Obamacare wasn’t supposed to give free health insurance to everybody. The Affordable Care Act’s authors expected the poor would enroll in Medicaid, while those with higher incomes would buy coverage through the new insurance exchanges, with subsidies that decrease as income rises. It isn’t working that way. A study published this week by the National Bureau of Economic Research shows that ObamaCare has turned out to be a giant welfare program, with millions of working- and middle-class Americans improperly receiving Medicaid—a reflection of the unpopularity of the exchange policies and incompetence of government oversight.
The 2019 Milliman Medical Index, which measures healthcare costs for individuals and families receiving coverage from an employer-sponsored preferred provider plan, found that health care costs have reached $28,386 for a family, an increase of 3.8% from the year prior. Health care costs for the average American adult are at $6,348. Milliman looks at five components of health care costs, including inpatient and outpatient care, pharmacy, professional, and other services.
The central unanswered question in the U.S. health system is how to discipline costs. The choice is between reliance on regulatory controls put in place by the federal government or injection of stronger financial incentives for consumers into the markets for medical services and insurance. Currently, the U.S. has a mixed public-private system with pricing controls applied to payments made by public insurance, and markets that function poorly because they are hobbled by misaligned incentives, some of which are caused by government policy. The result is widespread inefficiency. Credible estimates put the amount of wasted spending at about one-third of total costs.
A panel of federal appeals court judges on Tuesday sounded likely to uphold a lower-court ruling that a central provision of the Affordable Care Act — the requirement that most people have health insurance — is unconstitutional. But it was harder to discern how the court might come down on a much bigger question: whether the rest of the sprawling health law must fall if the insurance mandate does.
Scott Kohan woke up in an Austin, Texas, emergency room after an attack that broke his jaw. The hospital was within his insurance network. But the oral surgeon who set his jaw wasn’t. Mr. Kohan’s insurer refused to pay the surgeon’s $8,000 bill.
He’s not alone. An estimated 51% of ambulance rides, 22% of emergency-department trips, and 9% of elective cases, in which patients have time for due diligence, lead to surprise bills. These typically come from providers who refuse to join insurance networks so they can charge astronomical fees.
Congress could eliminate the Part D “protected classes” rule which forces insurers to pay for any drugs in six arbitrary categories, regardless of their price or value. (The Trump administration had proposed just such a reform, but withdrew it in a sop to the drug lobby.)
More substantially, Congress should require that drug companies selling drugs into Part D rebate any price increases above consumer inflation to Medicare, to offset the program’s taxpayer-funded subsidies.
Without reforms of this type, it’s highly likely that restructuring Part D would drive costs upward.
Consolidation in the health system and health insurance industries has been a focus for years. But a new report sheds light on how the “bigger is better” mantra has taken hold in companies that make syringes, X-ray machines or other healthcare products
The report, prepared by the Open Markets Institute using data from IBISWorld, shows a small handful of companies dominate their respective markets in certain healthcare sectors that tend to get less of a spotlight than their payer and provider counterparts.
Transparency, though essential, is not sufficient to bring down health care costs. Nor does it always need to be legislated. Laws aren’t required to force sellers of food, computers or clothing to post prices. That information is driven by consumers who actively seek value for their money. The most compelling motivation for doctors and hospitals to post prices would be the awareness that they’re competing for price-conscious patients.
The Department of Veterans Affairs on Thursday will begin allowing a broad section of its nine million enrollees to seek medical care outside of traditional V.A. hospitals, the biggest shift in the American health care system since the passage of the Affordable Care Act nearly a decade ago.
While department officials say they are ready, veterans groups and lawmakers on Capitol Hill have expressed concerns about the V.A., which has been dogged for years by problems with its computer systems. They worry that the department is not fully prepared to begin its new policy, which Congress adopted last year to streamline and expand the way veterans get care.
The Medicaid Drug Rebate Program (MDRP) was created by Congress nearly 30 years ago. It requires drug manufacturers to pay a rebate for all out-patient drugs dispensed to Medicaid beneficiaries. The percentage for this rebate varies by type of drug, with brand-name drugs requiring the greatest rebate and generics the least. In addition, the rebate must rise until it ensures that the net (of rebate) price of the drug matches the best price available to anyone in the private market. (MDRP is often referred to as the Medicaid “best price” policy.) Finally, there is an inflation penalty — an additional rebate equal to the amount by which the price increase exceeds the rate of inflation, measured by the Consumer Price Index for All Urban Consumers (CPI-U).