Monday, February 20, 2017

Health Action 2017: Times that try our souls

I attended Families USA's annual Health Action conference last week and found it deeply moving. My overview is up on  Here's an upshot of sorts:
The conference, to my mind, fulfilled the deepest purpose of such events. It was not so much a matter of convincing the troops that the goal of preventing the repeal of the ACA and further evisceration of Medicaid through block-granting is attainable. Some marquee speakers argued forcefully that those goals are achievable, others implied that the odds are long.

Strength lay more in the collective demonstration of expertise and commitment, evident as much in breakout workshops as in plenary sessions...
Then, zooming out to the plenaries, a highlight was outgoing (outgone?) acting CMS head Andy Slavitt's call to the assembled healthcareniks to respond to

Monday, February 13, 2017

More than half of ACA marketplace enrollees are in states that refused to expand Medicaid

I have noted on multiple occasions that in states that refused the ACA Medicaid expansion, marketplace enrollment has been bolstered by a large contingent of people who "should have" been enrolled in Medicaid. That is, over 2 million marketplace enrollees in those 19 states have incomes between 100% and 138% of the Federal Poverty Level (FPL) -- incomes that would have qualified all of them except for certain legally present noncitizens for Medicaid had their states accepted the expansion.

To review a few facts about these low income enrollees:

  • In nonexpansion states, 36% of enrollees had incomes in the 100-138% FPL range. In mid-2016 that came to about 2.1 million enrollees.

  • Close to 90% (or more*) of those low-income enrollees selected silver plans and so accessed Cost Sharing Reduction (CSR) subsidies that raised the actuarial value of their plans to 94%. That generally translates to a deductible of $0-250.

  • Customer satisfaction in the ACA marketplace is much higher among enrollees who are not in high deductible plans (defined by survey conductor Kaiser as under $1500 for an individual). In Kaiser's 2016 tracking survey, 74% of enrollees in lower deductible plans rated their plans good or excellent, vs. 59% of those in higher deductible plans. And again, the vast majority of enrollees in the 100-138% FPL range are in low deductible plans.

All that said, a fact hiding in plain sight (to me, anyway) is the extent to which nonexpansion states are over-represented in the ACA marketplace. This is not surprising, since a third of enrollees in those states should have been eligible for Medicaid. Nonetheless, I find it rather startling, based on state-by-state data released by HHS in December, that as of the end of the first quarter of 2016, the 19 nonexpansion states contained:

Friday, February 10, 2017

Love knows no repeal: HealthPolicyValentines 2017

Update 2/15: below is this year's complete harvest, as it grew from Feb. 10-14. Last year's trove is here. Love, 2015, here. First love, 2014, here.


I felt this afternoon I was getting quick-pitched on HealthPolicyValentines. But matron saint of the tradition, Emma Sandoe, tells me it's always kicked off on the Thursday before V-Day. So, like a loved one rushing to the scene of elopement, here am I (and see bottom for past years):

With this ring I thee wed;
with this kiss doth thou grace me.
Now promise you'll never
repeal and replace me.

     *      *      *

I can't call you true
on this true lovers' day.
You swapped my CSR
for this crummy HSA.

     *      *      *

Affordability and access!
We could eat our cake and have it
if we put our healthcare system
in the hands of Andy Slavitt.

Wednesday, February 08, 2017

Absent: A Novel speaks to our American present

Since the election, I've stopped reading the print newspaper in the morning. I can't take it in the early morning quiet. I inch into the news by degrees, via Twitter, at intervals throughout the day. I also miss a lot. 

I haven't read much fiction in recent years, so, in the void left by the paper, I resolved to take a tour of the world through fiction.  I thought I'd start with Najuib Mahfouz. But somehow along the way Amazon caught me with Absent by Betool Khedairi, a novel set in Baghdad during the sanctions period in the wake of the first Gulf War.  It's exactly what I wanted -- a day-by-day of life elsewhere. It's grown on me by degrees. It's magnificent.

It's one of those quiet and apparently plotless novels, built encounter by encounter, vignette by vignette, though it's plainly trending somewhere. The "quiet" is quiet desperation. People are slowly starving, or decaying for want of medicine or sanitation or employment (though everyone finds some way to scrape some kind of living). The backdrop is adults' memories of the Days of Plenty, the period before the blockade, and the first Gulf War, and the Iraq-Iran war -- when children going to school had pencils and uniforms, and crosswalks were repainted at intervals, and refrigerators had food in them and stayed on all day.

Monday, February 06, 2017

ACA doctors (of the law): What would you do with $3-5 billion per year?

Republicans in power certainly don't want the ACA marketplace to thrive. But for the most part they don't want it to precipitously collapse, either -- though it's not hard to imagine the Trump administration pushing it off a cliff and then trying to blame Democrats ("it was collapsing already...").

While Republicans have no real wish to make adequate health insurance affordable for lower income people, they may prove somewhat receptive to the wishes insistences of insurers, out of long habit and because, again, they don't want the market to collapse. The Trump administration is reportedly considering a package of short-term stabilizers that includes enabling by administrative fiat a minor increase to age banding (the multiple by which older enrollees can be charged more than younger ones); allowing insurers to cut off coverage for late payers after just 30 days instead of the current 90; and tightening the standards and verification for those seeking "Special Enrollment Periods" (SEPS) outside of open enrollment.

Wednesday, February 01, 2017

Repair, not replace -- rebranding, or real change? Watch the Medicaid expansion

The battle over ACA repeal-or-whatever is going to go through a lot of twists and turns and bold assertions that will fade like morning dew. Still, the latest Republican messaging and positioning seems at least potentially significant. From The Hill's Peter Sullivan:
Key Republican lawmakers are shifting their goal on ObamaCare from repealing and replacing the law to the more modest goal of repairing it...

“I'm trying to be accurate on this that there are some of these provisions in the law that probably will stay, or we may modify them, but we're going to fix things, we're going to repair things,” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), a key player on healthcare, told reporters Tuesday.

Monday, January 30, 2017

In a fraudster's grip

This is just to note that today Paul Krugman caught the essence of the Trump presidency in 80 words:
Our government hasn’t always done the right thing. But it has kept its promises, to nations and individuals alike.

Now all of that is in question. Everyone, from small nations who thought they were protected against Russian aggression, to Mexican entrepreneurs who thought they had guaranteed access to our markets, to Iraqi interpreters who thought their service with the U.S. meant an assurance of sanctuary, now has to wonder whether they’ll be treated like stiffed contractors at a Trump hotel.
Anyone over the age of five, regardless of political propensity or education level, should have been able to see that this is what Trump would deliver. Those who couldn't see it, driven by whatever passion or need, willfully shut their ears and eyes. His depravity was as manifest as Hitler's. Whether his will to evil is as intense, we'll learn.