Health Wonk Review: Spring Forward Edition

This has been a record-setting winter, and not in a good way (Here’s looking at you, New England). It’s also been a volatile time in the world of health policy–and the ACA in particular. We’ve had the second open enrollment period come and go, the Supreme Court has heard oral arguments around the provision of federal subsidies to health insurance exchanges not run by the states, and three Republican members of Congress have come out with a proposal to repeal and replace Obamacare. With much of the country still blanketed by snow, and the fate of the ACA up in the air until the Court’s expected ruling on King v. Burwell in June, let me assure you that there is a light at the end of the tunnel. We’ve just moved our clocks forward one hour this week, which will usher in the longer days and warmer temperatures that so many of us desperately await. As the mercury climbs higher, the snow begins to melt, and policy wonks ramp up their prognostications, I offer this Spring Forward edition of the Health Wonk Review. I hope that it will help you shake off the winter blues and be better informed about current developments in the world of health policy.

It should come as no surprise that the overwhelming majority of submissions for this edition are focused on the Supreme Court and King v. Burwell. Writing at the Healthcare Economist, blogger Jason Shafrin does a good job of presenting an overview of King v. Burwell for those who are not thoroughly familiar with the case, what’s being argued, and what’s at stake. As such, this seemed like a fitting piece to lead things off.

A close second, thanks to its comprehensive tackling of the case, is the Health Affairs Blog. While they have an entire set of posts on the topic, I’m linking solely to a post by Tim Jost, which in turn links to all the others. Tim’s post delves into the nuances of the oral arguments, looking specifically at the doctrine of constitutional avoidance raised by Justices Sotomayor and Kennedy. Lest you think that means they were suggesting that the ACA is unconstitutional, it doesn’t. Rather, it means that they were suggesting that the ACA be interpreted in such a way as to “avoid any constitutional issues.”

If that’s not enough for you, I encourage you to check out a post by Billy Wynne of the Healthcare Lighthouse. Billy’s reading the tea leaves from the oral argument and offers up his top 6 most pivotal moments during King v. Burwell. Some developments that have flown under the radar are Justice Alito’s assertion that the decision could be stayed to allow time for Congress or states to respond, if necessary, and the challengers’ concession that the context of the operative provision of the ACA is important to interpreting it. Ultimately, the post suggests that it was a better day for the Administration but warns against drawing strong conclusions from oral arguments.

After something of a hiatus, Maggie Mahar is back blogging at Health Beat. In a post asking “Will the Supreme Court Scuttle Subsidies?” she takes a clear stance. The rest of her post’s title is: No. (What Can’t Happen Won’t). Her reasoning? Legal precedent doesn’t support cherry-picking from the text of the law out of context, the Court would undermine its integrity if it sided with the plaintiffs, and the political fallout would hurt Republicans.

By contrast, John R. Graham, a senior fellow of the National Center for Policy Analysis, anticipates that the Court will find for the plaintiffs and that millions of people who are suddenly without subsidies will drop their coverage. According to Graham, however, that is not the cause for alarm that many policy wonks are suggesting. Rather, this will simply be an opportunity for Congress to work with the President to fix the various elements of the ACA that nobody seems to like. The idea is that rather than making a simple fix, Congressional Republicans can use this as an opportunity to make more significant changes to the law.

One such proposal is that put forward by Senator Burr, Senator Hatch, and Representative Upton. They proposed what they are calling the “Patient CARE Act” and I have been writing about that plan extensively of late. I encourage you to read about starting with this overview before proceeding to learn about what the GOP would like to do that will lessen consumer protections, make life more difficult for people with pre-existing conditions, reduce the amount of federal subsidies for health insurance, give more power to the states at the expense of the people, and provide more tax shelters for the wealthy under the label of consumer-directed health savings accounts.

Regardless of the outcome of the case, Wendell Potter isn’t optimistic. In a recent piece for the blog at healthinsurance.org he writes: “Regardless of how the Court eventually rules in King v. Burwell, your premiums will likely go up next year simply because the justices agreed to take the case in the first place.” He goes on to explain how the case has introduced uncertainty into the rate setting process, and how insurers tend to hedge their bets against such uncertainty by raising rates. Under that logic, you can thank those who are trying to get rid of Obamacare for raising your insurance premiums.

