| Last week the Trump Administration rolled out a semiannual summation of all the administration’s regulatory activity. Noteworthy for health policy observers, the administration has pushed back to November finalization of the proposed rule on manufacturer rebates for drugs purchased through the Medicare Part D and Medicaid Managed Care program. Opposition to the proposed rule has focused on the potential increase in costs to the federal government. It is important, however, to recognize just how uncertain the myriad cost analyses of this proposed rule are. AAF recently reviewed six cost estimates in detail here, but the key takeaway is that the numbers produced by these estimates depend greatly on behavioral responses that are enormously hard to predict correctly. |
Widescale drug importation from Canada, is not a practical solution to the problem of high drug costs. It is a distraction from efforts to address the real prescription drug cost drivers. Perhaps conflating its geographic size, importation proponents seem to overlook Canada’s small population, which is less than California’s. There’s no way that our neighbors to the north could supply the U.S. market—or even a handful of states—with all of its prescription drug needs. President Trump and legislators should redirect their efforts to proposals that could actually make a difference short term and long term in lowering costs.
The Centers for Medicare & Medicaid Services will take more time to judge the performance of navigator groups tasked with ACA enrollment outreach, the agency said Thursday. Performance is tied to funding. Starting in the 2020 open-enrollment period, navigator groups will be evaluated on a two-year performance period rather than one year. Federal funding is tied to how many people are signed up by the groups. The CMS said the change will help stabilize the program and improve consumers’ experience.
| Connecticut Gov. Ned Lamont and fellow Democratic lawmakers reached an agreement Thursday to create a public option that will allow individuals and small businesses to purchase health insurance through the state. The proposal also calls for re-establishing the individual mandate—a centerpiece of the ACA that required people to have health insurance or pay a penalty—that has since been eliminated at the federal level by Congress. The bill would also have the state seek permission from the federal government to buy prescription drugs from Canada and calls for taxing opioid manufacturers. [As if Connecticut didn’t have enough problems with crippling taxes and regulations, now this…] |
There’s a reason any mention of cost is notably absent from the recent CBO report on single-payer health care proposals. That’s because Democrats specifically asked for a report without cost estimates. They’re aware that the American public is unlikely to get behind their plan to outlaw private health insurance and launch a government takeover of the U.S. health care system. According to Emory University health economist Kenneth Thorpe, more than 70% of working Americans who have private insurance would wind up paying more for health care under a version of “Medicare-for-all” very similar to the one Sanders has introduced in the Senate.
| One solution to most instances of surprise billing is to simply eliminate the possibility of being treated by an out-of-network emergency, ancillary, or similar clinician at an in-network facility. There are multiple ways to accomplish this, but one approach—sometimes called “network matching” or an “in-network guarantee”—would require these facility-based clinicians to contract with every health plan that the facility at which they practice accepts or, alternatively, choose to secure payment from the hospital rather than insurers. That requirement can be imposed either directly or, alternatively, indirectly by making joining an insurer’s network the only way clinicians can secure payment. |
The Georgia Public Policy Foundation has long advocated for market-oriented solutions to Georgia’s health care challenges. The Foundation has released a report analyzing the cost and potential impact of two Section 1332 State Innovation Waivers the governor could consider:
- A reinsurance program that would apply to all large insurers in the state and “reimburse accumulated claim costs that exceed a set threshold within a given year.”
- A Georgia primary care access option, which would require large insurers to offer at least one plan that includes a direct primary care model.
Just as choice and competition make products and services less expensive in the rest of the economy, they can do so in health care. We must substantially expand Americans’ freedom to choose their own health insurance—both in public and private programs. We should gradually convert the Medicaid program from its current single-payer form into one in which enrollees receive tax credits to buy private insurance. And we should strengthen Medicare Advantage, the market-based form of Medicare whose consumer-driven structure has incentivized insurers to offer broader benefits, lower out-of-pocket costs, and better health outcomes than traditional Medicare does.
Health care advances have delivered great benefits to society, bringing material improvements in average life spans and quality of life. Yet these improvements have come at a cost—an ever-expanding portion of the US GDP is being consumed by healthcare expenses. Could technology be part of the solution by enabling delivery of healthcare advances while improving affordability? We have reviewed the evidence, done the math, and identified technology-enabled use cases that could create between $350 billion and $410 billion in annual value by 2025 (out of the $5.34 trillion in healthcare spending projected for that year).