Health Policy Blog

Obamacare Repeal & Replace 2.0: Where Do We Go From Here?

The failed House Republican American Health Care Act (AHCA) was always a work in progress. The three-phased approach to reform health care called for passage of the AHCA to repeal the Affordable Care Act (ACA) taxes and mandates; and slow the growth in Medicaid (phase one). Phase two was the selective tweaking of Obamacare regulations by the Secretary of Health and Human Services. Phase three was to be a forthcoming health care bill to revamp onerous insurance regulations.

Mar 29, 2017 | 85 comments | by Devon Herrick

Third-Party Payment Is The Root Cause of Health System Dysfunction

(A version of this Health Alert was published by RealClearHealth.)

Largely absent from the vigorous debate over reforming the nation’s health care laws is the understanding that simply being covered by health insurance does not reduce health care costs.

Before the Affordable Care Act (ACA) passed in March 2010, President Obama repeatedly promised that the typical family’s health premiums would go down by (sometimes “up to” but frequently “on average”) $2,500. That decline did not occur because the ACA strengthened the control that insurance companies—as opposed to patients—have over health care spending. In fact, Americans’ increasing dependence on health insurance over the last seven decades has been a major contributor to exploding health costs.

Mar 27, 2017 | 15 comments | by John R. Graham

Average Wait Time to See A Physician Up 30 Percent in Three Years

Merritt Hawkins, a physician-staffing firm has published its periodic survey of waiting times for appointments with physicians in 30 metropolitan markets. The results:

Average new patient physician appointment wait times have increased significantly. The average wait time for a physician appointment for the 15 large metro markets surveyed is 24.1 days, up 30% from 2014
Appointment wait times are longer in mid-sized metro markets than in large metro markets. The average wait time for a new patient physician appointment in all 15 mid-sized markets is 32 days, 32.8% higher than the average for large metro markets.

Mar 27, 2017 | 3 comments | by John R. Graham

California Single-Payer Bill Looks Backward, Not Forward to A New Era of Patient Choice

(A version of this Health Alert was published by the Orange County Register.)

Here we go again. The California state legislature is considering yet another bill to impose a so-called single-payer, government monopoly, health care system. This has long been an obsession of the militant California Nurses Union, because a health system under total government control would suit the narrow interests of union leaders. They would accrue power similar to that wielded by other public-sector unions and might even be able to negotiate contracts similar to those enjoyed by state and local employees, which are driving public finances across the state into the ditch.

Mar 23, 2017 | 4 comments | by John R. Graham

House Obamacare Repeal Bill Limits HSAs for Millions of Americans

Hand Holding Cash ca. 1998

The House Republican American Health Care Act Managers Amendment would not allow Americans to use their tax credits to fund an HSA. Instead of using their tax credit/HSA to pay for doctor visits, prescriptions and OTC drugs, Americans will only be allowed to use their credit for insurance. This is a big mistake – and a giveaway to insurers. Millions more Americans would have an HSA if the proposed $2,000 to $4,000 tax credits were automatically deposited into individuals’ HSAs for use on health insurance premiums, copays, cost-sharing and paying for direct care.

Mar 21, 2017 | 27 comments | by Devon Herrick

Where Does Your Insurance Premium Go?

AHIP, the trade association for health insurers, has a nifty infographic answering the question: “Where does your premium dollar go?”

Obviously designed to defray accusations that health insurers earn too much profit, the infographic shows “net margin: of only three percent. A full 80 percent of our premium dollar goes to paying medical, hospital, and prescription claims.”

Fair enough. However, the elephant in the infographic is the 18 percent of premium that goes to “operating costs.” Lest you think that’s a synonym for “overhead” or “bureaucracy,” AHIP helpfully explains: “Operating costs include consumer-centric activities such as communicating with members, running customer service operations, quality reviews, and data analysis, among other activities.”

Well, readers have to judge how “consumer-centric” those operations are.

Mar 21, 2017 | 7 comments | by John R. Graham

Veterans Health Administration Realizes It Should Buy, Not Build, Software

Imagine if you learned a government agency built its own office furniture, HVAC, or telephones. Even if there were a massive amount of corruption in government purchasing, it would be remarkable if a bureaucracy could do a better job building than buying.

Yet, for decades, the Veterans Health Administration has tried to do that with its Electronic Health Record (EHR). I cannot think of another health system that has built its own EHR, rather than buy it from a vendor. It makes as little sense as a health system manufacturing its own MRI machines.

President Trump’s newly appointed VA Secretary has confirmed he will throw in the towel on the VA’s home-brew system, VISTA, and buy a commercial EHR.

Mar 20, 2017 | Leave a Comment | by John R. Graham

The Logic Defying CBO Obamacare Replacement Score Breaks Its Own Rules, Among Other Problems

(A version of this Health Alert was published by Forbes.)

Dr. Tom Price, the U.S. Secretary of Health & Human Services has said the Congressional Budget Office’s recent “score” of the Republican Obamacare replacement bill defies logic. Even worse, it defies the very rules which govern the CBO.

The 2016 Budget Resolution, agreed by both the House and Senate in May 2015 directed the CBO to do so-called dynamic scoring of major legislation. Dynamic scoring includes proposed laws’ macroeconomic effects. It is especially important when new laws cut taxes, as the American Health Care Act would do. Old fashioned, static analysis does not result in accurate estimates.

For example, say a 10 percent tax on a base of $100 million raises $10 million. Cutting that tax to five percent would cut revenue by $5 million, under static analysis. This ignores the economic growth that would occur as a result of the tax cut.

Mar 17, 2017 | 96 comments | by John R. Graham

Mayo Clinic Admits it Prioritizes Privately Insured

Hand Holding Cash ca. 1998

The Mayo Clinic has admitted it places Medicaid and Medicare patients in a lower priority than patients with private insurance. This is something that many doctors and hospitals likely do. It is well known that Medicare pays physicians only about 80% of what private insurers reimburse for the same coverage. Medicare reimburses hospitals about 70% of private payers. Medicaid rates are a fraction of Medicare’s rates.

Mar 16, 2017 | 2 comments | by Devon Herrick

Bargain Basement vs. the Sky is the Limit Health Care

Caduceus with First-aid Kit --- Image by © Royalty-Free/Corbis

How much should a healthy person’s health insurance premiums reflect the cost of another person’s poor health status? Stated another way, how much should society invest in care for the sickest individuals? Moreover, should society invest in primary care or inpatient care?

Mar 15, 2017 | 84 comments | by Devon Herrick