Fortunately, for some states that have decided to run their own exchanges, like California, King v. Burwell is irrelevant. As Anthony Wright (no known relation–although maybe he and I share consider partnering up at Wright on Health) writes at the Health Access Blog: “We have our own state exchange, and while some worry about the political fallout, I have a hard time believing the President (or for that matter, Pelosi and Reid from CA and NV) would accept a compromise that undid coverage in the states that did the right thing, like California and Nevada. With a new President, all bets are off, but that was always true.”

And, while we’re talking about the states, it’s worth noting that many states are creating special open enrollment periods for residents who are just finding out about the individual mandate (and the associated tax penalty) when they go to file their taxes this year. The issue, of course, is that open enrollment ended February 15th, while the tax deadline isn’t until April 15th. Rather than penalize people for two years, states came up with the idea to let these individuals purchase coverage if they attest that they only learned about all these requirements to have insurance or pay a tax when they went to pay their taxes. But Louise at the Colorado Health Insurance Insider tells us that this won’t be happening in Colorado. According to the state’s insurance commissioner, Marguerite Salazar: “After considering all the factors and consulting with Connect for Health Colorado, the Division determined that the negatives of starting up another enrollment period outweighed the positives.”

Of course, not all wonks lead to SCOTUS. We also have a number of wonderful submissions on a variety of topics. Among these are David Williams’ piece on emulsifiers in the Health Business Blog. He highlights an intriguing and plausible new study in the journal Nature that suggests synthetic emulsifiers that are common in processed food could be a key cause of the obesity epidemic and a trigger for ulcerative colitis and Crohn’s Disease. He says that his family is avoiding emulsifiers as much as they can, and that food companies should develop emulsifier free products now in anticipation of rising demand.

Both Joe Paduda of Managed Care Matters and Tom Lynch of Workers’ Comp Insider are focused on the topic of workers comp. Joe explains that NPR and ProPublica have published the first in what will be a series of articles on workers’ compensation. What’s striking about the reportage, he says, is how misguided, misinformed, and just plain distorted it is. Tom explains that, by law, workers’ comp is the exclusive remedy for workers who are injured on the job. He underscores that, in exchange for relinquishing the right to sue, the employee receives employer-paid medical care and temporary wage replacement, but he also asks: Is they system fair? Some new research suggests maybe not.

Over at Health System Ed, Peggy Salvatore writes about health IT, exploring the disconnect between the cutting edge technology we’re developing and our ability to implement more basic technology throughout the healthcare delivery system. The result is likely to be a lot of wasted money. As she puts it “Our society and its component businesses are financing an infrastructure that serves the needs of people who live to be 100 in a time when babies are born who will live to see 2515.”

Friend of the HWR and InsureBlog author, Hank Stern, is also exploring some of the issues with healthcare delivery systems. In particular, he’s exploring the problem of nationalized healthcare schemes and economic inelasticity. SPOILER ALERT: Every nation rations healthcare.

At Health Care Renewal, Roy Poses explores what the recent U.S. experience with Ebola–and the fiascoes at one Texas hospital in particular–can teach us about another type of disconnect: that between the preparedness of our hospitals and health systems to respond to such threats and the public relations managers that paint an undeniably rosier picture. Hospitals managers are eager to maintain their pay and privileges, he says, especially when events lead to questions about them.

And speaking of hospitals, Bradley Flansbaum of The Hospital Leader, offers some thoughtful commentary on the limitations of using mortality rates as an outcome indicator of hospital quality. It might be easy to measure, but he argues it doesn’t provide us with the whole picture.

In an interesting post on the Population Health Blog, Dr. Jaan Sidorov applies the lessons of Joel Kotkin’s book on “The New Class Conflict” to health reform. He leaves it to readers if this paranoid perspective has an element of truth or if he’s being a right wing nut job. At the very least, you’ll learn about an obscure word: “clerisy.”

