Tag: "Health Care Access"

Access to Health Care Unchanged After Obamacare’s First Year

The Centers for Disease Control and Prevention (CDC) has released early estimates of health insurance and access to health care for January through September 2014. The National Health Insurance Survey (NHIS) is (in my opinion) the most effective survey of health insurance, because it asks people three different but important questions: Are they uninsured at the time of the survey? Have they been uninsured for at least part of the year? Have they been uninsured for more than a year?

As shown in Figure 2, the proportion of long-term uninsured is about the same as it was circa 2000. The proportion of short-term uninsured has shrunk a little in Obamacare’s first year.


Senate Dems: Get Pregnant, Then Get Health Insurance

Women joggingWhile everyone else is wondering whether the Supreme Court will replace Obamacare in 37 states with the actual Affordable Care Act as written, some Democratic U.S. Senators are urging women to dive deeper into Obamacare’s perverse incentives by encouraging them to delay getting health insurance until after they become pregnant.

As reported by Lydia Wheeler in The Hill, Senator Patty Murray has round up 36 signatures on a letter addressed to U.S. Health & Human Services Secretary Sylvia Burwell urging her to pull yet another “special enrollment period” out of her bag of tricks.

In a statement, Christina Postolowski, health policy manager of Young Invincibles, said she’s thrilled to see a growing chorus of leaders calling on the administration to create a special open enrollment period to make maternity coverage available to pregnant women year-round.

According to Postolowski’s December 2014 report “Without Maternity Coverage” maternity care and delivery ranges from $10,000 to $20,000 without complications.

The Kline-Ryan-Upton Republican Off-Ramp from Obamacare

Tomorrow is the day the Supreme Court hears oral arguments in King vs. Burwell, and all the talk is about what Congress will do if the Supreme Court directs the Administration to obey the law by not paying subsidies in the majority of states, which have declined to establish their own Obamacare exchanges and defaulted to the federal one.

The Wall Street Journal ran an op-ed (available by subscription) by John Kline, Paul Ryan, and Fred Upton, who chair committees of jurisdiction in the House of Representatives that will be tasked with proposing a Congressional response to this decision. Here’s what they write:

Let people buy insurance across state lines. Stop frivolous lawsuits by enacting medical-liability reform. Let small businesses band together so they get a fair deal from insurance companies.

Crowd-out Effect of CHIP Expansion 44 to 70 Percent

In 2009, Congress reauthorized the Children’s Health Insurance Program (CHIP), providing states added resources and options to insure children. About 15 states expanded CHIP eligibility to families with incomes up to 400 percent of the federal poverty level (an income of $94,000 for a family of four) with a median upper limit for coverage at 250 percent of poverty, the highest since CHIP’s inception in 1997. Federal CHIP funding is up for reauthorization in 2015 and some argue that CHIP is unnecessary because of Obamacare’s subsidies, which kicked in this year.


Source: “The Impact of Recent CHIP Eligibility Expansions on Children’s Insurance Coverage” from Health Affairs.

Paying Doctors for Performance Does Not Work

Aaron Caroll, in the New York Times:

doctor-xray-2“Pay for performance” is one of those slogans that seem to upset no one. To most people it’s a no-brainer that we should pay for quality and not quantity.

In Britain, a program was begun over a decade ago that would pay general practitioners up to 25 percent of their income in bonuses if they met certain benchmarks in the management of chronic diseases. The program made no difference at all in physician practice or patient outcomes, and this was with a much larger financial incentive than most programs in the United States offer.

Hits and Misses

States Spent $7.7 Billion on Prisoners’ Heath Care in 2011

GOV065A new report from the Pew Charitable Trusts reports that 41 states experienced growth in their correctional health care spending from fiscal 2007-2011, with a median increase of 13%. Further:

…state spending on prisoner health care increased from fiscal 2007 to 2011, but began trending downward from its peak in 2009. Nationwide, prison health care spending totaled $7.7 billion in fiscal 2011, down from a peak of $8.2 billion in fiscal 2009. In a majority of states, correctional health care spending and per-inmate health care spending peaked before fiscal 2011. But a steadily aging prison population is a primary challenge that threatens to drive costs back up. The share of older inmates rose in all but two of the 42 states that submitted prisoner age data. States where older inmates represented a relatively large share of the total prisoner population tended to incur higher per-inmate health care spending.

How Many Uninsured Texans Signed Up For Obamacare? Maybe 3 Percent of Those Eligible

The Left often attacks Texas as a holding pen of uninsured people. 5.7 million residents do not have health insurance. Yet only 733,757 signed up for Obamacare. And many of them dropped or lost insurance that they had before Obamacare launched. John Davidson of the Texas Public Policy Foundation figures that maybe only three percent of eligible, uninsured Texans signed up for Obamacare. According to Davidson, “The most likely reason is cost. Premiums on the exchange are significantly higher than average pre-ACA premiums on the individual market in Texas. Although subsidies offset these premium costs for some Texans, those earning about 250 percent of the federal poverty limit (FPL), or $29,175 per year, cannot expect their subsidy to significantly reduce premiums.”


Insurers are Starting to Pay for Cross-Border Treatment

In the New Republic, Adam Teicholz and Glenn Cohen discuss insurers whose provider networks run across the border:

conceptBefore dawn on a Wednesday in January, Cesar Flores, a 40-year-old employed by a large retail chain, woke up at his home in Chula Vista, California. He got in his car and crossed the border into Tijuana. From there, he headed for a local hospital, where he got lab tests — part of routine follow-up to a kidney stone procedure. He had his blood drawn and left the hospital at 7:30. He arrived home before 10.

But Flores’s situation isn’t medical tourism as we know it. Flores has insurance through his wife’s employer. But his insurer, a small, three-year-old startup H.M.O. called MediExcel, requires Flores to obtain certain medical treatment at a hospital across the border. In part due to cost-pressures generated by the Affordable Care Act, other sorts of plans that require travel have the potential to expand.

Who’s Your Doctor?

Over at Forbes, Bruce Japsen reports that the Affordable Care Act is boosting demand for primary care providers. As we’ve said before, Obamacare does nothing to boost physician supply. The millions of newly insured will increase their demand for medical care — and someone has to provide it. This has caused a Gold Rush of sorts among medical practices and hospitals scrambling for primary care providers.

Physician staffing firm, MerrittHawkins reports primary care providers — family physicians and internists tops the list. The number of requests for nurse practitioners and physicians’ assistants it’s been ask to recruits is up more than three times (i.e. 320 %). Advance practice nurses and physicians’ assistants didn’t even make the top 20 of most recruited medical practitioners three years ago. Here’s the current list.

In many cases, increased use of nurse practitioners and physician assistants can provide high quality care at reduced costs. I have long advocated increasing these professionals’ scope of practice as an important part of innovation in delivering medical care. On the other hand, this should happen as a consequence of increased consumer-direction of healthcare spending, not as a response to increased government control, as imposed by Obamacare.