2017 Begins with a Swirl of Health Policy Talks in D.C


#1

Is your head swirling over the health policy happenings? Me too. As I came back from a restful holiday break, headlines were buzzing as Democrats and Republicans prepared to battle over health care in DC. I dug around and put together a list of this week’s happenings for anyone that would like a quick brief of the political health care climate. Read more on the Diabetes Advocates Blog.


#2

Thank you for a great post summing this all up. I certainly agree with “don’t repeal without replace”.


#3

Thanks for post this @TypeJones. And I agree totally with @Karen_Graffeo. We need to make our voices heard. If Congress moves ahead and just guts the funding for ACA it will leave millions of Americans without insurance, decimate the health insurance industry and probably lead to higher costs for all of us. The thing to do is write to your Senators and Representatives. Do this even if you didn’t vote for them or you think they are whack jobs. They represent you. Tell them to vote against destroying what has been built without having a replacement.


#4

The recent flap over the House Ethics Committee illustrates the power the voters have if we just speak up. I might add that I have found Twitter to be a powerful too for getting your voice heard.


#5

if anyone wants to get started on Twitter, let me know. I’m @MarieBe over there and our DHF profile is @diabeteshf. we have > 31K followers


#6

Another week, and more to catch up on! New post, This Week in Washington 1/11/17.

With all this, I didn’t follow any of the confirmation sessions. Has anyone done their research on Price (Trump’s nominee for Health & Human Services Dept.) up next week? What are your opinions on him?


#7

Looks like it might be repealed without being immediately replaced. I am sorely disappointed, but hardly surprised. NMP!


#8

Price is a congressman and has introduced legislation to put in a new system to replace the ACA. Here’s an article describing his legislation in detail. Price is an orthopedic surgeon.

Like most of the replacement plans he uses tax credits to replace the direct subsidies the ACA uses to help people buy health insurance. The ACA’s subsidies are paid for by taxes and therefore don’t add to the deficit. Tax credits on the other hand add to the deficit unless matching cuts are made elsewhere.

Washington seems to prefer tax credits for solving almost any problem. This is the reason our tax returns are so complicated, every year there is another layer of tax credits to solve the problem of the day. The big beneficiaries of this system are CPA’s and tax firms.

Very low income people who under the ACA were added to Medicaid are taken off Medicaid and given a tax credit. Even with the tax credit most of these folks will not be able to afford insurance, so they will be back to using emergency rooms and not seeing a doc until it’s too late because they can’t afford the care.


#9

Great information in that summary – thank you! I will take a look at that link you sent also.


#10

Really? Well, no surprise I respectfully disagree.

My recollection of the Health Care System before the ACA was one of high quality care at substantially lower premiums and deductibles – ENORMOUSLY lower.

Of course, I didn’t have coverage for sex reassignment surgery, maternity services, child dentistry, and a long list of other things that I’m being forced to have as part of my policy now.

The fact is, health care was made worse for many, many more citizens than it made it better for. In my book, this is a disaster. You don’t, for example, starve 100 people doing just fine feeding themselves to deal with 3 other people who can’t and are starving.

My problem is NOT with expanding access, providing care for those that are uninsured due to poverty, etc. I’m all for that.

What I’m not in favor of is screwing over bajillions of other people for which things are working quite well in order to deal with the problems a tiny fraction are having. I’m for honest government, and the ACA was anything but an honest attempt to take care of the needy.


#11

I believe you are mistaken.

My reading of the proposal is that tax credits will replace ACA subsidies for private insurance premiums.

Medicaid is a completely different animal, and if my reading of the plan is correct, Medicaid will continue however the funds will be block-granted to states to administer the program as they see fit with a great deal more flexibility than they currently have from the Federal Government in spending Medicaid funds.

So, no, the poorest of the poor who are on Medicaid are not going to be simply given refundable tax credits to go out and buy insurance on their own with.


#12

The information I have seen suggests that overall health care costs in the US have markedly slowed. I know that my insurance before ACA was rising at an alarming rate and my companies policy increases since then have slowed. Unfortunately many of us conflate a number of changes that have occurred. First there has been a move to high deductible plans with health savings accounts. This changed started before ACA (actually in 2003). Granted many ACA plans are these high deductible accounts but unless you are being covered under the exchange your experience has nothing to do with ACA.

Also, it is important to realize that 20 millions Americans got insured under ACA. Many of those deferred health care, often resulting in higher overall health care costs. I know a relative who got her health care in the ER. That is truly expensive.

