PPI: Health Prices Continue to Rise Faster Than Others


October’s Producer Price Index declined 0.4 percent, month on month, and dropped 1.6 percent, year on year. Mild deflation continues to take hold in the general economy. However, it is not so in health care. Of the 14 sub-indices for health-related goods and services, only three declined month on month. Only six declined year on year (see Table I).

20151113 PPIa

Why Does Obamacare Over Invest in Spanish Customer Service?


The Center for Medicare & Medicaid Services (CMS) has started to publish its weekly reports on Obamacare enrollment via the federally facilitated exchanges.

A little over half a million people have selected a plan for the third open season. What is interesting is the exchanges’ overinvestment in Spanish capabilities. We first noted this last January.

The Snapshot reports that the average wait on the phone for a Spanish-speaking customer-service representative is 11 seconds, versus four minutes and 38 seconds for an English speaker. That’s 25 times longer. 52,023 of the 741,112 calls (seven percent) were in Spanish.


GOP Debate Highlights


The debate was all about the economy and economic security. Many of the candidates referenced Obamacare as a drag on the economy. But when pressed for examples of intrusive government regulations, too often they reached for more nebulous regulations and government obstructions rather than discuss the most expensive regulation most employers face — Obamacare.

Some of their comments and my observations:

Rubio: Obamacare is a drag on the economy and job creation.

Rubio’s new name for Obamacare: that crazy health care law.

Trump: Obamacare will be repealed.

Carly Fiorina wants to review every government regulation and repeal the bad ones. But she didn’t mention Obamacare until later in the debate, when she said it must be repealed.

Jeb Bush talked about ways to boost jobs and get the government out of the way. He didn’t mention the negative impact Obamacare has on hiring.

Kasich may have cut taxes, but his backing of Medicaid expansion is bad news for Ohio taxpayers in the future

Kasich would reform Medicare, but he expanded Medicaid rather than hold out for the flexibility to tailor Ohio’s Medicaid program.

Jeb Bush’s Positive Plan to Reform Medicare


Bush2(A version of this Health Alert was published by RealClearPolicy.)

Jeb Bush’s Medicare reform contains two proposals — premium support and Health Savings Accounts — that will have a significant, positive effect on seniors’ access to care and Medicare’s finances. In particular, the proposals will address four flaws in Medicare Advantage, an alternative to traditional Medicare in which seniors choose a plan from a private insurer.

Although Obamacare tried to cut seniors’ access to private plans, the use of these plans continues to grow. Before Obama took office, one-quarter of beneficiaries chose Medicare Advantage plans. Today, about one-third do. But despite their popularity, private Medicare plans do not live up to their potential for cost-effectiveness.

Gov. Kasich: Tax Cutting Medicaid Expander?


Ohio Governor Kasich likes to portray himself as a Budget Hawk. Yet, Ohio’s state budget increased by nearly one-third since Kasich took office (just over $50 billion to nearly $70 billion)! Kasich’s assertion that he is a fiscal conservative only works if you ignore boosting Medicaid, which will soon account for more than half of Ohio’s general budget. By contrast, spending on education is about half that amount. Medicaid spending will increase by nearly $5 billion from 2015 to 2017 alone.

Kasich is proud of his record cutting income taxes. While some taxes fell under Kasich, others rose. However, the tax burden on Ohio will likely climb as the feds begin to ratchet down Medicaid matching funds in 2017.  As the graph below illustrates, expanding Medicaid under the assumption that the federal government will continue to pay much of the bill is a dangerous game for Ohio taxpayers.




Why Do States Expand Medicaid?


In September the Kaiser Family Foundation released a report comparing Medicaid expansion states with states that have chosen not to expand Medicaid. The report generated little fanfare among either supporters or opponents of Medicaid expansion. It should have created a firestorm. The report sheds light on why many states have seemingly turned down free federal Medicaid funds, while other states eagerly gorge at the public trough.