Finally, it is my pleasure to welcome newcomer Al Lewis to the Health Wonk Review. Al submits two posts for your consideration. The first, co-authored by Vik Khanna, focuses on Healthcare’s Biggest and Most Expensive Urban Legend. The second, co-authored by Vik Khanna and Jon Robison, examines how Weight Loss Fines are Discriminatory and Counterproductive. I encourage you to show him some love so that he’ll continue submitting to HWR.

Well, that’s it, folks. I hope you’re now up to speed on the latest and best health policy blogging, and I trust that this edition has prepared you to go outside and enjoy the better weather. If it hasn’t reached you yet, don’t despair. It will arrive soon enough. Up next: Jennifer Salopek at Wing of Zock will host on March 26th.

 

 

 

Advertisement

 

Joe Paduda Hosts Health Wonk Review

Wright on Health’s latest post about the Kentucky Kynect Kynundrum makes it into the latest Health Wonk Review, along with numerous other fabulous submissions. All of which are presented by our host Joe Paduda of Managed Care Matters. Read it here.

 

Health Wonk Review Tackles New Questions In Health Reform

Health reform continues to be implemented, and new questions keep rising to the surface. In the latest edition of the Health Wonk Review, some of the best bloggers around take a look at these questions and provide some possible answers. Hop on over to the Colorado Health Insurance Insider and check it out!

 

Health Wonk Review Is Up

The latest, Valentine’s Day-themed, edition of the Health Wonk Review is up and it’s terrific. Check it out here.

 

Maggie Mahar Hosts Wonderful Health Wonk Review

Over at healthinsurance.org, Maggie Mahar hosts the latest edition of the Health Wonk Review, with the theme “Waste, Warnings, and the Future.” She includes one of our posts on proposed Medicaid cost-sharing that falls under the “warnings” category. There’s loads of other good stuff, too. You can check it out here.

 

Belated Link to Health Wonk Review

The latest Health Wonk Review has been up and running for a while at Jaan Sidorov’s Disease Management Care Blog. I am just now getting around to posting the link here. You should not wait to check it.

 

Health Wonk Review: A Masterful Edition

Last week at this time, Augusta National Golf Club was abuzz with activity as the Masters–the most beloved of all professional golf tournaments (except for that not allowing women thing)–got underway. Last Sunday evening, after an exhilirating finish in regulation, Bubba Watson defeated Louis Oosthuizen on the second playoff hole to claim his first “green jacket.” You can watch a moving clip here. It was a lifetime achievement for the self-taught golfer and fellow graduate of my alma mater, the University of Georgia, who stood out among a gathering of greats. I love the Masters, because it heralds the start of spring, the beginning of longer days, and the renewal of life. It is in that spirit that I present to you a “masterful” edition of the Health Wonk Review, full of fresh ideas, wonderful writing, and some of the best recent writing from some of health policy’s greats. The metaphor really breaks down after that, though, so just read on for the good stuff. (I was going to include pictures from last week’s tournament, but I don’t want any copyright issues–so I’m afraid you’ll have to use your imagination.)

On the 1st tee, we have continued talk of the Supreme Court. Joe Paduda asks what the opponents of health reform will do if the Supreme Court overturns the mandate: “If the Supremes overturn health reform and/or the individual mandate, employers, taxpayers, and individuals are going to see higher health insurance premiums. The entire market will be in a death spiral. As more opt out of coverage, the cost for the shrinking number of insureds will increase. Members of the Chamber of Commerce, the NFIB, and the Club for Growth will find their profits eaten up by health insurance premiums, or they’ll be forced to drop coverage entirely.

Hopefully they’ll be okay with that, secure in the knowledge that they’ve sacrificed good health and medical treatment, for themselves and their families, on the altar of liberty. Individuals outraged by the mandate will be free to find coverage on their own, coverage which will be unaffordable for all but the richest Americans without any pre-existing medical conditions…And no, the free market will not come up with a solution. If it could have, it would have by now.” I agree with this sobering, but accurate assessment, starting the round with a par.

Headed to number 2, a long par 3 over the water and into the wind, requires careful club selection. Fortunately, Jaan Sidorov of the Disease Management Care Blog is here to scrutinize the “Choosing Wisely” web site that lists common medical tests and procedures that are often unnecessary.  Being an evidence-based and a skeptic, Sidorov has little problem with the tests, but he does criticize the use of a relatively primitive web page in an attempt to change physician and patient behavior.  He comes away unimpressed and wonders if a Web 2.0 approach or adoption by the population health management vendors would result in better outcomes. Read Jaan’s full post, here. Armed with this information, you make par.

