Failure to Launch? The Independent Payment Advisory Board's Uncertain Prospects — NEJM

 

Yet 3 years after the ACA's enactment, the IPAB still has no members. Secretary of Health and Human Services Kathleen Sebelius described “active discussions” about IPAB nominees in February 2012 and said last month that the administration was “consulting” Congress regarding “potential members.” But President Obama has not yet nominated anyone for the IPAB, and Republican congressional leaders have refused to provide any recommendations for appointees. Even if Democrats settle on nominees, the controversy surrounding the IPAB will make their Senate confirmations, which are subject to filibuster, extraordinarily difficult. Presidents historically have made appointments when the Senate is in recess, and President Obama conceivably could fill some IPAB slots in this manner. But recess appointments are temporary, lasting only until the end of the next congressional session. Moreover, in January 2013, the U.S. Court of Appeals for the District of Columbia issued a ruling severely restricting the President's constitutional authority to make such appointments. The Obama administration is appealing that decision to the Supreme Court; meanwhile, in May, another federal appeals court echoed the D.C. Circuit's narrow interpretation of recess-appointment power. Even if the legal obstacles are circumvented, relying on recess appointments could undermine the IPAB's theoretically nonpartisan character. However, if no members are appointed, the power to recommend changes to Medicare when spending targets are exceeded does not disappear: it reverts to the secretary of health and human services.

Since Medicare spending is currently not projected to exceed the ACA's targets, there is no need for the administration to appoint members now. Yet the difficulties in launching the IPAB point to a more fundamental problem. The board's appeal lies largely in its aspiration to remove politics from Medicare — to create a policymaking process that is informed by experts and insulated from electoral pressures, interest-group demands, financial considerations, and partisan divisions. But given Congress's extreme partisan and ideological polarization, the ongoing fight over the ACA, the legacy of mythic “death panels,” and recriminations over Medicare reform, the IPAB's rough start should not be surprising. This is not the sort of political environment in which an independent board charged with making controversial decisions about one of America's most popular social programs is likely to thrive. These dynamics are unlikely to recede soon, which means that the IPAB is stuck in purgatory, neither operational nor canceled — an institution designed to be above politics that cannot escape the political binds holding it back.

The longer-term picture is, as always, cloudier. Perhaps President Obama will pursue recess appointments. A new president and Congress could, in 2017 and beyond, unshackle the IPAB in response to deficit pressures and the search for Medicare savings. And if Medicare spending growth accelerates, the IPAB's role could expand. Yet a new president could also refuse to appoint any members or enforce the spending targets, and Congress could repeal the IPAB in 2017. The IPAB's demise would, in that scenario, deal a symbolic blow to health care reform and cost containment. But the impact on Medicare expenditures and national health spending would be negligible. For all the hype, the Congressional Budget Office currently forecasts no savings from the IPAB over the next decade.

Regardless of the IPAB's future, one thing is clear: rather than removing politics from Medicare, the board's difficult early journey has underscored just how entrenched politics are in health care policy.

Failure to Launch? The Independent Payment Advisory Board's Uncertain Prospects — NEJM

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Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002–09

 

Many immigrants in the United States are working-age taxpayers; few are elderly beneficiaries of Medicare. This demographic profile suggests that immigrants may be disproportionately subsidizing the Medicare Trust Fund, which supports payments to hospitals and institutions under Medicare Part A. For immigrants and others, we tabulated Trust Fund contributions and withdrawals (that is, Trust Fund expenditures on their behalf) using multiple years of data from the Current Population Survey and the Medical Expenditure Panel Survey. In 2009 immigrants made 14.7 percent of Trust Fund contributions but accounted for only 7.9 percent of its expenditures—a net surplus of $13.8 billion. In contrast, US-born people generated a $30.9 billion deficit. Immigrants generated surpluses of $11.1–$17.2 billion per year between 2002 and 2009, resulting in a cumulative surplus of $115.2 billion. Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources.

Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002–09

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“Seismic shift” lifts primary care's impact on hospital revenues - amednews.com

“Seismic shift” lifts primary care's impact on hospital revenues - amednews.com

For the first time, primary care physicians are driving more revenue on a per-doctor basis to hospitals than are specialists, according to a survey of hospital chief financial officers by physician recruiting firm Merritt Hawkins. It's expected that this result is not a fluke, but a reflection of the growing emphasis on primary care by hospitals and the health care system in general.

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Uwe E. Reinhardt: Debating Doctors' Compensation - NYTimes.com

 

Debating Doctors’ Compensation

By UWE E. REINHARDT

Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.

Two themes run through the comments on previous blog posts that touched on the payment of the providers of health care. The first is that American doctors are paid too much. The second is that they are paid too little.

Could both propositions be right? Let us explore the issue by looking at some numbers.

A nice discussion of physician compensation with some rather eye opening graphs for the uninitiated!

Uwe E. Reinhardt: Debating Doctors' Compensation - NYTimes.com

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If this health plan is 'socialism,' we need more of it -- latimes.com

 

If this health plan is 'socialism,' we need more of it

As Obamacare's exchanges take shape in California, true, transparent, capitalistic competition will be seen among insurance firms, going toe to toe to win consumers.

David Lazarus

6:18 PM PDT, May 23, 2013

So this is what socialism looks like: Private companies competing for people's business in an open marketplace.

Californians got their first glimpse Thursday of what insurers plan to charge for coverage to be offered next year to about 5 million state residents who don't receive health insurance from employers.

In southern Los Angeles County, for example, Health Net is charging $242 a month for one of its plans. Blue Shield is charging $287 and Kaiser Permanente $325 for the same coverage.

For the first time, consumers are in a position to make an informed decision about health insurance. They can opt for the lowest-priced plan or they can factor in other considerations, such as personal convenience.

