Health Wonk Review: Who’s On First? Edition

These days, it seems we are awash in what Kellyanne Conway calls “Alternative Facts.” I’ve heard or seen more than one commentary questioning whether we are living in a post-truth age. As these opinion pieces typically lament: We were once entitled to our own opinions, but not our own facts. Now, it seems that we are all entitled to our own facts as well. The most recent example might be President Trump’s recent tweet proclaiming the Republicans’ “big win” in the special election for House district 6 in Georgia. In fact, the Democratic candidate, Jon Ossoff, captured 48.1% of the vote, while the leading Republican, Karen Handel, captured just 19.8% of the vote. In no rational world is that a GOP victory. Indeed, Ossoff and Handel now face a run-off election.

But this is the crazy state of things in America–and around the world–these days. And the irony is that the actual facts are confusing enough in their own right. As many of the posts in this edition of the Health Wonk Review make clear, there is little need to spin alternative facts, or move to a post-truth world (as if that’s even possible), when so much of what we are dealing with is hard enough to understand or solve as it is. In the spirit of things as they actually are coming across in ways that perplex even the wonkiest among us–and an homage to the return of baseball season–I offer the “Who’s On First?” edition of the Health Wonk Review.

As usual, the elephant in the room is the ACA. In fact, Joe Paduda wonders at the Managed Care Matters blog why the Republicans in Congress are still trying to repeal and replace the ACA after they missed their chance with the AHCA legislation that was pulled from the floor last month. For him, not even Abbott and Costello are enough–only Monty Python provides the lens to make sense of the GOP’s determination to fail again and harm itself further in the process.

Of course, if repealing and replacing doesn’t work, there’s always the administrative approach to destroying the ACA. And one way to do that is to stop paying for cost-sharing reduction (CSR) subsidies. At xpostfactoid, newcomer to HWR, Andrew Sprung writes: “Without CSR, the marketplace wouldn’t be even marginally serviceable for prospective customers with incomes below 200% of the Federal Poverty Level.” As he explains, over half of current marketplace enrollees fall below that level. He reviews how CSR enhances a silver plan, how CSR-enhanced silver compares to employer-sponsored insurance, and what the marketplace would look like without it.

At the healthinsurance.org blog, Louise Norris writes about the alternative facts being promoted by the GOP that the ACA marketplaces are in a death spiral. Not true, she says, but also not entirely false. Taking a closer look, Norris points to evidence that Obamacare is not “collapsing of its own weight,” but does find that a handful of state marketplaces appear to be on thin ice.

Beyond the health of the state Marketplaces, one of the real worries, if repeal and replace is ever passed, is what might happen to you if you have a pre-existing condition and are unable to obtain coverage in the absence of guaranteed issue. Charles Gaba of the ACA Signups blog has the numbers that members of Congress (and others) will care about. Namely, how many people in each Congressional district have a pre-existing condition and risk losing their insurance coverage.

An often floated alternative is to allow the sale of health insurance across state lines. This is a very common Republican idea, while Democrats are quick to highlight why such an approach will never work. At the InsureBlog, Mike Feehan debunks some of the myths surrounding the idea of purchasing health insurance “across state lines.” While I’m not personally sold on the idea, do be sure to check out the lively discussion in the comments section!

Before we leave the topic of health reform, Roy Poses has something for us to consider at the Health Care Renewal blog. Maybe, he suggests, we need to listen to providers for ideas about why our health care system doesn’t work as well as it could, and how to improve it. In his usual watchdog role, Poses finds that the authors of a recent National Academy of Medicine position paper are physicians, but they are also physicians who serve on the board of directors of health care corporations. Other authors were health care executives and lobbyists. Most of these major conflicts of interest were not disclosed, says Poses. In short, “The health care reform discussion in the US continues to be dominated by big corporate interests, even though they are often thinly disguised. We will not get far with true health care reform unless we can have an honest discussion which included voices of patients, and of health care professionals free of influence of big health care organizations, particularly big health care corporations.”

Turning away from health reform and to a couple of posts focused on medical treatment, we have entries from Jason Shafrin of the Healthcare Economist and David Williams of the Health Business Blog. Jason asks “Why aren’t there more cures?” He investigates why there are a lot a treatments that address diseases over time but fewer cures developed. Where testing and treatment–including curative treatment–does exist, it’s not always clear whether it’s beneficial. Nothing is without risk. But perhaps there is some middle ground. David writes about this in the context of PSA screening for prostate cancer. As he says “I oppose over-testing and over-treatment, so I really had to think hard five years ago when I turned 45 and my doctor offered PSA screening for prostate caner. The US Preventive Services Task Force (USPSTF) had just come out against PSA screening. I opted for the test at the time anyway. Now the USPSTF’s thinking is swinging around to my logic.” He explains in more detail in his thought-provoking post.

Finally, at Workers Comp Insider, Julie Ferguson–who also hosts our next edition on May 4–reminds us that Workers’ Memorial Day is coming up and explains why it is so important to remember the health and safety of the worker, especially in a time of regulation slashing and program defunding.

Well, that’s it for this edition. Get outside and enjoy the Spring–but maybe take a Claritin first!