The 3rd hole is a great place to take a break and make sure that you understand how the game is played. Enter Roy Poses, who writes often about ethics and conflicts of interest in health care at Health Care Renewal. This week, in a post entitled Conflict of Interest or Bribes? Biomet, Smith & Nephew Settle, Roy writes about a legal case that illustrates that some apparent conflicts of interest may in fact be health care corruption and suggests that true health care reform would better regulate and more strongly restrict conflicts of interest because of their potential for causing, or being health care corruption. A move in the right direction with a birdie.

Similarly, at the 4th, Julie Ferguson of Workers Comp Insider tells us that in a 50-sate roundup, there were no “A” students in the State Integrity Investigation, a $1.5 million public collaborative project designed to expose practices that undermine trust in state capitols. See her post: How does your state score for insurance, ethics, accountability, corruption? Tough break, bogey.

The 5th hole serves up an update on accountable care organizations, with Louise of the Colorado Health Insurance Insider. In “Cigna and CSHP Collaborating on an Accountable Care Program,” Louise writes “Cigna has already established their collaborative accountable care programs with provider groups in other states and the success of those programs is what’s driving the expansion into ten more states, including the collaboration with CSHP. Hopefully the program will continue to be successful in the new locations, resulting in better patient outcomes, more accessible and affordable healthcare, and better patient satisfaction. I would also expect to see more of this sort of collaboration between health insurance carriers and healthcare provider groups as time goes on.” In other words, par for this hole.

Another conspiracy appears to be in the works at the 6th, according to Neil Versel of the Meaningful Health IT News blog. In his recent post, Neil reveals that he wanted to attend the recent TEDMED conference, but found out that “TEDMED’s new owners say it won’t credential healthcare trade press unless they agree to be paid “media partners.” Double-bogey at the 6th.

The 7th hole offers an opportunity to regroup after struggling at the 6th. With Kat Haselkorn’s post “The Power of Employee Engagement” at the Corporate Wellness Insights blog, we learn of the subtle but crucial difference between employee participation and employee engagement in worksite wellness programs. In order to fully engage employees and improve population health, intrinsic motivation must be a factor. External motivators (like the ever-popular incentive program) can lead to high levels of participation but little personal investment in adopting healthy behaviors. Back on track with a birdie.

Headed to the 8th, we have “The Big Shift” written by Bob Vineyard of the InsureBlog. Does less health care really equate to lower health care costs? InsureBlog’s Bob Vineyard explores this conundrum and his answer may surprise you. The magnitude of wasteful spending amounts to a hazard, and after the penalty stroke, you’re lucky to escape with double bogey.

Finishing the front nine is David Williams of the Health Business Blog who has good things to say about health reform in Massachusetts. In his post “Massachusetts health reform has not driven up costs,” we learn that despite what GOP Presidential candidates would have you believe, Massachusetts has achieved its coverage goals without the undesirable side effect of increased per capita spending. We also learn that with near universal coverage in place, Massachusetts is ready to tackle costs. No need to lay up here, go for the green and make birdie.

As we kick off the back nine on number 10, it’s worth asking how other countries pay for health care. Jason Shafrin, who blogs at the Healthcare Economist, considers this topic in a post entitled Healthcare Spending in Indonesia. How do Indonesians pay for healthcare? What is the government’s role in the provision of healthcare services in Indonesia. The Healthcare Economist provides the answers. Eagle at the 10th is a great way to start off the back nine.

The 11th is a chance to hear from the relatively new voice of Brad Flansbaum, blogging at The Hospitalist Leader about the limited availability of healthy fruit and vegetable options in many neighborhoods in a post entitled “This is About Brussel Sprouts, Not Broccoli (And It’s Not What You Think).” After catching a bunker, it’s a solid par.

