delves into the single-payer debate, with a “don’t say I didn’t warn you” article. Williams astutely and succinctly summarizes the last seven years of GOP obstruction against the ACA, which was absolutely a moderate bill designed to appeal to Republicans (left entirely to their own devices, Democrats would have enacted single-payer decades ago). Williams notes that he is among those who want to “preserve capitalism and private innovation in healthcare” and that the best approach for people in this camp is to “embrace the Affordable Care Act and look for ways to improve it,” as the alternative will be an ever-increasing push towards single-payer.
Dr. Roy Poses‘ article on Health Care Renewal is a must-read, and is as shocking as it is sad. Hookworm, widely considered a disease of developing countries, was prevalent in the southern US a hundred years ago. But Dr. Poses explains that it’s returned, and is now as common in Alabama as it was in the early 20th century. The Shame of US Health Care Dysfunction: Hookworm Returns to Alabama details the near eradication of hookworm in the US by the 1970s and 80s, thanks in large part to adequate modern plumbing. But impoverished Alabama resident are unable to afford proper septic tanks (which can cost more than their annual income), and the government doesn’t seem to consider it their responsibility to help people afford adequate sanitation systems, despite the grave threat to public health. Dr. Poses explains that the Alabama study is “a vivid illustration of how dysfunctional the US health care system has become. After all, we spend more per capita than any other country on health care, and this is a result. But how much of that money goes to feathering nests of powerful health care leaders, and their cronies? We never needed true health care reform more.”
At HealthBlawg, David Harlow has an insightful article about multiple approaches to reducing opioid abuse. The article is jam-packed with facts and details, and Harlow notes that “the [opioid]problem is multi-dimensional, so the solution must be multi-dimensional.” Blame for the opioid crisis rests at many feet, and the solution will require multiple approaches.
If you’re interested in the intersection of health insurance and data science, Jay Norris (aka, my better half) has created a great data visualization of Kaiser Permanente’s individual market enrollment in Colorado, combined with 2018 premiums and actuarial value. Jay’s working on similar graphics for other Colorado insurers, but the complete data isn’t available on SERFF yet. Keep an eye out for more.
John Driscoll, CEO of CareCentrix, writes Trump’s Not Fighting for Lower Drug Prices. Can the States Take Over? Driscoll notes that during the campaign, Donald Trump “railed against drug prices” but has done nothing to address the issue since taking office. Rising pharmaceutical costs are 
a primary driver of overall health care inflation, and have become an ever-increasing part of the justification that insurers provide for raising premiums each year. So is this an issue that states could tackle on their own, as they have with various other issues that the federal government hasn’t addressed adequately? Driscol points out that “California has more people than Canada, Texas outranks Australia, and New York’s population is double that of Sweden’s. Yet pharma companies make sweet deals with all of those countries, at least compared with what we see in the U.S.” He goes on to note the hurdles that states would face, and the efforts that New York is making in this area. Certainly food for thought.
At Managed Care Matters, Joe Paduda (who is also a candidate for County Legislator, Onondaga County 6th District) shares his colleague, Peter Rousmaniere’s eye-opening article about the Harvey recovery effort in Texas and the state’s lax workers’ compensation laws. Texas doesn’t require employers to provide workers’ comp coverage to their employees (I didn’t know this!) and they’re facing a protracted recovery process that is sure to involve plenty of physically challenging work and various on-the-job injuries. Combine that with the depleted workforce due to the Trump Administration’s crackdown on undocumented workers, and you end up with “grief, schadenfreude, and uncertainty.”
Continuing the workers’ comp theme, Julie Ferguson at Workers’ Comp Insider explains a job that’s probably a lot more dangerous than most of us imagine. “Kicked, pummeled, taken hostage, stabbed and sexually assaulted … would you want a job that included these risks?” What job 
might this be? The answer — nursing — might surprise you. But “the rates of workplace violence in health care and social assistance settings are five to 12 times higher than the estimated rates for workers overall.” More than one in five nurses reported being physically assaulted at work during a 12-month period, and more than half were verbally abused.
At InsureBlog, Kelley Beloff writes about a study that found that cash incentives were effective in getting newly-insured low-income people to visit a primary care doctor. Beloff notes that getting patients to visit the doctor is only the first step, and an easy one at that (and expresses no surprise at the fact that people are motivated to go to the doctor when they’re getting paid to do so). The hard part is getting them to comply with the doctor’s advice after the visit is over.
At The Hospital Leader, Brad Flansbaum explains how hospice care is reimbursed by Medicare (spoiler alert: for the vast majority of care, it’s not very much), and the fact that providers are not always aware of how reimbursement changes when a patient switches to hospice care. In good news, he notes that CMS is testing some new benefit designs to see if they improve outcomes.
Jason Shafrin, aka The Healthcare Economist, recently attended a panel discussion at the National Press Club on Understanding the Value of Innovations in Medicine. His article summarizes the topics that were discussed, and he also included links to a full video of the panel discussion and the slide presentations.
And — editor’s privilege — I’m including two of my own articles in this edition. The first is an explanation of why children’s health insurance premiums are going up in 2018, for individual and small group insurance coverage. And the second is an overview of where health insurance companies are exiting and entering the exchanges for 2018 (note that it’s from late August, before Optima decided to reverse their planned coverage area expansion in Virginia — but hopefully you’ll find it to be a useful resource if you’re watching insurer participation in the exchanges across the country).
The next edition of the Health Wonk Review will be hosted by Brad Wright, at Wright on Health. If you’re writing great content about healthcare or health policy, send Brad an article for consideration in the upcoming edition. A full schedule of upcoming editions and an archive of previous Health Wonk Reviews is available here.
