Obamacare Enrollments Slow to a Trickle


Only 102,000 people enrolled in Obamacare via the federally operated exchange during the week of December 27 – January 2, bringing the total to 6.5 million. This supports my previous expectation that Obamacare enrollment is petering out.


Obamacare Increases ED Use in Los Angeles County


Los Angeles County, Obamacare’s Ground Zero (so described because of the huge number of its residents enrolled in Obamacare’s health insurance exchange) is seeing an influx of patients into hospitals’ emergency departments:

Data hospitals report to the state show that as insurance coverage was extended to hundreds of thousands of residents, ER visits for ailments not serious enough to require an admission grew 3.9% in the county in the first half of 2014, compared with the same period the previous year. The growth is in line with annual increases of 3% to 5% in the three years prior to the federal healthcare overhaul. (Los Angeles Times)

This is no surprise to readers of NCPA’s Health Policy Blog. We have always appreciated the evidence that increases in government-funded health coverage lead to increased ED use.

What is interesting about the data from LA County is that ED use in public hospitals declined, while use in private hospitals increased. That might indicate something about the characteristics of the patients newly insured under Obamacare.

Gallup’s Easily Misunderstood Health Insurance Survey is Out


For many months, I have struggled with the Gallup-Healthways survey of health insurance, which I criticized in a previous entry. Of all the surveys of health insurance it is the least informative, and I wish the Gallup folks would give their results better context. Unfortunately, because it is the timeliest, the media get excited about it, especially since Obamacare started.

The latest survey, which covers the 4th quarter of 2014, reported that the “uninsured rake sinks to 12.9 percent”. Just look at the graph: What a nosedive in the number of uninsured Americans! Well, not so fast.


FDA Regulation of Mobile Health Apps is a Real Threat


Do you want the Food and Drug Administration (FDA) to regulate your smartphone? Many in the booming digital health industry are indifferent to the risks of the FDA regulating apps as medical devices. As I noted in a recent Health Alert, the FDA’s current doctrine is to allow most new apps onto the market without regulation. However, this openness is defined only in rules written by the FDA itself, not legislation. Rep. Marsha Blackburn and others in Congress have proposed to amend the law to prevent the FDA from overreaching.

Entrepreneurs and patients who think that the FDA’s current posture is eternal should be aware of a campaign to regulate apps for health. Here’s a recent article from Mother Jones:

Online retailers like iTunes and Amazon offer thousands of apps promising all kinds of real-time information about your body — they can measure blood pressure, take your pulse, track your menstrual cycle, and tell you how well your lungs are working. Mobile health is one of the fastest-growing app categories: According to the consulting firm research2guidance, there are 100,000 mobile health apps on the market, double the number available two and a half years ago. The industry is worth some $4 billion today, and analysts predict that it will reach $26.5 billion by 2017.

How to Get a Medicaid Work Requirement? Bundle It with Paul Ryan’s Opportunity Grants


A similar version of this Health Alert appeared at Forbes.

Utah Governor Gary Herbert and North Carolina Governor Pat McCrory have asked President Obama to allow them to include work requirements in their Medicaid programs. Work requirements were critical to the success of welfare reform in 1996 and would also change Medicaid from a dependency-trap to a true safety net. The best way to achieve it would be through legislation, not relying on executive action.

A new study I’ve written for the National Center for Policy Analysis explains how including Medicaid and the State Children’s Health Insurance Program (CHIP) as part of safety-net reform, instead of keeping health care in its own silo, would greatly improve the federal welfare state for both recipients and taxpayers. Fortunately, House Ways and Means Committee Chairman Paul Ryan (R-Wis.) has proposed reforms to the federal safety net that could include Medicaid and CHIP.

Mr. Ryan’s proposal, Expanding Opportunity in Americafocuses on the Earned Income Tax Credit (EITC), housing and home-energy assistance, education assistance, food stamps (SNAP) and criminal sentencing reform. Ryan’s proposal hinges on the Opportunity Grant (OG). States would apply for OGs that would roll some or all of the federal spending on individuals and families in poverty into one lump sum for distribution to the states. States, civil society organizations and recipients themselves would all be responsible for transitioning recipients out of dependency and into self-reliance.

Ryan is looking back to the success of the 1996 welfare reform signed by a reluctant President Clinton after a successful campaign by House Speaker Newt Gingrich. Ten years after the reform, it was widely recognized as a significant success, even by the mainstream media. Medicaid, unfortunately, was never reformed in 1996.

There are very good reasons to reform all of these safety-net programs comprehensively, in one fell swoop.

Questioning the State’s Power over Patients


Here’s a tough issue:

A court will determine whether a 17-year-old girl, under something called the “mature minor doctrine,” can be forced to undergo chemotherapy after she refused treatment for her cancer.

Cassandra underwent two chemotherapy treatments in November and then ran away from home and refused to continue treatments, according to the court summary.

A court hearing ensued in which Cassandra’s doctors testified, and she was removed from her mother’s home and placed in state custody so that the state could make medical decisions for her.

She has been has been living at Connecticut Children’s Medical Center and forced to undergo chemotherapy for about three weeks.

The Hartford Courant reported that Cassandra has an 80 to 85 percent chance of surviving her cancer if she continues with her chemotherapy.

The article does not report religious objections to the treatment, but notes that Cassandra’s mother now supports her decision not to undergo chemotherapy.

Has Telehealth Gone Too Far, Too Fast?


Jerry King is the cartoonist for the Kaiser Family Foundation’s Kaiser Health News (which publishes a valuable daily briefing and is a great resource for healthcare news).

One of our issues at NCPA is digital health, especially telehealth (which we have researched since at least 2007). Things are finally moving in the right direction on telehealth adoption. King’s cartoon this morning made us wonder whether things are going too far, too quickly.


Original at Kaiser Health News.

Digital Health Venture Funding Doubled in 2014


A similar version of this Health Alert appeared at Forbes.

If it hasn’t happened to you already, it will soon: Your doctor, employer, health insurer, friend, or colleague will recommend you try a new smartphone app to keep you healthy. Apps are just one example of the fast growing area of “digital health,” which refers to applying the digital technology that has changed so much of our lives to the health care industry.

Two recent reports show how important digital health is becoming, and how fast. StartUp Health, a New York-based accelerator, and Rock Health, a San Francisco-based accelerator and seed fund, have independently reported that funding for new digital health ventures in the United States doubled in 2014.

Looking only at investments worth at least $2 million, Rock Health estimates that $4.1 billion of new capital was invested in digital health, up from less than $1 billion in 2011.


StartUp Health, which also captures smaller deals, estimates that $6.5 billion in new capital was invested in digital health in 2014, up from $1.2 billion in 2010.


Obamacare’s Effect on Uninsured is Trivial


At the end of 2014, Jason Furman and Matt Fiedler of President Obama’s Council of Economic Advisers published an analysis of the uninsured in the first half of 2014. The two economists boasted that “2014 has seen largest coverage gains in four decades, putting the uninsured rate at or near historic lows.”

Their own graph shows how exaggerated and misleading this claim is.


Podcast: Graham Explains the End of Obamacare’s Risk Corridors


One of NCPA’s successes in health policy last year was to influence the Congress to limit Obamacare’s “risk corridors”. This was the part of the 2010 Affordable Care Act that instituted an unlimited taxpayer liability to protect health insurers from losing money in Obamacare’s exchanges for three years.

Sean Parnell of the Heartland Institute interviewed Senior Fellow John R. Graham about the effect of the lame-duck Congress eliminating this unlimited taxpayer liability. You can listen to the 20-minute podcast here.

For a written description of this important win, please see here.