What’s New in Health Care Reform: July 20


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.

Insurers, Pushing for Higher Rates, Challenge Key Component of Health Law

For several years, the Obama administration has urged state insurance regulators to use tools provided by the Affordable Care Act to hold down health care premiums. Now federal officials will have a chance to practice what they preach as they confront big increases proposed in several states where they are responsible for reviewing rates. Federal officials defer to the insurance commissioners in 46 states deemed to have “effective rate review” programs. But in Missouri, Oklahoma, Texas, and Wyoming, the federal government is in charge of reviewing rates. And those reviews create an exquisite political challenge, spotlighting a pocketbook issue that affects millions of voters. Via NY Times.

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With Millions Covered, "Repeal and Replace" Gets Riskier

Uncompromising opposition to President Barack Obama's health care overhaul has been a winning issue for Republicans, helping them gain control of Congress. Capturing the White House would finally let them make good on "repeal and replace." Yet Obama's law has changed the nation in ways that many people wouldn't want reversed. Reviled as it may be, the law means people don't have to worry about being denied coverage due to medical problems, or fear policies that max out while a patient is undergoing chemotherapy. Millions who couldn't afford health insurance now have financial help. Ripping apart the social safety net in the name of rolling back the government's power would be politically self-defeating, a dilemma for Republicans. Via AP. 

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Top U.S. Health Official Highlights Need for Insurer Competition

The Obama administration’s top health official highlighted the importance of competition to insurance markets, as the Justice Department is poised to decide on two massive deals among four of the health-plan industry’s biggest players. Health and Human Services Secretary Sylvia Mathews Burwell said competition among insurers can reduce costs that consumers face and improve the quality of their health coverage. She declined to comment on her department’s view of Aetna Inc.’s proposed purchase of Humana Inc. or Anthem Inc.’s deal for Cigna Corp. If both mergers are completed, the industry’s five largest companies would be reduced to three. Via Bloomberg.

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Sylvia Mathews Burwell on 6 More Months of Health Care Fixes

Last summer, when the Supreme Court ruled on a major challenge to President Barack Obama’s marquee health care law, the name on the court case wasn’t Obama’s. The case was called King v. Burwell, and front and center—as she is in all attacks on Obamacare—as Sylvia Mathews Burwell. As HHS secretary, Burwell has become the most public face of Obamacare, its chief defender and the person driving the president’s final push for a health care legacy. With only six months left in the president’s term, Obama wants to use his remaining time in office to make medicine more efficient and less expensive, and Burwell is the point person to get that done. Via Politico.

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GOP Calls Out Obama for Millions of Unspent Dollars Amid Zika Fight

Top Republicans in Congress are demanding to know why the White House is holding onto more than $400 million that they say could have already gone to fighting the Zika virus. Six leading GOP appropriators wrote to President Obama, voicing strong concerns about the administration's slow pace in exhausting its existing resources on Zika, as Democrats dig in their heels to demand a $1.1 billion emergency spending bill. Via The Hill.

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Health Care Has Improved, Study Finds, but the Changes Are Small

The quality of health care has gotten better in many communities across the country, though the degree of change has been relatively small, according to a national study. Researchers for the nonpartisan Commonwealth Fund, who looked at conditions in 306 communities, found that health systems improved more than they worsened between 2011 and 2014. Increased insurance coverage because of the Affordable Care Act was a key factor—with states that expanded Medicaid to lower-income adults faring particularly well—as was doctors and other providers scoring better on quality and efficiency measures. Via Washington Post.

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Health Care Expenditures Heading toward 20% of Economy

Health care expenditures are expected to grow at an average rate of 5.8% for 2015 through 2025, according to new estimates released by the Centers for Medicare and Medicaid Services’ Office of the Actuary. The increase will bump up the health share of the economy from 17.5% in 2014 to 20.1% by the end of the period. At the same time, the number of uninsured people is projected to drop from 11% of the population in 2014 to 8%  in 2025. Via Morning Consult.

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Health Spending to Grow by Nearly 6% a Year through 2025

Spending on health care is projected to increase 5.8% per year during 2015-2025, the Centers for Medicare & Medicaid Services (CMS) said. That average "remains lower than the average over [the] previous two decades before 2008," which was nearly 8%, the agency noted in a press release. Overall, national health expenditures are estimated to have reached $3.2 trillion in 2015. In a press release, CMS Acting Administrator Andy Slavitt attributed the slower growth in part to the Affordable Care Act (ACA). "Per-capita spending and medical inflation also remain at historically very modest levels, demonstrating the importance of continuing to reform our delivery systems," he said. Via MedPage Today.

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U.S. Poised to Sue against Major Insurer Mergers

Justice Department officials are poised to block two proposed major insurance mergers, Bloomberg News reported. Officials have been reviewing the proposed Anthem-Cigna and Aetna-Humana mergers since both deals were announced last year. The DOJ is ready to file lawsuits to block the two proposed mergers over concerns that they would limit competition and harm consumers, according to the report. Via Morning Consult.

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Obamacare’s Surcharge for Smokers May Have Backfired

A provision of the Affordable Care Act that allows insurers to charge smokers higher premiums may have discouraged smokers from signing up for insurance, undercutting a major goal of the law, according to a study published this month. The surcharges, of up to 50% over nonsmokers' premiums, also showed no sign of encouraging people to quit. Via Washington Post.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.