Tag: "health policy"

Headlines I Wish I Hadn’t Seen

risingHealth care spending rose at the fastest pace in 10 years last quarter.

If you make playgrounds safer, kids will have more accidents.

Avik Roy hosts a paean to ObamaCare by Gene Sperling.

ObamaCare has had 38 significant delays.

Fifty-seven million Americans live in states where Tesla cannot legally sell its cars.

New York Might Drive Its ObamaCare Exchange Premiums Up Another 30 Percent

According to the U.S. Department of Health & Human Services’ March enrollment report, New York’s state-run ObamaCare exchange has signed up fewer than half the people who were determined eligible for the exchange when they enquired.

qweWhat is the problem? One seems to be that the provider networks available in the exchange are very narrow.

What the proposed solution? At a recent presentation, exchange officials threatened to impose out-of-network access requirement on insurers who bid to participate in the exchange. If rolled out in the direction the officials appeared to point, this would be an Any Willing Provider (AWP) provision, long a lobbying priority for organized medicine:

The lack of out-of-network benefits for individuals shopping on the exchange has been criticized by some business leaders, physicians and legislators, who say it provides little choice for consumers and hurts doctors who can be bullied by insurers into accepting lower reimbursements. Insurance executives say they need that leverage to keep premiums low and attractive to consumers shopping on the exchange…If out-of-network doctors and hospitals were required to be reimbursed by the insurer, premiums could rise as much as 30 percent, according to the insurance industry.

The Medieval Guild Lives On

LawiStock_000005825665XSmalls concerning nurse practitioners (NPs) vary across states, but the three biggest regulations that affect NPs are those that limit their ability to write prescriptions, to practice independently and to receive direct reimbursement from insurers:

  • When doctors are required to supervise NPs when prescribing controlled substances, physician wages increase by 7 percent while nurse practitioner wages decrease by 14 percent.
  • Those restrictions also increased the number of physician hours worked by 6 percent to 9 percent while decreasing the number of hours worked by nurse practitioners by 6 percent to 14 percent.
  • The price of a well-child medical exam rises by 3 percent to 16 percent due to these laws.

However, none of these regulations appeared to reduce infant mortality rates or malpractice premiums

Source: NBER Working Paper.

Laszewski on the Numbers

The vast majority of those who are entitled to subsidies have not claimed them:

It looks to me the Obama administration will claim at least 6 million enrollments by the end of March. But that will mean 75% of subsidy eligible people will not have bought a plan…

But adjusting that number for those not paying (15% to 20%), the real net enrollment number will be closer to 5 million…

There is a reason why millions of people are not signing up:

Stressed Over MoneyUnder ObamaCare, a family of four making $59,000 a year is expected to pay almost $5,000 a year net of the federal premium subsidy (more than 10% of their take-home income) for the Silver Plan that has an average deductible of almost $2,600 a year, or pay a fine of about $400. How many families like this have an extra $5,000 in their family budget to buy a policy with a deductible this high? Would this be a hardship for them?

A family of four making $71,000 a year would be expected to pay $6,700 a year net of the subsidy for a plan with the same average $2,600 deductible, or pay a fine of about $600. Would this be a hardship for them? (More)

There Are Five Losers for Every ObamaCare Winner

Duke University’s Chris Conover has examined who wins and who loses under ObamaCare. Losers include pretty much everyone: Medicare beneficiaries, Medicaid beneficiaries, employees, and self-insured.

His conclusion:

When all is said and done, were ObamaCare fully in place right now, 166 million of today’s population could reasonably count themselves as losers in various ways, while only 34.6 million would be lucky enough to count as winners. That’s a ratio of 4.8 losers for every winner — not a particularly good outcome for any policy initiative, much less a “signature” legislative initiative.


It’s Official: No More March 31st Deadline

I’m not making this up. From the Washington Post:

Under the new rules, people will be able to qualify for an extension by checking a blue box on HealthCare.gov to indicate that they tried to enroll before the deadline. This method will rely on an honor system; the government will not try to determine whether the person is telling the truth.

If you find that hard to believe, how about this?

The rules, which will apply to the federal exchanges operating in three dozen states, will essentially create a large loophole even as White House officials have repeatedly said that the March 31 deadline was firm. The extra time will not technically alter the deadline but will create a broad new category of people eligible for what’s known as a special enrollment period.

Can the States Extend the ObamaCare Mandate Deadline?

On Monday, Minnesota said it would extend a completion deadline for anyone who starts the process of enrolling in a plan by midnight on March 31 but doesn’t finish it. Maryland and Nevada also have extended the deadline for people who can show they began to sign-up before the end of the month…”We sort of liken it to if you are standing in line to vote and the polls close but you are still able to go ahead and vote,” said Scott Leitz, interim chief executive of Minnesota’s health-insurance exchange, MNsure. Mr. Leitz said people will have to prove that they tried to sign up to be eligible for flexibility. (WSJ)

It’s Zeke vs Me

In the Wall Street Journal. In recognition of ObamaCare’s 4th anniversary. Guess which one of us lacks a sense of humor?

I write:

money-burdenFor the past 40 years real, per capita health-care spending has been growing at twice the rate of growth of real, per capita income. That’s not only true in this country; it is about the average for the whole developed world.

Clearly, this trend cannot go on forever. So what does ObamaCare do about that? It limits the government’s share of the costs while doing nothing to protect individuals or their employers.

The law restricts the growth of total Medicare spending, the growth of Medicaid hospital spending and (after 2018) the growth of federal tax subsidies in the health-insurance exchanges to no more than the rate of growth of real GDP per capita plus about one half of 1%. This means that as health-care costs become more and more of a burden for the average family, people will get less and less help from government — to pay for insurance the government requires them to buy!

Zeke Emanuel with a somewhat different point of view.

What’s Wrong with This Uwe Reinhardt Idea?

Our friend from Princeton writes in The New York Times:

In a column in this paper’s Economix blog, I proposed that by age 25 an individual had to choose whether she or he would join a health insurance system based on social solidarity, with community-rated premiums, or instead join a system for rugged individualists, with medically underwritten premiums based on health status.

Only under the most dire economic circumstances would rugged individualists in this scheme ever be allowed into, say, Medicaid, to avoid human suffering that could be mitigated by critically needed health care. But thereafter the individual would not be allowed to accumulate any assets or enjoy income above the poverty level until he or she had paid back all premiums from age 25 on.

I would expect at least 95% and maybe more would choose the individualistic market. The reason: community rating benefits about 5% of the population at the expense of the other 95%. (Since income is disregarded here, the 5% could all be rich! And yes, I get the irony of calling that outcome “social solidarity.”)

Hits and Misses

Milton Friedman’s legacy.

Tom Miller is disappointed in the Coburn/Burr/Hatch health reform bill.

South Korea will not regulate Samsung’s Galaxy S5 (a smartphone with a heart-rate sensor) as a medical device. (See also previous blog entry)

Medicare Advantage cuts: Insurers’ advocacy campaign contradicts Wall Street analysts’ rosy outlook.