Thursday, November 30, 2017

Late Days of Empire Edition: Health Wonk Review

We're addled on many fronts here in Trumpville, and this week's Health Wonk Review reflects that. We have snapshots of a country that continues to trail its peers in population health measures; an opioid vendor looking to short-circuit potential tobacco industry-level liability; an individual market for health insurance offering unaffordable plans to many of the unsubsidized, and freakish bargains to some of the subsidized; and, for a little futuristic relief, a human resources tech vendor that may chain healthcare data to a block, where it shall remain unaltered forever and ever.

At Workers' Comp Insider, Tom Lynch  looks at what the U.S. gets for spending 41% more on health care than our wealthy nation peers in the OECD and 81% more than the entire 35-nation OECD average. Spoiler: not much. We're "sort of like a big-market baseball team spending gazillions more for players than any other team, only to finish out of the running."

At Managed Care Matters, Joe Paduda notes that Purdue Pharma is trying to strike a deal to resolve all state claims relating to opioids. He warns:

For workers’ comp payers, it is time to get together and develop a legal strategy and approach to suing opioid marketers. The human and financial damage caused by Purdue, Endo and their ilk is incalculable and continuing to grow. Without a successful legal action, employers and taxpayers will be footing the bills for decades to come.
While the U.S. may rank low in population health measures,  Roy Poses at Health Care Renewal notes that the country ranks high among developed nations in public perceptions of corruption.  Flagging Transparency International's most recent polling, conducted globally from March 2014 through January 2017, Poses notes that 
more than one-third of US respondents thought that most executive branch leaders, legislators, and business executives are involved in corruption,  Just less than one-third thought that most government officials are involved in corruption.  More than one-half of US respondents thought that the government is handling the fight against corruption badly.
As Poses recounts in some detail, healthcare industries in the U.S. are far from immune from corruption.

At the Health Business Blog,  David E. Williams, president of Health Business Group, interviews Brian Platz, CEO of human resources software provider SilkRoad Technology, about potential blockchain applications in healthcare, specifically the blockchain database on offer from a vendor called Fluree. A principle benefit, Platz asserts, is  permanence and transparency in the database. In drug trials, for example, blockchain might enable the recording of results in real time in a way that can't be altered. The progress of drugs through a supply chain can potentially similarly be frozen in amber. Will the promised transparency benefits clash with needs for privacy and security?  Tune in to the podcast.

Now on to the ACA marketplace and its discontents, as well as its stubborn successes:

With the Alexander-Murray bill to fund Cost Sharing Reduction subsidies being held out by Susan Collins as an offset to the Senate tax bill's effective repeal of the individual mandate, David Anderson asserts that the CSR funding train has left the station. Insurers have priced CSR in, and markets have adjusted. Here's David's rather stunning claim:
Alexander-Murray when measured against current reality is a $200 billion dollar reduction on health insurance subsidy spending.  Funding CSR makes Bronze and Gold plans much more expensive for subsidized buyers.  It does not meaningfully change non-subsidized premiums for most states as they were smart enough to not require a broad load on and off-Exchange.  Funding CSR makes a lot of people a lot worse off.  Right now we are seeing good enrollment numbers.
At ACA signups, Charles Gaba asks a question for our times. As ACA marketplace enrollment hurtles toward this year's finish, will Trump Sabotage A (cutting off CSR funding, thereby making bronze and gold plans cheaper for subsidizing enrollees) cancel out Trump Sabotage B/C/D (cutting advertising, outreach and enrollment period length)? Gaba reads the rather confusing enrollment data  tea leaves and comes up with... a range.  Bonus: Gaba branches out into film-making with an affecting tale about an adorable three-legged stool you may have heard of.

After two years of sharp premium increases in the individual market, a lot of unsubsidized people dependent on that market are going to be exempt from the individual mandate this year (if Republicans don't kill it off entirely). At, Louise Norris lays out the rules for exemption methodically and clearly, as is her wont -- considering every eventuality, such as "What if you're uninsured November through February?" (think about that a moment).

And in case you've lost track of which states have filed ACA Section 1332 "innovation waivers," and what HHS has done with them, Louise will bring you up to speed on that too at Verywell.

Finally, here at xpostfactoid, I suggest that some of us ACA marketwatchers need to curb our "free bronze" enthusiasm a bit. To some prospective low income enrollees, the Trump-skewed marketplace offers what may feel like a Hobson's choice between free plans that don't give them access to actual healthcare ($7,000 deductible, anyone?) and more comprehensive CSR-enhanced silver that feels prohibitively expensive (say, $120/month with an $800 deductible for a person earning $24,000).

Note: The Roy Poses contribution was added at 5:00 p.m., 11/30.

1 comment:

  1. I have been feeding much of your comments to congressional candidates so they understand what Trump did which may not be the catastrophe everyone thinks it is. I have been saying all along also. Thank you for your continued support of the truth.