Insurers, meanwhile, are going toe to toe to win customers, keeping prices as low as possible and stepping up quality of service.

Amazingly, the sky hasn't fallen and the world as we know it hasn't come to an end.

Critics of Obamacare have long warned of the dire consequences of reforming the U.S. healthcare system. The federal Affordable Care Act constitutes a government takeover of healthcare, they have said. We might as well be living in Cuba.

In reality, what we're seeing is some much-needed sunlight being cast upon a market that for too long has operated largely in the shadows, denying consumers the information they need to make choices about medical treatment.

Private insurers will have to meet minimum standards for coverage when they begin open enrollment in October, allowing people to compare apples to apples for the first time when shopping for individual or family policies.

Insurers also will have to post their prices in a clear and easily accessible fashion, introducing a long-absent element of competition to the market.

"It will be a one-stop shop for selecting policies," said Devon Herrick, a healthcare economist at the National Center for Policy Analysis. "That should make things a lot easier for people."

If this health plan is 'socialism,' we need more of it -- latimes.com

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Overruns Forcing Lower Payments to Some Providers in Stopgap Health Program - NYTimes.com

 

WASHINGTON — The Obama administration said Monday that it was cutting payments to doctors and hospitals after finding that cost overruns are threatening to use up the money available in a health insurance program for people with cancer, heart disease and other serious illnesses.

The administration had predicted that up to 400,000 people would enroll in the program, created by the 2010 health care law. In fact, about 135,000 have enrolled, but the cost of their claims has far exceeded White House estimates, exhausting most of the $5 billion provided by Congress.

Under a new policy issued by Kathleen Sebelius, the secretary of health and human services, “health care facilities and providers will get paid less” for providing the same services to patients in the federal program, known as the Pre-Existing Condition Insurance Plan.

In most cases, payments to health care providers will be capped at Medicare rates, which are substantially less than the commercial insurance rates they have been receiving. The new policy generally prohibits doctors and hospitals from increasing charges to consumers to make up the difference.

Michael T. Keough, the executive director of the North Carolina Health Insurance Risk Pool, said the new policy was one of several steps taken recently by federal officials to control spending.

“They are trying to stanch the hemorrhaging,” Mr. Keough said.

The federal government notified some states last month that it was setting a ceiling on costs that would be reimbursed from June through December of this year. In effect, state officials said, the new limits shift the financial risk of the program from the federal government to those states.

Congress established the program to provide coverage to people with pre-existing conditions who had been uninsured for at least six months, and Ms. Sebelius has said, “It literally saves lives.”

The program provides a transition to 2014, when most consumers will be able to obtain insurance regardless of their pre-existing conditions.

Federal officials froze enrollment in the program in February, but costs continued to grow rapidly.

Overruns Forcing Lower Payments to Some Providers in Stopgap Health Program - NYTimes.com

It is worth remembering, that these patients had run out of options for access to treatment before the program.

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Market, insurers will keep premiums low, analysts say

Just how much premiums will change depends on the state you live in, Kingsdale said.
Individual premiums decreased when Massachusetts' health care took effect, he said, because the state already had high-priced and insurers were not allowed to turn away the sick and could not charge large premium differences based on age, gender and health.
"Other states will see exactly the opposite happen," he said. "Their premiums tend to be quite low, but they're getting skimpy insurance."
In Oregon, Ario said, large differences in premium prices have already appeared.
In one case, a 40-year-old non-smoker in Oregon could buy a low-cost or bronze-level plan for $162 a month from one company or the same plan from another for $400 a month, Ario said. Anti-trust laws prevented the insurers from comparing pricing before developing their premiums.
When the companies with the higher rates saw their competitors' lower premiums, he said, they asked the state to allow them to file for reduced premiums.
"The good news is that in most marketplaces, there will be some carriers that will be bold and price competitively to get more market share," Ario said.

Market, insurers will keep premiums low, analysts say

For a quick rundown on what the "gold, silver, and bronze" plans will cover, go here.

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Public in Deep South supports expanding Medicaid, poll finds, but lawmakers don’t - KansasCity.com

WASHINGTON — Even though governors and lawmakers in five Deep South states oppose a plan to cover more people through Medicaid under the health care overhaul, 62 percent of the people in Alabama, Georgia, Louisiana, Mississippi and South Carolina support expanding the program, according to a new poll.
The level of support for expanding Medicaid – the state and federal health insurance program for the poor and disabled – ranged from a low of 59 percent in Mississippi to a high of 65 percent in South Carolina, according to the poll by the Joint Center for Political and Economic Studies, a leading research and public policy think tank that focuses on African-Americans and other people of color.
Brian Smedley, director of the center’s health policy institute, said the findings show that lawmakers who are blocking Medicaid expansion in the five states are “out of step with their constituents.”

Public in Deep South supports expanding Medicaid, poll finds, but lawmakers don’t - KansasCity.com

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How Austerity Kills - NYTimes.com

 

If suicides were an unavoidable consequence of economic downturns, this would just be another story about the human toll of the Great Recession. But it isn’t so. Countries that slashed health and social protection budgets, like Greece, Italy and Spain, have seen starkly worse health outcomes than nations like Germany, Iceland and Sweden, which maintained their social safety nets and opted for stimulus over austerity. (Germany preaches the virtues of austerity — for others.)

As scholars of public health and political economy, we have watched aghast as politicians endlessly debate debts and deficits with little regard for the human costs of their decisions. Over the past decade, we mined huge data sets from across the globe to understand how economic shocks — from the Great Depression to the end of the Soviet Union to the Asian financial crisis to the Great Recession — affect our health. What we’ve found is that people do not inevitably get sick or die because the economy has faltered. Fiscal policy, it turns out, can be a matter of life or death.

How Austerity Kills - NYTimes.com

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