Map of Malfunction: Health Wonk Review

This month's Health Wonk Review offers a smorgasbord of smart takes on the morphing ACA marketplace; various dysfunctions (and one or two functions) of U.S. health care; and political wars over Medicare and the ACA.

Whither the ACA?

First up: A trio of bloggers who focus mainly on the ACA each grapple with current political currents and policy and service changes.
                           
Louise Norris takes to VeryWell Health to pose a basic question What is Reinsurance and Why are States Pursuing It? Spoiler: it reduces premiums mainly at federal government expense, offsetting some of the disruption and sabotage of the past two years. And at healthinsurance.org, Louise covers everything you need to know about short-term plans -- past, present and immediate future -- with her signature thoroughness and clarity. Here she delves into pros and cons for an individual and here into changes in law and variations by state. Worth noting: while Louise fully recognizes the harm that the short-term market may do the ACA-compliant market, she also recognizes that many people are priced out of the current market and for some, short-term offerings may prove emphatically better than nothing.

Over at Balloon Juice, Duke's David Anderson warns that CMS's apparent plan to open catastrophic plans to more enrollees could roil the separate catastrophic risk pool. He maps out the two poles of catastrophic attraction: for those who expect to need little health care and have the resources to cover a "shock event," and those who know they will hit the out-of-pocket maximum on any plan.

Reacting to a Texas judge's apparent sympathy with the plaintiffs in Texas v. U.S., the suit by 20 Republican attorneys general and governors that seeks to have the ACA voided, Charles Gaba worries not so much about the endgame as about the effects of a possible injunction. Could the marketplace be facing another shock event?

There's a land that I see where the children are free*

Politically, California increasingly seems like another country altogether -- one where the government is committed to making affordable insurance available to all, or as close to all as possible within a U.S. political and funding framework. At Health Access California -- a driving force behind this sustained effort and part of the 50-member  Care4All California campaign-- Yasmin Peled marks the passage of a raft of bills designed to ward off current and potential future Trump administration sabotage. Recently passed bills ban the sale of short-term plans; ban Medicaid work requirements by statute; tightly regulate AHPs; codify the ACA's minimum MLR of 80% as state law; and launch a feasibility study for a state public option in the ACA marketplace.

Whom do you trust on Medicare?

At Managed Care Matters, Joe Paduda sees some irony in Republican attacks on Democrats' Medicare for All proposals:

The same folks who want to cut $537 billion from Medicare are now claiming only they can “protect” Medicare.

Out on the campaign trail, President Trump and Gov Rick Scott (R FL) are claiming “Medicare for All” would somehow harm Medicare, and seniors need to vote for them to preserve Medicare as it is.

U.S. health care in all its dubious glory

Henry Stern at InsureBlog reviews a blockbuster "bill of the month" exposé by Kaiser Health News' Chad Terhune, chronicling how a high school history teacher in Austin, TX was rushed to an out-of-network hospital for life-saving care after a heart attack -- and then socked with an out-of-network bill in excess of $100,000.  The story, spotlighting apparently egregious charges, shamed the hospital into forgiving the bill -- and helped spur bipartisan national legislation introduced last week to control balance billing. Only federal action can fully address the problem, because -- as Hank emphasizes --  self-funded plans, which cover the majority of Americans insured through their employers, are not subject to state regulation on this front.

In a podcast at the Active Business Blog, David Williams interviews ActiveRADAR CEO David Henka about pharmaceutical cost control abroad and at home. Henka suggests that global pharma companies essentially balance-bill U.S payers. That is, they know the restricted prices they'll get from other countries, and use the U.S. market to hit their earnings projections -- knowing they can basically raise prices at will here. One tool his company markets to help U.S. plan sponsors fight back (a little) is reference pricing: offering one drug in a given category as a benchmark, and making patients pay the difference if they want a more expensive drug in that category.

At The Medical Care Blog, Red Thaddeus Miguel, kicking off a "Bang for the Buck" series, focuses on cost-effectiveness research, with a look at a study that analyzed cost-benefit in a hospital-based smoking cessation program. The study found that healthcare costs for those who underwent the treatment were dramatically lower than among those who opted out, though the authors acknowledge that the results might be partially confounded by differences between the two groups.

At Health Care Renewal, Roy Poses takes a suspicious sniff at a Caribbean medical school that claims to be a cut above competitors but seems "even more opaque than its secretive peers."

Finally, here at xpostfactoid, I delve into Republican claims that they really really will protect access to health insurance access for people with pre-existing conditions -- and that their ACA repeal bills of 2017 did so. Perhaps more to the point, I wonder why we're all obsessed with pre-ex protections to the exclusion of spotlighting the trillion dollars Republicans tried to cut out of federal spending on Medicaid and marketplace subsidies last year -- and will doubtless execute if they maintain control of Congress.

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* with thanks to Marlo Thomas