Health Jobs Dominate Great Jobs Report


BLSObservers cheered the October Employment Situation Summary, which reported 271,000 civilian nonfarm jobs added. This is a big turnaround from the September report, which was very disappointing. Nevertheless, the two months have one thing in common: Jobs in health services dominated the growth in jobs. Whether job growth overall is strong or weak, health care keeps increasing its share.

Health care accounted for 45,000 of the 217,000 jobs added overall in October (Table I). That’s a rate of growth of 0.29 percent, much higher than 0.18 percent growth in non-health jobs. Jobs in ambulatory facilities accounted for 27,000 of the increase, which hospital jobs only increased by 18,000. Ambulatory jobs now account for a significantly higher share of health jobs than hospitals do. This change is positive, because hospitals are inefficient and overly expensive facilities for many procedures.

20151105 Health Workforce TI

Hillary Clinton Profits from Big Pharma, Big Insurance


Chris Jacobs of the Conservative Review has an interesting review of Hillary Clinton’s business income from health insurers and pharmaceutical manufacturers:

At the end of this campaign’s first debate for Democratic presidential candidates, Hillary Clinton claimed that she counted the pharmaceutical and insurance industries as her enemies. Since that time, various reports have focused on the way in which her campaigns, as well as the Clinton Foundation, have profited from contributions by drug and insurance companies. However, few have reported how Bill and Hillary Clinton personally profited from insurance and drug company largesse.

To call it mere profit would be an understatement. As the below spreadsheet shows, financial disclosure records filed by the Clintons demonstrate that since Bill Clinton left office in January 2001, he and his wife have received more than $9.3 million in honoraria for speeches before groups associated with health care, and a whopping $3.4 million for speeches paid for by groups in the drug, device, and insurance industries (bolded in the spreadsheet).

(Readers can download the spreadsheet at Mr. Jacob’s article.)

My own conclusion is that the health insurers will get what they paid for, if Mrs. Clinton is elected President, whereas the drug-makers will be reminded of the old adage that “you cannot buy politicians; but only rent them.”

Rock Star Physician Rebels Against Medicare Bureaucracy


Confident DoctorsRebekah Bernard, MD, who wrote a book titled How to Be a Rock Star Doctor:  The Complete Guide to Taking Back Control of Your Life and Your Profession, has written an open letter to her Medicare patients. Here are the choice bits:

For every office visit that we spend together, I spend at least as much time on what Medicare deems as necessary documentation, especially a new program called meaningful use.

To comply with Medicare requirements, I’ve had to spend thousands of dollars and massive amounts of time instituting electronic health records, adapting my practice to conform to the computer technology that wasn’t created to help me, your physician.

And next year the whole ballgame changes for physicians as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) goes into full effect, with a complete paradigm shift in Medicare payment from “fee-for-service” (I send a bill for your medical care, Medicare pays me), to “value-based payment” (I submit a bill, and I get paid if Medicare thinks that I’ve done a good enough job).

The kicker is that the pot of money remains constant – so even if every doctor makes an ‘A’ grade, half of them will be paid less money, just by nature of this “budget-neutral” payment system.

Up to this point, I have managed to play by the rules that Medicare has set.

In 2017, this may no longer be the case.

Unaffordable Care Act Third Open Enrollment Nothing to Celebrate


The third Obamacare Open Enrollment period began November 1st. As a result, many families are faced with a tough choice: purchase coverage they cannot afford with few tangible benefits, or pay an equally unaffordable penalty and hope they do not become sick. The Internal Revenue Service determined that 7.5 million individuals opted to pay the penalty rather than purchase health coverage in 2014, far more than originally projected. The penalty for going without coverage in 2014 was only $95 or one percent of income, whichever was greater. Yet the tax year data found the average penalty paid was double the minimum. This suggests it wasn’t the poor who were going without coverage; the poorest individuals either qualified for generous subsidies, Medicaid or got an exemption from the penalty. Many of those who paid the penalty were likely individuals who did not qualify for subsidies and could not afford Obamacare coverage due to the costly mandates. To make matters worse, the costs are rising fast.