The things that I have seen suggest that rising health care costs have measurably slowed since ACA. I’d be interested in hearing personal experiences. Did people end up with high deductible plans? Was it related to ACA or did you get pushed into them before ACA?

Also Kaiser did a study on employer sponsored health plans. They rose 63% from 2001 to 2006, 31% from 2006 to 2011 and only 20% from 2011 to 2016 (under ACA).


#13

The old system was OK if you had insurance through your employer, except for the double digit inflation in premiums year after year. Like many employers mine raised the deductible every year to mitigate the increase. In 7 years my deductible went from $500 to $5000. @Brian_BSC is correct the rate of healthcare inflation has slowed significantly since the implementation of the ACA.

I once had to face a major illness by my wife without insurance. We had lost our insurance because of a nearly doubling of premiums in one year, we simply had no room in our budget for an increase like that. We had no insurance through work and paid for it 100% ourselves. BTW this was in 1989. Believe me you don’t want to go through this.

The company I work for has a seasonal workforce. The reporting requirements for a business like ours are especially onerous. We purchased software to fill out the paperwork but it wouldn’t handle a workforce such a ours. We spent a large amount of time getting our data correct and filing the forms.

As the IT guy where I work I was deeply involved with this process. In spite of this I didn’t complain because I knew it saving countless people the struggle I went through.

The ACA could certainly be improved but I have yet to hear a proposal from the repeal crowd that covers more people or seriously tackles health care inflation.

As far as I’m concerned we should start with universal coverage and work back from there. And yes the dirty little secret is that it won’t be free, and the rich will have to pay more than the middle class and the middle class will have to pay more than the poor. So be it.


#14

Another way to look at the problem is to come up with practices that might work, or do work in other parts of the world. I would love to see a system where universal basic coverage is offered to everyone. The caveat being that this coverage would be nowhere near as comprehensive as the current coverage. But it would have to cover cost effective treatments for all emergency and chronic diseases. Then if you would like coverage for the more advanced (i.e. expensive) treatments you would have to pay for additional insurance. The problem, in my mind, is that the current, you can have access to every possible treatment, regardless of cost isn’t going to work no matter how much we pay. The current system of double digit inflation isn’t going to work no matter if it has slowed or not. It is putting too many people in a place where a 5k or higher deductible is required. If we would just be honest and say this is what is covered, and this is not what is covered, and let people make an informed choice. Yes for diabetics, this might mean no CGM or Pump without supplemental insurance, but I am much more offended by people not being able to afford a modern insulin. Without new thinking, this problem isn’t going away, it is just getting kicked down the road.


#15

Do you really think, in the long run, it’s cheaper paying for increased ER visits, dialysis, and other complications than it is financing these advanced tools as an investment in the future?


#16

No I don’t, but that is just my opinion. Until someone completes a study that shows this is the case, it is just an opinion. I also think that if you look at many places that have universal healthcare, many things like CGM’s are not offered, but also no one goes bankrupt from having a health problem. I am more than willing to accept the supplemental insurance situation, in exchange for universal care. Until we actually make moves that limit the cost curve, the dollars spent on healthcare costs will continue to grow at an unacceptable rate until everyone has a $20,000 deductible and unless you need a triple bypass it will all be out of pocket.


#17

[quote=“BadMoonT2, post:13, topic:58360, full:true”]

[quote=“Dave26, post:10, topic:58360”]
My recollection of the Health Care System before the ACA was one of high quality care at substantially lower premiums and deductibles – ENORMOUSLY lower.
[/quote]The ACA could certainly be improved but I have yet to hear a proposal from the repeal crowd that covers more people or seriously tackles health care inflation. [/quote]Well, I have, and I suspect the difference is nothing more than measures I believe will be effective that you do not. For example opening up the entire nation to competition (the “sell across state lines” issue); allowing private citizens to create buying groups (like what large employers look like to insurers); many other things that, in my opinion, make the health care market and industry less efficient than it could be.[quote]
As far as I’m concerned we should start with universal coverage and work back from there. And yes the dirty little secret is that it won’t be free, and the rich will have to pay more than the middle class and the middle class will have to pay more than the poor. So be it.
[/quote]Fair enough.

In contrast to you, this approach terrifies me. There is little I can think of that the government manages that I say, “gee, I’m so happy with the quality, service, responsiveness, care for my concerns, etc. I want them managing my health care!”.

Need more? Veteran’s Administration.

No, my experience with just about anything Government is in charge of is quite the opposite. I hear a similar perspective from just about everyone, right, left, liberal, conservative. This is not about politics. This is about basic sensibility. I don’t keep taking my cars to a mechanic that doesn’t fix my car on time, does a lousy job, ignores my phone calls, overcharges for parts, and on and on. I’d be crazy to recommend them to a friend.

