Steve Anderson’s Health Wonk Review

Steve Anderson’s edition of Health Wonk Review somehow manages to find new news from last week’s Republican convention.

That would be impressive enough, but wait, there’s more!

David Williams’ deep dive into dialysis – an industry that exemplifies the conflicts and adverse motivations inherent in our health care system.

A revealing look at healthcare “ministries”; a business which, at the very least, requires a leap of faith across a very deep chasm.

And a critical de-construction of President Obama’s JAMA article about ACA.

A great way to start your week!


Clinton health 2.0

Medicare for more, caps on premiums and out-of-pocket spending,

Presumptive Democratic nominee Hillary Clinton’s health plan builds on ACA in several key ways, with an over-arching goals of providing more consumer choice and reduce the financial burden on consumers.

  • a tax credit of up to $5,000 per family to offset a portion of excessive out-of-pocket and premium costs above 5% of their income.
  • incease financial incentives for states to expand Medicaid
  • allow younger seniors to “buy-in” to Medicare

Let’s take these in order.

Tax credit

The Clinton plan’s tax credit is intended to address a growing concern; while premium costs aren’t zooming up (altho 2017 premiums look to be increasing at near-double-digit rates) deductibles, co-pays and coinsurance are becoming increasingly problematic.  The $5,000 tax credit is intended to offset some of these increases, and is coupled with a limit on total insurance and related expenses of 8.5% of family income and a mechanism intended to reduce costs for those earning more than 400% of the federal poverty level. (this last can make a huge difference, as costs for those just under 400% can be a fraction of what those earning just above 400% pay).

The subsidy isn’t limited to lower-income folks, and will certainly increase costs and concerns about affordability. However, indications are that take-up among the more affluent would likely be fairly low – and the subsidy pales in comparison to the favorable tax treatment currently enjoyed by those with employer-based insurance. Notably, there’s effectively a “fade-out” of the impact of the 8.5% cap for the truly affluent just because that 8.5% represents a pretty high figure for those with a lot of income.


Clinton proposes federal payment of 100% of the cost for any state that expands Medicaid for three years (declining to 90% thereafter).  Her plan also includes increased funding for education and enrollment activities for Medicaid-eligibles.

Medicare buy-in

The yet-to-be-finalized plan would allow seniors as young as 50 to buy in to Medicare. If enough seniors chose Medicare, rates for “regular” insurance on the Exchanges would likely decrease as the average age of members would decrease, thereby decreasing expected costs. And, insurance premiums for those seniors buying in would almost certainly be several thousand dollars lower than they can currently get via the Exchange. Clinton contends, with some justification, that adding more consumers to Medicare would reduce overall health care costs.

Medicare’s buying power and regulatory authority gives it much more control over health care price and utilization.  That, plus the sheer number of Medicare recipients, makes it the dominant force in the marketplace.  While providers may balk, many will find it necessary to go along – or lose a substantial chunk of their patient base.

However…Medicare is a mash-up of four separate and distinct parts, with different deductibles, treatment requirements, cost sharing, and treatment limits.  While it is well understood by practitioners, that’s only because it is THE dominant health insurer in every market.  Streamlining and rationalizing the benefit plan would make it much more palatable to under-65s.

Clinton has yet to dive into the details, but given the attention span and appetite for same among the eligible-voter population, those details are going to get attention from a very limited group of health care geeks (your faithful author included).

What does this mean for you?

Depends on whether a) Sec. Clinton is elected; b) the Dems take over the Senate; and c) the Dems make significant inroads in the House.


The future of ACA – the wonks sound off

18% of our economy is healthcare.  To know where it’s headed and how it will change, read Louise Norris’ edition of Health Wonk Review.

Louise has a plethora of posts from really smart people about the Path Forward for ACA and health reform, plus thought-provoking takes on pharma pricing, conflicts of interest, grandfathered health plans and the working person’s travails in 1915.


HWR’s Cornucopia overflowed!

Two entries were inadvertently left out of last week’s Health Wonk Review – my apologies!

