Health Wonk Review: Pivoting Towards the General Edition

For a long time, it seemed like the lead story on the Today show was the weather. More recently, it has been politics, and this week, things got even more interesting (if that was possible). On Tuesday, Bernie Sanders pulled off a surprise victory over Hillary Clinton in Indiana extending the Democratic primary season a while longer (although Clinton’s camp is quick to point out she leads by about 3 million votes), while Donald Trump won Indiana by double digits and became the presumptive nominee as Ted Cruz and John Kasich both suspended their campaigns. In short, it’s looking more and more like the country faces a choice between Clinton and Trump as our next president. Now, all the talking heads are pontificating about what we can expect from both candidates as they pivot towards the general election, which is wonkspeak for making an appeal to more moderate voters than they courted during the primaries. As I looked over the submissions for this edition of the Health Wonk Review, I was struck by the tremendous amount of variety being presented. Sure, there was some focused attention on a couple of prominent developments, but overall, it felt like a miscellany of health policy writing. There is something in here for everyone. It appeals to the middle. A month ago, Jaan Sidorov gave us a politics-free edition, and two weeks ago Peggy Salvatore went with a theme based on the order in which things hit her email inbox. So, why don’t we just tell it like it is? The Health Wonk Review is moving away from the extreme themes and pivoting towards the general edition.

Like a good politician, let me contradict myself about this being a general edition right out of the gate with a bunch of posts about the exit of UnitedHealthcare from the ACA marketplaces. On this topic, we have Andrew Sprung at the healthinsurance.org blog asking why some carriers appear to be thriving in the ACA’s marketplaces and why some – like UnitedHealthcare – are taking a dive. You can read what he proposes are the elements of marketplace success for an insurer here. At HealthReformExplained.com, Sean McGuire also takes a look at “the big insurer marketplace exodus” and examines what this will mean for people’s ability to obtain coverage and the costs of that coverage. David Williams of the Health Business Blog places the blame on UnitedHealthcare. As he puts it, United exiting the marketplace says more about United’s shortcomings than it says about problems with the marketplace. Read more here.

In other marketplace related news, Louise of the Colorado Health Insurance Insider discusses the passage of SB2 by the Colorado Senate, which she says is a waste of time. According to her, “if Connect for Health Colorado couldn’t gain access to the funding needed to be sustainable, the worst case scenario would be the dissolution of the exchange, and a switch to Healthcare.gov. And the federally-run exchange would charge 3.5% of premiums – the same as Connect for Health Colorado’s administrative fee that triggered SB2. And under ACA guidelines, every carrier that sells plans both on and off the exchange would have to spread their total exchange fees across their full book of business…which is the exact problem that SB2 is attempting to address.”

The other topic with multiple submissions is MACRA–the Medicare Access and CHIP Reauthorization Act of 2015. CMS just released their proposed MACRA regulations, and as you could expect, according to Brad Flansbaum of the Hospital Medicine blog, every specialty society and interested party dug in and found something to critique. Yet, Flansbaum writes, the AMA is unbeloved and overvilified in the whole MACRA process. And, according to Peggy Salvatore of Health System Ed, it’s time to prepare for legal challenges. Without the solid data, clear benchmarking and reasonable outcomes that account for the reality of caregiving in widely diverse regions with wildly diverse patient populations, quality- and outcomes-based payment just isn’t ready for prime time.

What has been happening with the job market thanks to the ACA? Joe Paduda of Managed Care Matters writes, “There’s been a lot of blather about the impact of ACA on employers’ decisions on work hours – most of it anecdotal at best, and lots ideologically driven.” Joe’s latest post is here to tell you what is really happening, and why it’s too early to tell much.

Before we shift gears from the political, Anthony Wright of Health Access California offers a suggestion for moving the country towards single payer. He writes, “The great primary debate on health reform had some missed opportunities, but as Senator Sanders seeks to influence the party platform, he could spell out concrete steps—some that California has implemented or is considering–that would improve the health system and bring us closer to the Medicare for All system he advocates.”

As usual, Roy Poses is on the hunt for a scandal of unethical proportions. In his latest post at Health Care Renewal, he examines comments from Fox commentator John Stossel who lamented his recent experience at New York Presbyterian Hospital–an unpleasant stay he chalked up to the hospital’s “socialist bureaucracy.” Poses wonders how, exactly, this private non-profit hospital with a board of trustees dominated by corporate CEOs of large financial firms like AIG, Merrill Lynch, and Citigroup, warrants a socialist label. He has a good point! By contrast, Hank Stern of the InsureBlog underscores that there was a great deal of truth to some of Stossel’s other comments about his experience, which are reflective of issues throughout the U.S. healthcare system. And speaking of hospital boards, Dr. Jaan Sidorov of the Population Health Blog reviews a recent JAMA article on how hospital boards should provide governance oversight of population health programs.

While recent news reports find that medical errors are now the 3rd leading cause of death, Julie Ferguson of the Workers Comp Insider shares a post about the opioid crisis and the fentanyl factor, at a time when prescription drug overdoses have outpaced auto crashes and gunshots in annual fatalities.

Putting the health in health policy, we have a trio of posts from the Medical Care Blog, the Health Affairs Blog, and the Healthcare Economist. At the Medical Care Blog, Lisa Lines suggests that death is not always an adverse event. She writes, “In a high-quality health care system, a patient’s preferences for less intensive end-of-life care must be respected. In those cases, the predictable end result of less intensive end-of-life care – mortality – must also be accepted as the preferred outcome and not count against a healthcare provider’s quality record.” Very true. What about readmissions? The Healthcare Economist, Jason Shafrin, investigates whether Medicare managed care decreases hospital readmissions. I’m not going to tell you the answer. You need to go here to find out.

And then there’s the Zika virus. On the Health Affairs Blog, Alexandra Phelan and Lawrence O. Gostin examine the implications of a potential Zika virus outbreak this summer and whether the U.S. is prepared to handle it. With alarming imagery, the authors write: “It is one thing to fail to prepare for an emerging infectious disease if the risks are uncertain. But it is quite another to fail to act when the facts are clear: we know that Zika is coming to the US, that it harms newborns, and will disproportionately affect poor women and their children. Failure to prepare for a storm that is spreading rapidly in our region, heading for our shores, and which could affect the next generation is unconscionable. It is also a major political mistake. Imagine if nine months following a Zika virus outbreak this summer babies are born with severe birth defects, and poor women testify in Congress holding their babies. It would, and should, result in a public moral outrage.” The authors specifically discuss the Obama Administration’s supplemental funding request of $1.86 billion to Congress to respond to the Zika virus domestically and internationally.

Finally, David Harlow of the HealthBlawg reports back from the MIT Hacking Medicine Grand Hack 2016. The final presentations gave him a terrific glimpse of digital health innovation at the bleeding edge. Read his take here.

Well, that’s it for this edition of the Health Wonk Review. By the time I host again, the election should be close to over. Hopefully, you can take some solace in that.