"Obamacare: Where's The Train Wreck?"
Alan: Republican fondness for falsehood exceeds Beelzebub's.
HHS may emphasize the individual-mandate penalties to boost sign-ups. "It would be a calculated approach to prompt sign-ups, a task that the law’s supporters expect to be more difficult, or at least more complex, than in its coverage’s inaugural year....The administration and Burwell frequently repeat the point that the law is 'working' — meaning that millions of people are getting affordable health coverage. Over the next several months, they’ll surely talk more about actual individuals who got coverage in the first year and hammer home that the law offers tax subsidies to many. Last year, advocates were worried about concentrating too much on one of the law’s least popular aspects. Rather than emphasize punishment, they tried to tout benefits. But focus groups conducted by PerryUndem found that the mandate was a strong motivator to getting people to sign up." Jennifer Haberkorn in Politico.
Government will release preliminary data on pharma's payments to doctors. "President Barack Obama's health care law requires manufacturers to report payments and gifts to physicians, unless they are valued at less than $10. It's part of a shift under his administration...to open the books of the medical profession. A few months ago Medicare released its massive claims database, showing program payments to more than 825,000 providers for 2012....Some doctors' offices have started curbing pharmaceutical marketing....But many doctors also receive significant payments to help drug companies conduct clinical research." Ricardo Alonso-Zaldivar in the Associated Press.
Explainer: What we're learning about drug-company payments to doctors. "Many, many health professionals have relationships with industry....Some doctors have relationships with many companies....The biggest companies aren’t always the ones that spend the most. Some smaller drug companies spend big, too....Meals vastly outnumber all other interactions between drug companies and doctors. But they account for a much smaller share of costs....Does any of this disclosure work? Well, it depends on what your definition of 'work' is....Some patients have told us that a payment has caused them to question a doctor’s prescription for a certain drug. Other patients have said that it gives them confidence that their physician is an expert." Charles Ornstein, Ryann Grochowski Jones and Eric Sagara in The New York Times and ProPublica.
And Texas and Florida did expand Medicaid — for kids. "Republican lawmakers in Florida and Texas snubbed the Affordable Care Act’s Medicaid expansion for adults, but their states did broaden the program this year -- for school-age children....That little-known provision of the health law is a key reason hundreds of thousands of kids gained coverage in the state-federal health insurance program for the poor, according to a Kaiser Health News survey of a dozen states. While many of those kids were previously enrolled in another government insurance program, children are typically better off in Medicaid....Several other factors helped drive the increases: Some of those kids might have been eligible under the old rule, but enrolled this year because of the focus on the health law’s open enrollment." Phil Galewitz in Kaiser Health News.
In addition to these... Here are some other Obamacare surprises. Joanne Kenen and Sarah Wheaton inPolitico Magazine.
Money talks: Medicaid expansion makes headway in Republican states. "Two things have led to a change of heart for some Republican politicians. Most of the 27 states that are already expanding the program have begun to reap billions in federal subsidies for insurers, hospitals and healthcare providers,putting politicians elsewhere under intense pressure to follow suit. As demonstrated by Pennsylvania's deal with Washington, the Obama administration has also proved willing to accept tweaks that give the private sector a greater role in providing healthcare and place new responsibilities on beneficiaries. All of that has got as many as nine states talking to the administration about potential expansion terms." David Morgan inReuters.
Related: As Obamacare pays medical bills, red states feel even more pressure on Medicaid. Bruce Japsen in Forbes.
HHS watchdog: Medicaid quality, access vary wildly across states. "Each state is largely free to set its own standards for care, including the distance a patient travels to see a doctor, the time a patient must wait for an appointment and the patient-to-doctor ratio within certain regions. Those standards vary widely across states and are largely unregulated by the federal government, according to an investigation by the inspector general’s office....As a result, federal officials say they don't know whether a state’s standards 'are adequate to ensure access to care.' While setting standards is a state responsibility, the audit says the federal government should strengthen its oversight and provide more guidance to states about how to run a managed Medicaid program." Sarah Ferris in The Hill.
It's not just a Medicaid issue. It's a health-care issue. "The inspector general’s report focused on Medicaid, but Obama administration officials are wrestling with similar issues as they set standards for private health plans sold on insurance exchanges under the Affordable Care Act. Standards for 'network adequacy' have become an explosive political issue. Many consumer advocates want the federal government to set stricter standards. But many insurers say they have been able to hold down premiums by providing access to a limited group of doctors and hospitals. The Obama administration is caught in the middle. It wants to guarantee access to a wide range of providers while holding down premiums, which are paid by consumers and subsidized by the federal government." Robert Pear in The New York Times.
Long read: Experts outline how they'd improve Obamacare for year two. Politico Magazine.
Poll: Americans still confused about Obamacare. Sarah Ferris in The Hill.
Federal doctor ratings face accuracy, value questions. "Consumers searching this fall for the best doctor covered by their new public or private insurance plan won't get very far on a federal database designed to rate physician quality. The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It's so limited, health care experts say, as to be useless to many consumers. This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament." Jayne O'Donnell in USA Today.
Should you be able to see any doctor you want? "People don't like being told 'no,' especially when it comes to something as personal as their health care. They also don't like rising health-care costs. And therein lies the health-care system's existential debate about narrow networks. Narrow networks...aren't new, but they're emerging as one of insurers' major levers for keeping down costs under the Affordable Care Act. The ultimate question for the health-care system and everyone who interacts with it is just what limits patients can accept before avoiding another 1990s-style backlash against managed care. In just a few weeks, voters in South Dakota will actually get to weigh in on this question, thanks to a ballot initiative." Jason Millman in The Washington Post.
BINDER: Report shows employers reining in health-care spending — with a twist. "The same report shows that employers are spending more than they did last year on their portion of the premiums. Moreover, they are voluntarily spending additional sums of money above and beyond what they pay in health insurance premiums...First, about two-thirds of the large employers that offer high-deductible plans voluntarily pair them with tax-protected health savings accounts that help employees pay out-of-pocket costs....Many are also paying to exclude some benefits from the deductible requirements, such as preventive care, prescription medications or physician services for diabetics. What are we to make of this? Employers’ first consideration is not cost, but value." Leah Binder in Forbes.
BAGLEY: What should the law do about out-of-network ER doctors? "The absence of meaningful choice when it comes to emergency care may provide an opportunity for Labor to enact a rule treating the costs of such care differently. What if Labor issued a rule saying that payments to out-of-network ER docs would count toward the out-of-pocket spending cap, so long as the care was received at an in-network hospital? This would be only a partial solution. Before they reach their out-of-pocket cap, patients would still be on the hook for out-of-pocket payments to ER physicians. But at least they’d have some financial security in the event that they racked up extraordinary out-of-pocket costs. In any event, these sorts of abusive billing practices have got to end." Nicholas Bagley in The Incidental Economist.
FRAKT: Auto-renewing your coverage may be bad for you — and for competition. "My colleagues Margot Sanger-Katz and Amanda Cox wrote recently that shopping around for the best price can be crucial for people renewing their coverage on the health insurance exchanges this fall. But evidence suggests that many people probably won’t do that. Not only is that bad for them, but it can also harm competition, which is bad for everyone. A basic truth about health insurance, as with many other things, is that people hate to shop around and change products. They have a status quo bias. That bias can be exacerbated by a large number of plan choices, as consumers in some exchanges face." Austin Frakt in The New York Times.