Category Archives: Health Care

The Effects of Terminating Payments for Cost-Sharing Reductions

Source: Congressional Budget Office, pub no. 53009, August 2017

Under the Affordable Care Act (ACA), insurers receive federal payments to cover costs incurred when offering plans with reduced deductibles, copayments, and other cost sharing to some people who purchase plans through the ACA marketplaces.

If those payments for cost-sharing reductions stopped after the end of this year, participating insurers would raise premiums to cover the costs. CBO and the staff of the Joint Committee on Taxation estimate that ending those payments would increase the federal deficit, on net, by $194 billion from 2017 through 2026, mostly because that change would result in increased costs for premium assistance tax credits. The number of people uninsured would be slightly higher in 2018 but slightly lower starting in 2020….

How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016

Source: Munira Z. Gunja, Sara R. Collins, Michelle M. Doty, Sophie Beutel, Commonwealth Fund, Issue Brief, August 2017

– The number of U.S. working-age women lacking health insurance has fallen by nearly half since the ACA was enacted
– Because of the ACA, women are finding it easier to buy an affordable plan that fits their health needs

From the abstract:
Issue:
Prior to the Affordable Care Act (ACA), one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium because of their health, or had specific health problems excluded from their plans. Beginning in 2010, ACA consumer protections, particularly coverage for preventive care screenings with no cost-sharing and a ban on plan benefit limits, improved the quality of health insurance for women. In 2014, the law’s major insurance reforms helped millions of women who did not have employer insurance to gain coverage through the ACA’s marketplaces or through Medicaid.

Goals:
To examine the effects of ACA health reforms on women’s coverage and access to care.

Method:
Analysis of the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2016.

Findings and Conclusions:
Women ages 19 to 64 who shopped for new coverage on their own found it significantly easier to find affordable plans in 2016 compared to 2010. The percentage of women who reported delaying or skipping needed care because of costs fell to an all-time low. Insured women were more likely than uninsured women to receive preventive screenings, including Pap tests and mammograms.
Related:
Appendices
Chartpack (pdf)
Chartpack (ppt)
Press Release

Beach Town Tries To Reverse Runaway Growth Of ‘Sober Homes’

Source: Greg Allen, NPR, Morning Edition, August 10, 2017

Some local and state officials in South Florida are calling for more regulation of addiction recovery residences to help combat insurance scams.
Related:
Sober Homes Task Force Report 2017
Source: Palm Beach County, Sober Homes Task Force Report, January 1, 2017

Grand Jury Report
Source: State Attorney for the 15th Judicial Circuit, Palm Beach County, December 8, 2016

Delray Beach Principles to Guide Zoning for Community Residences for People with Disabilities
Source: Daniel Lauber, prepared for the City of Delray Beach Florida, May 2017

Industry Payments to Physicians for Opioid Products, 2013–2015

Source: Scott E Hadland, Maxwell S. Krieger, and Brandon D. L. Marshall, American Journal of Public Health (AJPH), Vol. 107 no. 9, September 2017
(subscription required)

From the abstract:
Objectives.
To identify payments that involved opioid products from the pharmaceutical industry to physicians.

Methods.
We used the Open Payments program database from the Centers for Medicare and Medicaid Services to identify payments involving an opioid to physicians between August 2013 and December 2015. We used medians, interquartile ranges, and ranges as a result of heavily skewed distributions to examine payments according to opioid product, abuse-deterrent formulation, nature of payment, state, and physician specialty.

Results.
During the study, 375 266 nonresearch opioid-related payments were made to 68 177 physicians, totaling $46 158 388. The top 1% of physicians received 82.5% of total payments in dollars. Abuse-deterrent formulations constituted 20.3% of total payments, and buprenorphine marketed for addiction treatment constituted 9.9%. Most payments were for speaking fees or honoraria (63.2% of all dollars), whereas food and beverage payments were the most frequent (93.9% of all payments). Physicians specializing in anesthesiology received the most in total annual payments (median = $50; interquartile range = $16–$151).

Conclusions.
Approximately 1 in 12 US physicians received a payment involving an opioid during the 29-month study. These findings should prompt an examination of industry influences on opioid prescribing.

Bureau of Prisons: Better Planning and Evaluation Needed to Understand and Control Rising Inmate Health Care Costs

Source: U.S. Government Accountability Office (GAO), GAO-17-379, Published: Jun 29, 2017

From the summary:
What GAO Found
From fiscal years 2009 through 2016, the Bureau of Prisons (BOP) obligated more than $9 billion for the provision of inmate health care and several factors affected these costs. Obligations for health care rose from $978 million in fiscal year 2009 to $1.34 billion in fiscal year 2016, an increase of about 37 percent. On a per capita basis, and adjusting for inflation, health care obligations rose from $6,334 in fiscal year 2009 to $8,602 in fiscal year 2016, an increase of about 36 percent. BOP cited an aging inmate population, rising pharmaceutical prices, and increasing costs of outside medical services as factors that accounted for its overall costs.

