#FullRepeal Daily Digest

The Federalist: 12 Reasons Why Medicaid Expansion Is A Terrible Idea

• Medicaid doesn’t actually improve health outcomes.
• Medicaid promises people health coverage, but often denies them access to quality doctors.
• Expanding Medicaid without reform accepts a broken status quo that fails patients and taxpayers.
• Obamacare’s expansion is a one-size-fits-all, all-or-nothing approach.
• Medicaid expansion could increase the cost of private health care.
• Medicaid expansion crowds out other private health care options.
• Obamacare’s Medicaid expansion is financed with $1 trillion in tax hikes and $700 billion in cuts to Medicare.
• It’s unrealistic to think the projected level of Medicaid spending under Obamacare’s expansion can be sustained.
• Uncle Sam can unilaterally change the terms of the deal whenever he feels like it…
• Expanding Medicaid could force states to reduce funding for education, increase state tuition, or cut transportation funding.
• Expanding Medicaid could force states to increase taxes.
• Obamacare repeal becomes harder and harder as more people pile into Medicaid.
• [RELATED] Philly.com: Medicaid re-envisioned: By reducing dependency we can benefit everyone
  • [In Medicare] Nearly 30 percent of beneficiaries have taken advantage of them by choosing to direct their share of the taxpayers’ contributions toward private Medicare Advantage Plans rather than the fee-for-service plan managed by the government.  Many beneficiaries exercise their choice by paying extra for somewhat better coverage, either as an extra premium for their MA plan or for a private Medigap plan to top up their government coverage.
  • But for people on Medicaid, either the mothers, children, and disabled who were the traditional beneficiaries or the able bodied adults who have become newly eligible in states accepting the ACA’s expansion, there is rarely meaningful choice, and no opportunity to pay more to get more.  Physician payment rates that are 40% below what private insurers pay, enormous difficulties in getting referrals to specialists, and very limited networks of inconveniently located doctors are all typical.
  • …one of the options under Medicaid should remain a public option (as in Medicare but not in the ACA exchanges) for those beneficiaries who trust the government and like what it offers.  But it should not be the sole option.  Calling this arrangement a “voucher” would be political death, but calling it a “free choice contribution” might give it bipartisan appeal—and if it works well, taxpayers reluctant to throw good money after bad into the existing Medicaid program might have second and more generous thoughts…
  • The upbeat argument for this approach recognizes that the time is ripe.  Medicaid is changing under the ACA, and even states reluctant to go with the expansion of old-style Medicaid to the able bodied poor might go for this.  The realistic argument is that Medicaid is not working in many states.  It does not give the poor the same help as the government gives to other groups, so opening the doors to alternatives is at least worth a try.  And a program that does not stigmatize citizens with lower incomes may improve both their current wellbeing and their future prospects.

Washington Free Beacon: VA Spent Tens of Millions on Ad Campaigns, Audits, Green Energy

• An analysis of records on the government’s official spending website shows the VA spent $1.3 billion in the past five years for “support” and “professional services.” These contracts included millions of dollars for a campaign to put the VA in a positive light, lodging and training of employees, and energy programs to make VA facilities more sustainable.
• One Free Beacon reader emailed us about a solar panel electric car charging station at the Grand Junction, Colorado VA facility installed for vets with electric cars that need charging. It is unclear how many veterans who visit the Colorado facility have electric cars. VA auditors have now flagged that facility in the wait time scandal.

Associated Press: Insurers will propose changes to Obama health law

• Insurers want to change President Barack Obama's health care law to provide financial assistance for people buying bare-bones coverage. That would entice the healthy and the young, the industry says, holding down premiums.So-called catastrophic plans are currently not eligible for the law's subsidies, and only 2 percent of the 8 million consumers who signed up this year picked one.
• The proposed change is part of a package of recommendations that America's Health Insurance Plans, the main industry trade group, plans to release Wednesday. Others address how to smooth transitions for consumers who switch insurance companies, as well as making it easier for patients to find out which hospitals and doctors are in particular plans and whether their medications are covered.
• [despite some initial public opposition]… the industry has also become one of the administration's main allies in carrying out the law, enduring the cascade of rollout problems last fall and working behind the scenes to make sure consumers whose old plans got canceled were able to maintain coverage. That's earned insurers public expressions of gratitude from top health care officials in the administration.

