Is Obamacare Improving Care? A Decisive Majority Happy With ACA

"Obamacare: Where's The Train Wreck?"

http://paxonbothhouses.blogspot.com/2014/01/wheres-train-wreck.html

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How is Obamacare faring at improving care?

Survey: Strong majority happy with their ACA coverage. Sarah Ferris in The Hill.

A year after launch, Obamacare is rejigging an already complex health-care system. Is it working?"America’s health system, the world’s biggest, involves a tangled mess of rules and a hotch-potch of public and private institutions. It combines dazzling technology with minimal cost controls and spotty coverage. In 2012 it left some 48m people uninsured despite gobbling up 17.2% of GDP....Rather than scrap this system, Obamacare rejigs it. It expands Medicaid to include millions of not-quite-poor Americans. It seeks to create a market where individuals can buy health insurance, pooling risks without the backing of a large employer. Ultimately, it aims to expand coverage and deliver better care at a lower price. Its record is mixed so far." The Economist.

Current Obamacare enrollment at 7.3M. "The figure — which is the number who had signed up and paid as of mid-August — is a drop from the 8 million who had chosen plans but not necessarily paid by mid-April. But it’s much higher than the 6 million that the Congressional Budget Office forecast would be covered this year, a number that seemed unattainable when the botched launch of HealthCare.gov slowed signup to a crawl last October....The figure’s release also starts to answer a long-term question facing Obamacare: will people stay on the rolls? It will be a particularly important question in the second year, when the Obama administration tries to enroll millions more Americans in the president’s signature health law." Jennifer Haberkorn in Politico.

Why the drop from 8.1M signups isn't surprising. "The 7.3 million figure isn't cumulative — it represents a 'snapshot in time,' HHS said. It includes people who signed up during open enrollment and are still paying their premiums, as well as people who have come into the system since then....A certain degree of 'churn' was always expected within the exchanges: People would cycle out when, for example, they get jobs that offer health insurance, and others would cycle in due to life changes that made them eligible to sign up for coverage outside the open-enrollment window....The number could drop again at the end of the month, when individuals who have not verified their citizenship or immigration status will lose their coverage." Sam Baker and Sophie Novack in National Journal.

The U.S. health-care system among least efficient in the world. Can the health law fix that? "The U.S. health-care system was among the least efficient in the developed world two years before major changes from Obamacare began to go into effect. America’s health-care system ranked 44th of 51 nations assessed by Bloomberg, in terms of per person spending, life expectancy and health-care cost as a percentage of the economy. It’s an improvement from 46th of 48 last year, yet Serbia, Turkey and China still scored better....Obamacare is slowly attempting to pay U.S. doctors based on health outcomes, instead of how many procedures they perform. The pressure on the U.S. will only grow as its population ages." Anna Edney in Bloomberg.

Under Obamacare, two-thirds of insured women now get their birth-control pills free. Sarah Kliff in Vox.

Long read: How much do we spend on wasteful care? Sarah Kliff in Vox.

Shopping around could be crucial for Obamacare customers next year. "In many places premiums are going up by double-digit percentages within many of the most popular plans. But other plans, hoping to attract customers, are increasing their prices substantially less. In some markets, plans are even cutting prices. Health policy experts and patient groups say that insurers may be skirting the spirit of the Affordable Care Act by adding some generic drugs to higher cost tiers....As the law’s designers intended, plans are competing for customers, which often holds cost down. But...consumers are stuck with tough choices — swallow a big premium increase or switch to a cheaper plan that may cover different doctors and hospitals." Margot Sanger-Katz and Amanda Cox in The New York Times.

Hospitals are merging and using the ACA as a justification. The FTC is wary. "Hospitals often say they acquire other hospitals and physician groups so they can coordinate care, in keeping with the goals of the Affordable Care Act. But the agency, the Federal Trade Commission, says that mergers tend to reduce competition, and that doctors and hospitals can usually achieve the benefits of coordinated care without a full merger. The commission is using...the Clayton Antitrust Act of 1914, to challenge some of the mergers and acquisitions, and it has had remarkable success in recent cases....Deborah L. Feinstein, director of the bureau of competition at the Federal Trade Commission, said the health care law did not repeal the antitrust laws." Robert Pear in The New York Times.

Under Obamacare, the difference between insurers hospitals is vanishing in some places. "Anthem Blue Cross, California’s second-largest insurance company, is entering an unusual arrangement with seven hospital groups in Southern California: Together they’ll create a joint health plan where rival hospitals and the insurance company will share in profits and losses....The new plan, called Vivity, is the latest example of the blurring line between the companies that provide medical care and the ones that manage risk — and costs — for patients. Most hospitals currently make more money performing a surgery than providing preventive care to avoid one, but under the Affordable Care Act they’re being encouraged to change that....The law encourages arrangements that reward hospitals for better outcomes." John Tozzi in Bloomberg Businessweek.

Some patients fall through cracks as hospitals cut back on charity care. "Other low-income patients may be in for the same surprise. Hospitals across the country are rethinking their financial assistance policies now that the Affordable Care Act is making insurance available to more people....It’s not clear yet how many hospitals already have made their financial assistance policies stricter, but examples have been cropping up across the country....Some critics say hospitals may be overestimating the ACA’s benefits when they change their financial assistance policies....Hospitals also say the ACA is making things complicated for them." Alan Bavley in The Kansas City Star.

Obamacare: From electoral lightning to just another policy issue. "It would be an overstatement to say the Affordable Care Act has disappeared from the fall election campaigns. It hasn’t. Republicans are still running attack ads about it, as are outside conservative groups. Democrats are mostly quiet on the law, but occasionally they’ll speak up — as Sen. Mark Pryor of Arkansas did — to focus on one of its benefits and promise never to let insurance companies run the show again. But even Republicans who still believe it’s a significant issue, and a damaging one for Democrats despite its benefits, can’t point to races that are likely to be decided on the health care law alone." David Nather in Politico.