BOP lacks or does not analyze certain health care data necessary to understand and control its costs. For example, while BOP’s data can show how much BOP is spending overall on health care provided inside and outside an institution, BOP lacks utilization data, which is data that shows how much it is spending on individual inmate’s health care or how much it is expending on a particular health care service. BOP has identified potential solutions for gathering utilization data, but has not conducted a cost-effectiveness analysis of these solutions to identify the most effective solution. BOP also does not analyze health care spending data, i.e., what its institutions are buying, from whom, and how much they spend. BOP has pursued some opportunities to control its health care spending through interagency collaboration and national contracts, but it has not conducted a spend analysis to better understand trends. Doing so would provide BOP with better information to acquire goods and services more strategically.

BOP has initiatives aimed to control health care costs but could better assess effectiveness and apply a sound planning approach. Since 2009, BOP has implemented or planned a number of initiatives related to health care cost control, but has not evaluated their cost-effectiveness. Further, BOP has engaged in a strategic planning process to help control costs, but has not incorporated certain elements of a sound planning approach, such as developing a means to measure progress toward its objectives and identifying the resources and investments needed for its initiatives. By incorporating these elements, BOP could enhance its planning and implementation efforts before expending resources, better positioning itself for success as it aims to control health care costs.

Why GAO Did This Study
As of June 2017, BOP was responsible for the custody and care—including health care—of about 154,000 inmates housed in BOP institutions. Health care includes medical, dental, and psychological treatment. BOP provides most care inside its institutions, but transports inmates outside when circumstances warrant. GAO was asked to review health care costs at BOP institutions.

This report addresses: (1) BOP’s costs to provide health care services and factors that affect costs; (2) the extent to which BOP has data to help control health care costs; and (3) the extent to which BOP has planned and implemented cost control efforts.

GAO analyzed BOP health care obligations data for fiscal years 2009 through 2016, gathered information on BOP’s health care cost control initiatives through a data collection instrument, and reviewed BOP’s health care related strategic plans. GAO also interviewed BOP officials and visited 10 BOP institutions, selected in part, for total and per capita medical services costs. ….

Costs and Outcomes of Mental Health and Substance Use Disorders in the US

Source: Rabah Kamal, Cynthia Cox, David Rousseau, et al for the Kaiser Family Foundation, JAMA Infographic, Visualizing Health Policy, August 1, 2017

This Visualizing Health Policy infographic looks at costs and outcomes of mental health and substance use disorders in the United States (US). Nearly 18% of adults reported having a mental, behavioral, or emotional disorder in 2015, including more than 1 in 5 women. Furthermore, nearly 3% of people aged 12 years or older reported addiction to or misuse of an illicit drug in 2015, including more than 7% of people aged 18 to 25 years. However, 1 in 5 people say they or a family member had to forego needed mental health services because they couldn’t afford the cost, their insurance wouldn’t cover it, they were afraid or embarrassed, or they didn’t know where to go. Mental illness treatment accounted for $89 billion, or 5%, of total medical services spending in 2013, behind checkups/prevention and circulatory disorders. Mental health and substance use disorders together were the leading cause of disease burden in 2015, surpassing cancer and cardiovascular disease, among others. Relative to countries of similar size and wealth, the US has had higher rates of death from unintentional poisonings, the majority of which were due to drug overdoses. In 2013 the age-standardized rate of death from unintentional poisonings per 100 000 population was 12.4 in the US compared with 2.5 on average in comparable countries.

Costs and Outcomes of Mental Health and Substance Use Disorders in the US

The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes

Source: Mark Duggan, Gopi Shah Goda, Emilie Jackson, National Bureau of Economic Research, NBER Working Paper No. 23607, July 2017
(subscription required)

From the abstract:
The Affordable Care Act (ACA) includes several provisions designed to expand insurance coverage that also alter the tie between employment and health insurance. In this paper, we exploit variation across geographic areas in the potential impact of the ACA to estimate its effect on health insurance coverage and labor market outcomes in the first two years after the implementation of its main features. Our measures of potential ACA impact come from pre-existing population shares of uninsured individuals within income groups that were targeted by Medicaid expansions and federal subsidies for private health insurance, interacted with each state’s Medicaid expansion status. Our findings indicate that the majority of the increase in health insurance coverage since 2013 is due to the ACA and that areas in which the potential Medicaid and exchange enrollments were higher saw substantially larger increases in coverage. While labor market outcomes in the aggregate were not significantly affected, our results indicate that labor force participation reductions in areas with higher potential exchange enrollment were offset by increases in labor force participation in areas with higher potential Medicaid enrollment

A Brief History of American Health Reform

Source: Colin Gordon, Jacobin, July 25, 2017

In order to win universal health care, we have to understand what — and who — we’re up against. ….

….In health care, private providers and private financing mechanisms were well ensconced long before any meaningful public intervention. The stakes are very high and, historically, a diverse array of private health interests have spent lavishly on political campaigns, and haunted congressional hearings and anterooms. But what has shaped health policy, and stymied reform for the last century, is not so much the combined clout of private interests as it is the tangle of compromise and competition that’s emerged from the scrum as they jockey for influence over policy, for advantage over each other, and for unfettered access to public spending.

Over the last century, the terms of that corporate compromise have been altered through changes in medical care, and changes in the ways medical care is sold, underwritten, packaged, subsidized, regulated, and consumed. The influence of private interests has persisted but, from the first consideration of “health security” in the Progressive Era to the tortuous repeal of the Affordable Care Act over the last few months, which interests have weighed in — or prevailed — has shifted.

Tracing those shifts (sometimes subtle, sometimes profound) is important not just to our understanding of the history, but also to our efforts to win a more just health system…..