Hole number 12 comes courtesy of the Health Affairs Blog. In a piece from their “Contributing Voices” section by David Lansky, the President and CEO of the Pacific Business Group on Health, titled “Public Reporting Of Health Care Quality: Principles For Moving Forward,” David notes challenges for public reporting, discussed in articles in the March issue of Health Affairs and elsewhere, including the shortcomings of hospital reporting, the importance of framing quality information in ways consumers can understand and apply to real-world decisions, and the need for more consumer-relevant measures. He suggests that we have not done a good job designing public reporting programs to deal with these challenges, but he says the answer is not to abandon reporting but to do it right. Accordingly, he offers several principles for moving forward, such as meeting consumers where they are — rather than trying to lure them to stand-alone websites or publications — and implementing measures that consumers say they want, regardless of the inherited limited data infrastructure. Things continue moving in the right direction with a birdie at the 12th.

Lucky number 13 is a piece from John Goodman’s Health Policy Blog at the National Center for Policy Analysis that explains the economic sense of choosing a high deductible health plan. In an attempt to avoid moral hazard, you lay up short of the green, and two putt for bogey.

A string of pars on 14, 15, and 16, leads to Anthony Wright’s Health Access blog on the 17th, exploring “What California Has at Stake at the Supreme Court.” According to Wright, California is well on its way to implementing health reform—and so hundreds of thousands, if not millions,would lose coverage and financial help if the ACA were to be struck down. California was desperately trying health reform before “Obamacare,” and the status quo is unsustainable, so it will try again with or without the federal law (including improving upon it, especially if a part is struck down)—but it would be very, very hard without the tools and resources from the Affordable Care Act. On the green under regulation, with another two putt, this time for birdie.

Finishing the round at the 18th, we have an excellent post from Joanne Conroy, MD, writing at Wing of Zock, who explains how health reform could really benefit from having some continuity of leadership at CMS. According to Dr. Conroy, “The “who’s right” of partisan politics gets in the way of what’s right. Our health care system is too important to be a political football. Stable leadership does not remove the input of elected officials. It just makes recruitment of health care leaders to government service and the implementation of sound policy more efficient if you are not playing musical chairs every 18 months.” The long birdie putt drops in.

Well, that’s it. If you’re playing along at home, we’re 2 under for today’s round. Not bad after a series of dramatic ups and downs. Stay tuned for the next edition of Health Wonk Review being hosted by everyone’s favorite “To Be Determined.”

 

New Health Wonk Review Is Up

“Louise” over at the Colorado Health Insurance Insider blog hosts the latest Health Wonk Review. The theme this time around is the 2012 Presidential Campaign. If you think you’ve already had enough of that–even before the general election gears up–you’re wrong. You need to read these posts, because they are just that good.

 

Last Health Wonk Review of 2011

The last Health Wonk Review of 2011 is up at the blog “Health News Watchdog.” It’s their first time hosting, and they did a great job. (And I’m not just saying that because my post is included.) Here’s the link.

Visit B.Wright Consulting

 

Health Wonk Review: Holiday Shopping Guide

At the Wal-Mart in Seekonk, Massachusetts near my home, the Christmas decorations went up before the last of the Halloween candy was sold. It was almost as if they’d forgotten about Thanksgiving altogether. Then “Black Friday” came, and it was clear that the significance of Thanksgiving was to delineate the pre-game warm-up from the official start of the holiday shopping season. People camped out in advance for the best bargains, mobbed each other before sunrise, and proudly carried home their treasure. Then, no sooner than Black Friday was over, we had “Small Business Saturday” and “Cyber Monday” on its heels, encouraging us to “buy local” and “buy online,” respectively. But, if you’re like me, you still have loads of shopping left to do, and we all know that it can be extremely difficult to find the perfect gift for that special someone on your list. In that spirit, I’ve taken it upon myself to create the Health Wonk Review Holiday Shopping Guide. With the best of the health policy blogosphere represented, you’re sure to find something for everyone on your list, from your drunk uncle to your wonk-in-law.

First off, just about everyone on your list is bound to be concerned with the topic of Maggie Mahar’s post “How Health Care Reform Can Create Jobs and Cut Costs.” She explains how health care reform provides funding for nurse practitioners,community health workers, nurse mid-wives and other health care professionals who are very well-trained to do some of the things that doctors do–at a lower cost. In fact, she highlights some research suggesting that such a shift has the potential to improve quality as well. (As an aside, Maggie recently left The Century Foundation, and is no longer writing HealthBeat, though she continues to write about healthcare on other websites.)

