January 2014 has been a big month in the world of health policy. For starters, it marked the implementation of the major provisions of the Affordable Care Act. Related to that, the President devoted a significant chunk of his State of the Union address to the topic of health reform. And, finally, your host for this edition of the Health Wonk Review–Wright on Health–unveiled a new and improved blog, which, like the ACA itself, will be implemented over an extended period.
Before I jump into all of the wonderful entries from my fellow contributors, I wanted to take a moment to tell you about the steps we’re taking here at Wright on Health. Please indulge my shameless self-promotion for a moment. For starters, we’ve expanded our team of contributing authors. Joining Nicole Fisher and me are Robert “Bob” Hackey, PhD, Professor of Health Policy at Providence College in Rhode Island, and Shirie Leng, MD, an anesthesiologist from Boston.
With these additions, our goal is to provide you with a wider variety of high-quality content, which spans the perspectives of academics, consulting, and clinical medicine. Of course, we’re still looking to grow. If you’ve ever been interested in blogging about health care or health policy, or if you conduct health services research that you think the public would benefit from understanding, we encourage you to join our team. It’s easy to get started. Just send us an email indicating your interest (and that includes you current HWRs). Over the next several months, we’ll be exploring how to work best with the University of Iowa College of Public Health, and making significant improvements to the design and content of the blog, so keep stopping by and checking us out to see what’s new. Now, on to the rest of this edition’s entries!
First,a lot has happened with ACA implementation, and people are still talking about it. We begin with Louise at the Colorado Health Insurance Insider, who explains that when it comes to private insurance on the exchanges, even with the new regulations, plan designs still vary a LOT. You can trust that your plan doesn’t have holes anymore, which is awesome, but it’s still not very easy to compare apples to apples.
On the topic of the exchanges, we also have Wendell Potter, who takes Wall Street Journal reporters to task for a January 18 story that took a “glass is half full” approach to reporting survey about enrollees in ACA’s health insurance marketplaces. The article focused on the fact that 2.2 million who signed up for coverage through the exchanges already had insurance. The real news, Potter says, is that the ACA has been steadily “chipping away” at the number of uninsured ever since it was enacted.
But not everyone feels the same way about the ACA. According to John Goodman who writes about “Risk Adjustments in ObamaCare” at his Health Policy Blog, “There is no such thing as a ‘price’ in the Affordable Care Act….The business model for health insurance companies has been completely turned on its head….[and] These incentives are precisely the opposite of what needs to happen to make the program work.”
At the state level, Anthony Wright of the Health Access Blog takes a look at ACA implementation in California. According to Wright, “We are just starting to make the ACA work, but some are already moving on to the next expansion fight, to cover the remaining uninsured, without regard to immigration status. The ACA both excludes undocumented immigrants, but creates a model that states and counties can build on top of.”
Also at the state level, Joe Paduda of Managed Care Matters chimes in with an update on Medicaid expansion in Michigan. With the Michigan GOP coming out in support of expanding Medicaid, Paduda now expects other states to follow suit, driven in large part by struggling health care systems and hospitals. Just like back in the sixties, it makes too much sense.
And then there’s Target. The firm recently cut health benefits for its employees. The Health Business Blog’s David Williams explains that how you interpret Target’s move depends on your view of the Affordable Care Act. My view is that ObamaCare is a great boon to part-time workers generally, and that not many part-timers will miss their employee sponsored coverage
Then, we have Jason Shafrin, the Healthcare Economist, discussing whether countries with a single-payer healthcare system should subsidize private insurance. He gives examples of Australia, Spain, and the UK, which do so, and looks at why they do it, and whether or not it’s a good idea.
That’s not all that different, really, from the federal government subsidizing the private insurance industry in the spirit of Medicare Advantage. But we’re trying to get away from that model in the post-ACA world by reducing Medicare Advantage payments. Yet, the InsureBlog’s Mike Feehan reports that Medicare Advantage plans may be enjoying a resurgence, as private Medicare Advantage insurers believe they have figured out how to provide better benefits and better service than traditional Medicare, for the same cost.
And, on the issue of who pays what and how much, we have two related posts from the Health Affairs blog on the landmark CMS-Maryland hospital rate-setting agreement. Robert Murray, President of Global Health Payment LLC and former Executive Director of the Health Services Cost Review Commission (HSCRC), Maryland’s groundbreaking all-payer hospital rate-setting agency, writes that the new model “will transform its hospital rate-setting system from a focus on controlling per-case cost toward population health and the total cost of hospital care per capita”; he outlines the policy implications of the agreement and challenges it will face. Carmela Coyle, president and CEO of the Maryland Hospital Association, discusses the ways in which the state’s hospitals will have to change their focus and writes that the agreement, “for the first time on a statewide level, provides the framework of a system that can deliver on the elusive Triple Aim of health care — reducing costs, enhancing quality and patient experience, and improving health.”
But the ACA is not the final piece of health care legislation to consider. Billy Wynne of Healthcare Lighthouse describes and comments on legislation recently introduced by Senator Ron Wyden (along with bicameral, bipartisan co-sponsors) that would reform Medicare through an emphasis on improving care for the chronically ill. With Senator Wyden ascending to the Finance Committee Chairmanship in the coming weeks, the bill is getting a considerable amount of attention.
Rounding things out, Roy Poses at Health Care Renewal shares two related posts on an unusual case: CareFusion’s large payment to a company owned by a prominent physician who also was co-chair of a National Quality Forum committee. The Department of Justice alleged the payment was a kickback meant to have the co-chair “throw” an NQF standard so that it would favor the CareFusion product. Skeptical NQF reviewers, however, smelled something wrong and wrote the product out of the final standard. CareFusion has now paid a $40.1 million settlement. This case is important as it shows how far those desperate to sell their product or service may be willing to go to promote it, how deliberately created conflicts of interests really may be kickbacks and bribes, and how skeptical health care professionals must be about the various well-intended edicts from on high that rain upon them.
And, finally, last but not least, Julie Ferguson of Workers’ Comp Insider notes that the recent explosion at the Omaha Nebraska feed plant that killed two and injured many others has all the hallmarks of a combustible dust incident. Many point to the failure of OSHA and the Obama administration’s to take regulatory action on passing a combustible dust standard, something that has lagged since the 2008 Imperial Sugar Refinery explosion that killed 14 workers and injured 36.