What’s New in Health Care Reform: Jan. 4

shutterstock_372242584-1-1024x625What'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.


After Obama, Some Health Reforms May Prove Lasting

Expanding insurance coverage to more than 20 million Americans is among Mr. Obama’s proudest accomplishments, but the changes he has pushed go deeper. They have had an impact on every level of care—from what happens during checkups and surgery to how doctors and hospitals are paid, how their results are measured and how they work together. Via NY Times.

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Why Obamacare Is Unlikely to Die a Swift Death

The Congressional Budget Office said it would not count people with minimal insurance as being covered under an alternative to the Affordable Care Act, according to a blog post by the nonpartisan CBO. The CBO and the Joint Committee on Taxation anticipate that under some ACA replacement proposals—which don’t clearly specify what type of coverage could be purchased with federal tax credits—insurers may start offering non-group plans that would not meet their expectations for adequate coverage, the CBO said in today’s post. Via Washington Post.

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Obamacare Is First Item on Congress' Chopping Block

Congress is back in session, and leaders of both houses say their first order of business will be to repeal Obamacare. If they do that, it will be a slap in the face to President Barack Obama just three weeks before he leaves the White House. The Affordable Care is the outgoing president's signature achievement, marked by an elaborate signing ceremony in March 2010 at the White House, with lofty speeches from the vice president and Obama himself. Via NPR.

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For Many, Fewer Obamacare Choices Doesn't Mean Higher Prices

Almost a third of all counties in the United States have just one insurer in the marketplace for people buying individual coverage for 2017. In 2015, just 7% had one insurer, according to a Kaiser Family Foundation analysis. Twenty percent or one in five Obamacare consumers will choose 2017 plans in counties served by a single insurer, according to the government. But there's a surprising bottom line: Although prices are going up in almost all areas, they're not significantly higher than they are for people living in areas served by multiple insurers, according to data reviewed by consulting firm Avalere Health. Via NPR.

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The U.S. Spends More on Health Care Than Any Other Country. Here’s What We’re Buying

American health-care spending, measured in trillions of dollars, boggles the mind. Last year, we spent $3.2 trillion on health care—a number so large that it can be difficult to grasp its scale. A new study published in the Journal of the American Medical Association reveals what patients and their insurers are spending that money on, breaking it down by 155 diseases, patient age and category—such as pharmaceuticals or hospitalizations. Via Washington Post.

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Hospitals in Safety Net Brace for Health Care Law’s Repeal

Before the health law, the hospital had to absorb the cost of caring for many uninsured patients like Mr. Colston. Now, with President-elect Donald J. Trump and the Republican-controlled Congress vowing to dismantle the law, Temple and other hospitals serving the poor are bracing for harsh financial consequences that could have a serious effect on the care they provide. Since the election, hospitals have been among the loudest voices against wholesale repeal of the health law. In a letter to Mr. Trump and congressional leaders this month, the two biggest hospital trade groups warned of “an unprecedented public health crisis” and said hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings. Via NY Times.

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Trump’s Health Secretary Pick Leaves Nation’s Doctors Divided

When President-elect Donald J. Trump chose Representative Tom Price of Georgia to be his health and human services secretary, the American Medical Association swiftly endorsed the selection of one of its own, an orthopedic surgeon who has championed the role of physicians throughout his legislative career. Then the larger world of doctors and nurses weighed in on the beliefs and record of Mr. Price, a suburban Atlanta Republican—and the split among caregivers, especially doctors, quickly grew sharp. “The A.M.A. does not speak for us,” says a petition signed by more than 5,000 doctors. Via NY Times.

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Medicare Penalizes Hospitals in Crackdown on Antibiotic-Resistant Infections

The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties. The punishments come in the third year of Medicare penalties for hospitals with patients most frequently suffering from potentially avoidable complications, including various types of infections, blood clots, bed sores and falls. This year the government also examined the prevalence of two types of bacteria resistant to drugs. Based on rates of all these complications, the hospitals identified by federal officials this week will lose 1% of all Medicare payments for a year—with that time frame beginning this past October. Via NPR.

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GOP Wants Trump to Trim Obamacare Benefits, Say Congress Aides

Facing a years-long wait before they can fully implement a planned repeal of Obamacare, Republicans lawmakers are exploring how the Trump administration can quickly trim required health insurance benefits under the law and lower the cost of health plans, said key GOP congressional aides. Republicans plan to use a fast-track procedure to repeal the Affordable Care Act, but with a built-in delay to postpone full repeal for years while they navigate the complexities of passing a replacement. By going after the benefit rules now, however, they can take advantage of the broad authority given to the executive branch when the law passed to make faster changes, said the aides, who spoke on condition of anonymity because the process is ongoing. Via Bloomberg.

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GOP Report Details Extensive Talks around Appropriation to Pay Insurers

House Republicans released what they say is evidence showing the Obama administration broke the law when it funded an Affordable Care Act program aimed at helping lower-income people pay for insurance coverage. The Ways and Means and Energy and Commerce committees released an addendum to a July report that argued the 2010 law did not provide funding for the program known as “cost-sharing reductions” or CSR. The 31-page addition includes information the committees have gathered from the administration since July, including descriptions of conversations between officials debating whether to use a permanent appropriation for tax credits and refunds for program. Via Morning Consult.

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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.