05.13.2014

#FullRepeal Daily Digest

New York Times: More Insured, but the Choices Are Narrowing

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans.
In 2010, 24 percent of the largest employers offered smaller networks, chosen for their low costs or quality. Last year, 27 percent offered them and 44 percent said they were considering them, according to Mercer, a benefits consulting firm. Some companies are experimenting with different tiers of networks, charging workers more if they go to the broadest network, said Joseph Kra, a Mercer consultant.
There has been pushback, however. When United Healthcare reduced the size of networks in some Medicare Advantage plans, consumer groups and regulators balked. Dr. Ho, the chief medical officer, said the insurer offered patients the opportunity to continue receiving certain treatments, like chemotherapy, with their existing provider.

National Journal: The States Where Obamacare Could Still Go Badly Several states are in danger of seeing big premium increases

Premiums will go up, on average, across the board—premiums go up every year. But a range of factors could drive higher-than-average increases in certain places. States that fell short of their overall enrollment goals, and where the people who did enroll are mostly older and sicker, are more at risk for large premium hikes. So are states that don't have much competition among insurers.
[RELATED] Washington Post: Hospitals see blue-red divide early into Obamacare's coverage expansion [ many hospitals are continuing to lobby to expand the broken Medicaid system]
- The Hospital Corporation of America, which has facilities in 20 states, reported a big gap in Medicaid and uninsured admissions between expansion and non-expansion states. In the four states it operates where Medicaid expanded under the ACA, the company saw a 22.3 percent growth in Medicaid admissions, compared to a 1.3 percent decline in non-expansion states. The company also had a 29 percent decline in uninsured admissions in the expansion states, while non-expansion states experienced 5.9 percent growth in uninsured admissions, chief financial officer William Rutherford said.

Washington Examiner: Obamacare's employer mandate hits low-wage workers the hardest, study says

"Employers with 50 or more workers not offering coverage pre-[Affordable Care Act] are the same employers that are highly likely to not offer in the future, therefore incurring the ACA's penalties," the study reads. "Because the nonoffering firms are much more likely to be firms dominated by low-wage workers ... low-wage employees will bear the greatest brunt of the penalties imposed. Therefore, using employer penalties as a tool for financing reform tends to be a regressive approach."
What's interesting about the study is that it isn't coming from a group traditionally opposed to the law. In fact, quite the opposite. The study argues that ditching the mandate will strengthen the law and help it become more entrenched.
"Eliminating the employer responsibility requirements should substantially diminish employer opposition to the ACA," the study reads. "In fact, without that burden, employers may play more of a role promoting the expansion of coverage under the law."

Forbes: The Health Insurance Trap

Third party entities don’t spend money like you and I do. We care about two things when we buy a product: quality and affordability. Insurance providers aren’t overly concerned about either. Affordability isn’t their biggest concern because they’re spending someone else’s money—their members’ premiums. They’re also not concerned as much about quality because they’re spending that money on someone other than themselves—the patients receiving treatment.
This is a basic reflection of human nature. It’s also the single worst way to spend money, according to the late Noble Prize-winning economist Milton Friedman. The best arrangement, as he demonstrated through his economic work, occurs when individuals spend their own money on themselves.
Obamacare bears this out. Plans currently offered on health care exchanges frequently include smaller doctor and hospital networks. Many patients must now decide whether they want relative affordability or more options.Compare this to a health care system without third party insurance companies, whether public or private. It already exists—and it’s working. In the fields of cosmetic surgery, Lasik eye surgery, alternative medicine, and dentistry, the absence—or minimal presence—of third party entities has driven prices down and quality and service up.
There’s also a growing market of health care providers who refuse to accept third party insurance or Medicaid precisely because both they and their patients can save money. For instance, I had a patient who saved $17,000 on a single treatment. He paid me and the hospital directly rather than going through his insurance company.
Every patient and every doctor should demand a similar arrangement. Instead, Obamacare’s architects expanded a health insurance system that artificially increases costs and decreases choice. That’s not what the doctor—or the patient—ordered.

Stateline (Pew Charitable Trusts): Health Insurance and Death Rates [there is a range of opinion and studies debating whether health insurance has a significant impact on mortality]

In a study released last week, Harvard School of Public Health professors Benjamin Sommers, Sharon Long and Katherine Baicker conclude that “health reform in Massachusetts was associated with a significant decrease in all-cause mortality.”
…a 2009 study by Richard Kronick of the Health Research and Education Trust found that when adjusted for health status and other factors, the risk of subsequent mortality is no different for people who lack insurance than for those who are covered by employer-sponsored plans. Kronick’s conclusion: “There is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States.”

Reuters: Medicare pays billions of dollars for wasteful procedures – study

As many as 42 percent of U.S. Medicare patients were subjected to procedures providing little if any medical benefit, costing the government program up to $8.5 billion in wasteful spending, according to a study published on Monday.
The research, reported in JAMA Internal Medicine, is the first large-scale analysis of what Medicare spends on procedures widely viewed as unnecessary, from advanced imaging for simple lower back pain to pre-operative chest X-rays and putting stents in patients with stable heart disease. The study looked at the frequency at which doctors used 26 such procedures in 2009.