Of course, many of you know somebody who wants nothing more than for the Affordable Care Act to be repealed by Congress or overturned by the Supreme Court. I’d recommend that you send them Joe Paduda’s article “Repealing Health Reform 20-20-20” from the Managed Care Matters blog which explains what will happen without reform. Newsflash: It ain’t good. If health reform is overturned, 20% of Americans may be without coverage in 2020, yet we’ll be spending 20% of our GDP on health care.

If reform does go forward as planned, the Colorado Health Insurance Insider’s Louise wonders if large self-insured groups will restructure their benefits to steer unhealthy employees into the health insurance exchanges. If that happens, it could lead to a death spiral that unravels the entire system. It’s hard to tell the future, but for the person on your list who enjoys reading suspenseful novels or happens to suffer from an anxiety disorder, they could have a lot of fun with this post.

President Obama’s job is pretty tough, so I’m sure he’d appreciate a little something from you this time of year. Especially after receiving the open letter “Dear Mr. President” from Dr. Kerry Willis who gives the President some suggestions on how to save money and increase the value to the system of providing medical care at the Healthcare Talent Transformation blog.

You’re going to want to impress your boss, so why not send them some research and commentary from the fine folks at Health Affairs? In “Implementing Bundled Payment: No Pain, No Gain?”, author Emma Dolan describes the progress that has been made in overcoming challenges to implementing bundled payment arrangements. Her post responds to a November Health Affairs journal article by researchers from RAND and Harvard that highlighted some of the difficulties encountered in implementing the Prometheus bundled payment initiative of the Health Care Incentives Imrprovement Institute. 

If they still want more, they might enjoy Vince Kuraitis’ take on the Leavitt ACO Report, which identified 164 ACOs in the U.S. According to Kuraitis, the report has the potential both to overestimate and underestimate ACO and accountable care-like activities. His hunch is, however, that it’s far more likely to be understating just how much accountable care activity actually is going on.

If you have family or friends in Florida (and who doesn’t?), they might like to know about supporters and opponents of Florida’s push to control its opioid problem, which Jon Coppelman of Workers’ Comp Insider talks about in the post “Opioid Abuse in Florida: Who Controls Controlled Substances?”

For the sports fan on your list, there’s Gary Schwitzer’s article at the Health News Watchdog blog. Schwitzer

explains how, while watching a college basketball game, he heard an ESPN announcer link Jimmy Valvano’s metastatic adenocarcinoma with Tubby Smith’s prostate cancer. He was shocked, and his post explains why: Not all cancers are alike and not all coaches’ cancer stories are alike. And they don’t all warrant a call for more screening. 

And what’s health care without corruption? At Health Care Renewal, Roy Poses writes about an ecological country-level analysis that showed that perceived corruption levels predict country’s levels of child (under age 5) mortality, controlled for other known mortality predictors.  Health care and other forms of corruption may kill, at least indirectly. Poses uses the study to highlight the need for true health reform to enable research on, education about, and advocacy against health care corruption, instead of dismissing it as just recent unpleasantness. If you have a beloved cynic on your list, send them to Roy’s post on how “Corruption Kills.”

Lastly, for the skeptic on your list, who–despite your sending them the “We’re #37” video repeatedly–thinks that the American health care system is the best there is, why not send them John Goodman’s latest piece “Do We Really Spend More and Get Less?” from the National Center for Policy Analysis? While I can’t say I agree, Goodman lays out an interesting argument that suggests that the U.S. isn’t really doing that bad vis-a-vis other developed nations. And, if that doesn’t do it for them, then might I suggest Avik Roy’s carefully reasoned explanation of “The Myth of Americans’ Poor Life Expectancy,” which I do tend to agree with.

Well, that’s it for now. There will only be three shopping days ’til Christmas when Gary Schwitzer hosts the next edition of Health Wonk Review over at the Health News Review Blog. Until then, best of luck finding something for everyone on your list!

Visit B.Wright Consulting