From Bill Danylik comes this report on a survey indicating perhaps half of large employers are going to be affected by the “Cadillac Tax by 2018.  Fine by me; the tax was part of the great compromise reached to fund ACA way back when.  It is intended to reduce the favorable tax treatment of benefits, one that subsidizes rich benefit plans.

Posting at the blog, Wendell Potter provides insight into why some states have experienced big increases in individual health insurance premiums.  Mr Potter thinks this is due to the similarity between the US health insurance business and the casino industry.

Hmmm, will Native Americans will come to rule health insurance soon?

OK, if you’re off today, enjoy.  If not, back to work!


Health Wonk Review’s overflowing cornucopia!

Harvest time is here, and we have a cornucopia of cogitation from contributors for your consideration. (sorry, it’s late…)


The lede

This may be mis-named, as Roy Poses MD’s take on the latest in the ongoing revolving door debacle presents a decidedly unappetizing look at regulatory processes. The candidate nominated to head the FDA has strong ties to the industry he will be regulating.  While a superficial review of Robert Califf’s CV doesn’t indicate much of concern, a deeper dive uncovers a board position at a drug company and various and sundry other financial ties.

Dr Poses’ unstinting efforts to teach the rest of us about the far-too-chummy relationships between regulators and regulatees makes him one of our industry’s best.

Implementing Reform

In what may be the umpteen gazillionth effort by the GOPers in the US House of Representatives to do something, anything to kill PPACA, we now have a lawsuit filed by that august body accusing CMS of overstepping its authority re cost-sharing subsidies for exchange enrollees. Attorney Max Horowitz, an expert in the law brings us this tight description of the issue; if you just want to know the basics, click thru.

A huge effort has been underway to automate and integrate health care delivery.  Peggy Salvatore shares the latest from the Office of the National Coordinator of Health IT. The ONCHIT announced that it has rolled back Meaningful Use requirements and put in place a 10-year plan for complete nationwide health IT interoperability. These two documents come on the heels of the release of the Federal Health IT Strategic Plan two weeks ago. This is a big deal folks…

Meanwhile, the Colorado version of ACA seems to be moving along albeit with bumps along the way, some of them – shockingly – created by the same folks who continue to try to kill PPACA.  Colorado Health Insurance Insider shares what’s happening as health plans set premiums for future years and wonder what happened to the Risk Corridor payments they were promised. Thanks Louise!

The fine folk at HealthAffairs are careful students of all that is payment reform; they direct our attention to limitations in the current shared-savings models employed by Medicare, limitations that means those models don’t work that well for low cost ACOs.  Two execs have come up with a creative alternative, one with global risk-adjustment that may address some of the issues with the current model.  This is exactly what health reform is supposed to do – get smart people to figure out better ways to do things.


Reports of the death of physician private practice may be exaggerated – or at least very, very premature.  Jaan Sidorov at Population Health Management provides a very interesting post detailing why and how small physician groups are competing quite well in these days of mega-huge health systems.

My contribution is a piece offering a quick review of a bunch of issues in the healthcare world including the Cadillac tax, premium increases, employee cost sharing, and payer consolidation. All in one easy-to-digest bite!

This next post may cause major indigestion in corporate board suites.

While company executives seem to always escape without any penalty when their companies do bad things, one exec may well get hammered.  The top exec at Massey Mining, the company tied to the Upper Big Branch mine disaster is facing trial for his role in the tragedy that killed 29 miners.  The question to be addressed involves the level of responsibility a CEO has when things go horribly wrong.  WorkCompInsider’s Julie Ferguson includes links to some pretty telling video detailing what CEO Don Blankenship is is accused of.

For post-prandial lethargy sufferers

You know those health plan emails encouraging you to exercise? They may get more serious soon…Hank Stern and friends at InsureBlog are telling us that FitBit may be one way healthplans will find out exactly how many steps you’ve taken.  Not to worry; it will be HIPAA compliant.

We’d be remiss if we didn’t give Hank a shout-out; his blog recently was named the #2 Men’s Health Blog.  I gotta believe something from Maxim hit the top spot – no other way to keep IB off the top of the podium…and you know how shallow men are!

That’s enough for now.  enjoy your Friday, have a ball this weekend, and get out to those Farmer’s Markets!