What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.
Makeover Coming For HealthCare.Gov
Acknowledging at least tacitly the difficulties of some health care consumers, the Obama administration plans major changes toHealthCare.gov this year to make it easier for shoppers to find health insurance plans that include their doctors and to predict their health care costs for the coming year. With substantial premium increases coming in some states in 2016, administration officials are expecting that many consumers already in the Affordable Care Act’s networks will have to switch health plans and find new doctors as they scramble for cheaper alternatives. And millions more Americans could be receiving health insurance through health care marketplaces for the first time. Via NY Times.
Where We Stand: No Clear Path On Spending, Debt, Highways, And More
Before departing for a weeklong recess, the House Budget Committee marked up a reconciliation package that repeals five key portions of the Affordable Care Act. The package — which repeals the individual and employer mandates, several Obamacare taxes that are unpopular with industry groups and the Independent Payment Advisory Board — is expected to receive a floor vote in the House this month. Via Morning Consult.
Insurance Dropouts Present A Challenge For Health Law
On Nov. 1, a new sign-up period for health insurance under the Affordable Care Act will begin, and insurers, health care providers, and enrollment groups are ramping up campaigns to encourage 10.5 million eligible uninsured people to buy policies. But even as those efforts begin, the public insurance exchanges, also known as marketplaces, created by the law are facing another challenge: keeping the customers they already have. Via NY Times.
Health Care Reform 2015: Under Obamacare, Half Of Uninsured Do Not Qualify For Subsidized Health Insurance Or Medicaid, Analysis Shows
For nearly 18 million Americans, the Affordable Care Act spelled an end to months, years or sometimes even decades without health insurance. But for half of the 32.3 million Americans who remain uninsured after the law went into effect, key provisions of Obamacare won’t help them, an analysis published showed. Via International Business Times.
Tapping Lab Data to Improve Utilization
Lab test overutilization falls under the Institute of Medicine's "Unnecessary Services" category, which accounted for $210 billion in excess health care spending in 2009. Since then, avoiding unnecessary, outdated, or more expensive versions of equally effective tests has become a primary goal for cost reduction and quality improvement efforts, such as the American Board of Internal Medicine's "Choosing Wisely" campaign. Via Advance Healthcare Network.
Medical Prices Higher In Areas Where Large Doctor Groups Dominate, Study Finds
The October Health Affairs study examined the average county prices paid by preferred provider insurance organizations in 2010. It focused on 15 high-volume, high-cost medical procedures across a variety of specialties, including vasectomy, laparoscopic appendectomy, colonoscopy with lesion removal, nasal septum repair, cataract removal, and knee replacement. Via Kaiser Health News.
Study: U.S. Spends More On Health With Worse Results
The United States spends far more per person on health care than other wealthy countries, but often has worse health outcomes, according to a new report. The report from the Commonwealth Fund, a health research group, reinforces a critique that reformers have long pointed out about the U.S. health system. Via The Hill.
Health Care Reforms Already Underway, VA Insists
Congressional critics say Department of Veterans Affairs health offerings need to be overhauled. VA's leader insists that work is already underway. In a tense, at times confrontational hearing, VA Secretary Bob McDonald responded to a new congressionally mandated report calling for drastic changes throughout the system, citing “shortfalls in overall accountability, role clarity, personal ownership, internal communication, and proactive problem-solving.” Via Military Times.
Health Care Reform’s Digital Crisis in Confidence
The debate over the legitimacy of Obamacare—the colloquial name for the Patient Protection and Affordable Care Act—seems to be subsiding, until at least the 2016 elections are over. Two U.S. Supreme Court decisions upholding it, along with Congressional repeal efforts stymied so far by the Senate’s filibuster power and the President’s veto pen, suggest that greater attention now will be focused on implementation. Some of its provisions, such as coverage for pre-existing medical conditions and for children through age 26, have broad bipartisan support. The goal of expanded coverage to millions of Americans formerly in the ranks of the uninsured also seems to be moving in the right direction: toward greater inclusion. Via Brookings.
How the U.S. Can Reduce Waste in Health Care Spending by $1 Trillion
During the presidential campaign, Americans will be bombarded with proposals to improve the U.S. health care system in ways big and small that would either build on or radically revamp the Affordable Care Act (ACA). All will claim to reduce costs and improve quality. In order to accomplish this, proposals will largely focus on what is termed “wasteful spending” in health care, spending not associated with improved quality that, by some estimates, accounts for over one-fourth of total health care spending. Via Harvard Business Review.