Health Wonk Review: Repeal Fatigue Edition

For health policy wonks, 2017 has been exhausting. First, Paul Ryan pulled a bill from the floor of the House because he didn’t have the votes. Obamacare supporters–or at least those opposed to the notion of taking insurance coverage away from tens of millions of Americans–breathed a sigh of relief only to watch a revised version of the bill pass the House a short while later. Then, the Senate took up repeal legislation, only to vote it down at the hands of Senators Collins, McCain, and Murkowski. The zombie seemed dead once more, but zombies rarely stay dead. Soon, we learned of Graham-Cassidy. Then, just this week, after Senators Collins, McCain, Paul—and potentially Murkowski—announced their opposition to the bill, the GOP leadership announced that the Senate would not vote on Graham-Cassidy. Given budget reconciliation rules, the Senate only has until September 30th to pass a repeal bill with just 50 votes (Vice President Pence then casting the tie-breaking vote). Thus, it would appear that repeal efforts will be delayed until the spring of 2018 when fiscal year 2019 begins, and new budget reconciliation rules are established. All of that said, I am sick and tired of sitting on pins and needles as this process has unfolded. Based on the submissions I received this week, many of my colleagues seem to share my sentiments, as very few posts focused on Graham-Cassidy. In recognition of that, I present you with the “Repeal Fatigue” edition of the Health Wonk Review.

First up, though, I’m going to get the Graham-Cassidy post out of the way. Charles Gaba at ACA Signups who submits “Revenge of the Three-Legged Stool: Graham-Cassidy Edition” to explain how the proposed bill would disrupt the individual insurance market using everybody’s favorite health care metaphor. Meanwhile, the HELP Committee hearings in pursuit of bipartisan legislation to stabilize the individual insurance market hinged in large part on loosening up the ACA’s Section 1332 “innovation waivers,” through which states can propose to alter — and potentially redesign — their ACA marketplaces. The flashpoint concerns the so-called “guardrails,” which stipulate that a waiver proposal must demonstrate that the alternative scheme will cover at least as many people, with coverage at least as comprehensive and affordable as in the state’s existing marketplace, without increasing the deficit. Can those standards — or the way in which HHS applies them — be eased in any way acceptable to Democrats? In How could Patty Murray ‘thread the needle’ with Lamar Alexander? Andrew Sprung of xpostfactoid sketches a boundary line that Democrats may have to decide whether to cross. Finally, InsureBlog’s Henry Stern discusses the lie that was “bending the cost curve down.”

Jay Norris of Colorado Health Insurance Insider, writes “In Colorado, (like most states) we don’t have a reliable measure for the network size for each insurance carrier. I’m trying to get the ball rolling with a python program I wrote to parse SERFF data and create the bar chart shown in the submitted post. So far, the results are somewhat surprising and very interesting. I’m almost finished with a script that will automatically parse all 64 Colorado counties and create bar charts for each county. I’m trying to finish that script tomorrow and will hopefully have some county level data included in that same post.” Read the full post here.

Jason Shafrin, the Healthcare Economist, revisits a classic article describing why the way doctors die is different compared to the rest of us.

At the Health Business Blog, David Williams writes “Clinical registries produce real world evidence that can be used to improve quality and change clinical guidelines. However, data collection and submission is manual and time-consuming, and hospitals are increasingly turning to external vendors to help. A new study shows that this market will reach nearly $2 billion in the next five years.” Check it out here.

Two posts focused on vulnerable populations. Holly Stockdale and Susan Haber, writing for the Medical Care Blog, share the post “Despite ACA mandates for states to streamline renewal, many beneficiaries still need assistance to retain Medicaid coverage.” According to Stockdale and Haber, “Enrollment in Medicaid has been shown to enhance access to health care for our nation’s most vulnerable citizens. Yet despite these benefits, a substantial number of beneficiaries lose coverage at the time of renewal. An article by Xu Ji and colleagues, published in this month’s issue of Medical Care, demonstrates how critical maintaining continuous Medicaid coverage is for beneficiaries with mental health conditions.” In this month’s episode of #CareTalk, David Williams (Health Business Group) and John Driscoll (CareCentrix), chat about the recent hurricanes that have impacted the USA and what can be done to protect vulnerable populations.

In “More Dumb Things Leaders Say About Health Policy,” Health Care Renewal’s Roy Poses writes “We have discussed many instances of ill-informed leadership of health care organizations. But there has been nothing quite like the recent ignorance of political leaders, often as brought out by the debate over whether to ‘repeal and replace Obamacare.’ Here are three examples from the top of the US executive branch, but also – just for old times sake – from the CEO of one of the biggest US for-profit health insurance companies. Once again I speculated on how much of this is due to “managerialism,” the idea that all organizations, including health care, should be run by people with management backgrounds, but not necessarily with any expertise in what the organizations actually do, again including health care. Or is it part of a growing anti-intellectual trend? In any case, the increasing tendency of top leaders who control health care to ignore facts (and often logic) is extremely dangerous. True health care reform would enable leadership that is well-informed, upholds the values of health care professionals, is honest, open and transparent, is willing to be accountable, and is thoroughly ethical.”

Joe Paduda of Managed Care Matters shares a fascinating post about the opioid crisis. According to him, “Opioids may be a key reason many males are no longer in the workforce – with major implications for Medicaid, workers’ comp, the economy, and health care providers.” Read the full post here.

Lastly, at the Workers Comp Insider, Iowa’s legislature recently enacted a series of measures designed to effect workers’ compensation reform. After a recently announced reduction in the state’s workers’ comp rates, Tom Lynch of Workers’ Comp Insider thinks that someone may need a lesson in the principle of correlation does not equal causation.

That’s it folks. Sorry for the lack of pictures–my turn in the hosting rotation coincided with a busy week. Now go and enjoy a few months without any impending repeal and replace votes!