My colleague Dr. Robert Graboyes encourages us to instead think about how to produce better health (not health insurance—not even health care) for more people at a lower cost, year after year. This requires allowing and fostering the kind of revolutionary innovation in the health care industry that we’ve seen in other fields, like information technology. It requires allowing consumers to choose treatments, even high-risk ones. But it also requires innovation in the provision and payment of health care.
For instance, advancements in gene therapy and personalized treatments could one day offer a cure for cancer or disorders currently considered incurable, sometimes with only a single injection. In 2017, the Food and Drug Administration approved its first gene therapy treatment, Kymriah, for acute lymphoblastic leukemia. The FDA expects 10 to 20 cell and gene therapy approvals annually by 2025.
American consumers and policymakers are increasingly concerned about the high cost of prescription drugs. According to the Kaiser Family Foundation, one in four people taking prescription drugs report difficulty affording their medication. There is bipartisan support for policies that could help lower drug prices and their burden on consumers. Legislation has been introduced and regulatory actions have been advanced to promote competition among drug manufacturers and slow the growth of prices.
The single-payer health insurance proposal known widely as Medicare for All (M4A) cannot be enacted without first answering certain questions. Foremost among these is whether the public would support shifting more than $32 trillion in M4A’s first 10 years from private health spending, over which consumers retain some discretion, to federal health spending, over which consumers do not. A related open question is whether the federal government can adequately finance this amount of spending without triggering significant adverse economic effects. Other unanswered questions include M4A’s effects on health providers, the prescription drug market, and private health insurance. M4A would add further to national health cost growth unless provider reimbursements are cut more sharply than lawmakers have been willing to do historically. Yet the consequences of enacting such payment cuts simultaneously with a substantial increase in health service demand are unpredictable.
One aspect of CMS’ price transparency initiative has received a great deal of attention recently. Our updated guidelines now require hospitals to post a list of their current “standard charges” on the internet in a machine-readable format — meaning the data can not only be read electronically but can also be imported or read into other databases. Previously, CMS required hospitals to make their standard charges available in response to an inquiry, but too often this meant making the information available only in print or a PDF that couldn’t be aggregated with other data and that wasn’t broadly available.
Expert witness Grace-Marie Turner of the Galen Institute said policies like the new Section 1332 guidelines aren’t meant to drive a stake into the Affordable Care Act, but rather give more discretion to states to tailor health care needs specifically for their own citizens. “Cost relief” is the driving force behind state discretion, Turner said.
GOP lawmakers balk at the rising costs of Obamacare premiums for constituents who fall into middle-range tax brackets. And putting healthy people in the pool with the chronically ill, some say, just adds to the premium hike.
CNN and NBC exit polling last November showed a huge Democratic advantage on health care. But socialized medicine wasn’t on the ballot.
As for 2020, Democrats know people don’t want socialized medicine, so they have been calling it “Medicare for All” even though the prototype legislation ends Medicare along with private insurance. Consumers may be starting to figure this out.
Optum Rx, one of America’s largest pharmacy benefit managers (PBMs) sent a letter to drug companies outlining several demands the companies must meet if they seek to lower list prices for their medicines. This would put another obstacles in the path of lowering drug prices.
The letter was sent to several drug manufacturers. In it, Optum demanded a couple of things: 1) at least seven quarters notice before a company reduces its list prices, and 2) equivalent rebates off of lowered prices as compared to existing prices. The message is unclear whether Optum wants rebates to stay the same or the same percentage of a price. But either way, drug companies are unhappy with the letter, since many companies are looking to lower list prices for certain drugs. Additionally the letter was high handed and Optum seems like it is attempting to dictate the terms of various projects.
Gov. Brian Kemp unveiled legislation Wednesday that could remake health care for hundreds of thousands of Georgians. Or just a few.
The Patients First Act would give the governor wide latitude to approve a range of options in pursuit of federal “waivers” with the aim of improving government-funded health care access for the poor and middle class.
HCCI’s annual reports examine year-over-year and 5-year cumulative trends in health care spending for individuals with employer-sponsored insurance, segmented by health care service category. Downloadable tables and interactive tools allow for further exploration of the data that power these reports.
This year’s report found that average annual health care spending for individuals with employer-sponsored insurance increased to an all-time high of $5,641 in 2017, despite little change in the utilization of services overall. While overall spending growth slowed in 2017 compared to 2016, the report finds that prices continued to drive rising costs.
The Utah Legislature on Monday passed a bill to replace the voter-approved Medicaid expansion with a skinny expansion, a move that may encourage other states to seek similar scaled-back expansions with full federal funding.
The Republican-controlled Utah Senate approved legislation passed by the state House of Representatives Friday that replaces the voter-passed expansion to adults with incomes up to 138% of the federal poverty level with an expansion only to 100% of the poverty level. It passed on a near party-line vote, with one Republican joining all Democrats in opposition.