You all keep recommending that mechanic to me, and everyone else, to get our cars fixed.

As such, it is utterly baffling to me why anyone seems to think that in THIS case, it will be done well. In THIS case G3 employees are going to give a rat’s ■■■ about my issues. THIS time employees will be held accountable for failing to provide that high level of care and service I demand.

You really believe that? Are you including in your plans changes to the Federal Employment Regulations to allow for the accountability I’m talking about? You know, when you can’t get anyone to return your calls and straighten out issues with filling your insulin prescription?

Ort do you think people will lie, cover for each other, and pretty much ignore you waiting for it to blow over?

Again: Veteran’s Administration.

The problem with government solutions is you have NO power or leverage at all. All you have is your vote. You have no where to go if you don’t like what you’re getting. With the private sector, you have people that are motivated by their business, and WANT you to be their customer. They also know that you can go somewhere else if they do a lousy job.

Fool me once, shame on you. Fool me twice… The ACA has helped about 7 million people. It has crapped on hundreds of millions.

For the record, I am covering my family right now with a Covered California, Silver Obamacare plan from Blue Shield, which we just renewed. So I’m eating my own dog food on this one.

I have a question for current recipients of US Federal Health Care: Medicare recipients, how’re those CGMs working out for you? Keeping you from having scary hypos overnight while asleep?

Oh, that’s right – you can’t get CGMs. The government has determined they’re not necessary enough.

Those of you thinking that, with Uncle Sam in charge, everything will be rainbows and unicorns are smoking some good stuff. I predict that, with universal health care, we’ll get something very much like what Veterans get, Seniors, and people in other countries get. Which means I will no longer be getting G5 sensors, I won’t be able to use the Omnipod, Afrezza, and it will probably be a decade after closed-loop systems brought to market before we’ll be able to have them.

But then, I forgot that new innovation will dry up as well as profits supporting future product R&D is squeezed out of controlled prices because the general public, you see, thinks you need nothing more than R and N insulin. Everything else is gravy.

Think I’m being extreme? Spend some time talking about this issue (diabetics, insulin, insulin analogs and their prices vs. R and N, etc. – you’ll be shocked). Not people that know and love you. People that don’t know you, don’t care about you (in any more than the fellow-citizen general sense).


#18

I would like the make (I expect a futile, wasted effort) it very clear where I stand on this:

I am strongly opposed to socializing the control and provisioning of health care (or primary education, for that matter). I think the best results are achieved with the greatest liberty – both for those offering health care products and services, and those consuming them.

I also believe there is a social obligation in any organized society to provide various safety nets for basic necessities, health care being one of them. For that reason, I support without reservation some degree of public funding for health care.

The best plan for this I’ve seen was McCain’s voucher-based plan back when he was running. Everyone gets a voucher sufficient to pay for a basic insurance plan. This is financed through tax revenue.

The are a gazillion details that could be discussed and debated, but the main point is Uncle Sam stays out what and how Health Care is delivered. Otherwise, politics, rather than what the patient needs, drives what health care you can, and can not have.


#19

Yes, that may happen. Most European countries have some kind of universal health care and not all of them cover CGMs or only for special groups of patients like patients with sky high A1cs (e.g >8% or >10%) or hypo unawareness. The NHS does not cover CGMs for example. Health insurance in my country (the Netherlands) does not cover CGMs either. Insurance companies do allow some hospitals to give a limited number of patients a CGM for diagnostic purposes or to solve the aforementioned issues. Thus only a small minority of patients gets a CGM and an even smaller minority gets it for long term use. The Omnipod is covered like any other insulin pump. Hospitals and insurance aren’t state-run, but the government pretty much determines what is covered and what isn’t. The government isn’t convinced yet about the benefits of CGMs.

This is not to say that I’m not happy with my insurance, but as you say it isn’t “rainbows and unicorns”. Perfectly satisfying health care systems don’'t exist.


#20

You do realize that this is an inherent contradiction. You cannot transfer resources from rich to poor and share risks across our society without government intervening. If you just give everyone a “voucher” then only the rich will get good health care. The poor will be left with minimal catastrophic insurance and will not have access to health care. This is the whole point of major government regulation and programs throughout our society. This is why we have Medicare and Medicaid. This is why we require insurance to not “exclude” populations.

I hear you complaining about how ACA has harmed “hundreds of millions.” Can you explain what you mean? You seem to have this idea that ACA has raised costs or denied health care to people. What do you mean by this? Do you have studies to back this up?