The Wall Street Journal: Mixed Bag for Health Co-Ops Many of the Nonprofit Insurers Falling Short of Goals

• Many of the nonprofit health-insurance cooperatives created by the Affordable Care Act have enrolled far fewer people than they had hoped, according to figures obtained by a Republican-led House committee, calling into question their viability.
• Fourteen of the 23 co-ops reported to the panel that, as of April 1 or later, they had enrolled significantly fewer people than they had projected for 2014 when they obtained $2 billion in federal loans from a fund created under the health law. The shortfalls create steeper obstacles for the plans to succeed and repay the loans.
• Health-insurance co-ops are nonprofit insurance entities governed by their members…designed to give consumers an alternative to traditional plans and inject competition into the law's new online insurance marketplaces, putting pressure on established plans to offer lower premiums.
• But a series of factors impeded co-ops' success during the first main sign-up period under the law, which ended in March. Some priced their plans higher than other insurers in their states. The Obama administration's decision to allow people to renew existing insurance plans that were canceled took away potential customers. Moreover, technical problems at state and federal enrollment websites hampered co-op sign-ups.
• [RELATED] Real Clear Markets: A Healthcare Stumble That Could Wreck the Obamacare Façade
  • Now the co-ops are facing perhaps their biggest test to date. At stake, may be whether these plans can stay in business for another year. Also on the line is a more profound question of politics and policy. Whether or not the co-op plans will be the triumph of government administration over markets that many liberal policy makers had envisioned when they wrote this provision into the original law.
  • A number of the co-ops have announced their 2015 rates in filings this week. Some of these plans are proposing to sharply cut their premiums. Private insurers are going to be raising their 2015 premiums an average of about 10% in many states (to reflect their higher costs as a result of Obamacare's rocky rollout). By contrast, some of the co-op plans will be proposing to cut their premiums by a similar magnitude.
  • If the co-ops can successfully lower premiums, and still offer comparable benefits, liberal policy makers will hail the scheme as a triumph of government over markets. If they can't pull off these rate cuts, then the co-op plans could end up bankrupted. In many states, the co-ops didn't start out as the cheapest insurance options. So the rate cuts come on top of premiums that are, at least in some cases, above average. But the reductions in 2015 premiums are still highly significant as a matter of both politics as well as business. These reductions, and the outcome, bear close watching.

Forbes: The Grim Prospect of Life Without Antibiotics

• A 2002 change in FDA requirements for the clinical testing of antibiotics helped to create the shortage of new antibiotics.  To enhance the statistical power – and therefore, the confidence level — of Phase III antibiotic clinical trials, FDA more than doubled the number of patients required.  
• As antibiotics researchers David Shlaes and Robert Moellering observed in that same year, because in the pharmaceutical industry business considerations play a critical part in setting R&D priorities, corporate programs with modest potential markets and large costs are automatically deprioritized unless there is some other, overriding strategic issue to be considered.  Thus, one unintended result of promulgating these guidelines will be a decrease in the number of companies performing antibacterial research.
• Their prediction was accurate: Since 2002 all but a handful of the major pharmaceutical companies have abandoned their antibiotics R&D programs.
• In July 2013, however, the FDA released new draft guidelines for the conduct of antibiotic clinical trials – part of a self-described “reboot” of policy at the agency.  The new guidelines may help, but some experts, such as UCLA Professor of Medicine Brad Spellberg, have warned that the new guidelines don’t represent significant change, and that much more improvement is needed for trials to become feasible again.