Checking Up On Health: December 2, 2014

Health Policy News and Views
Compiled by Benita M. Dodd



Oops, they did it again. And even I missed it this time.

The Obama administration has become notorious for making major announcements while Americans are distracted. On Friday afternoons before a holiday weekend has become standard.

On Thanksgiving eve, The New York Post reports, the administration dumped reams of mind-numbing ObamaCare regulations into the Federal Register, including yet more unilateral rewrites of the Affordable Care Act.

“The stunt has even worked to keep most of the media from reporting on the rules. Yet the changes these regulations make in the health-care law are substantial,” the Post reports.

The basics, according to the Post:

  •  Obama will require large employers to provide more coverage than the Affordable Care Act specifies. The move disqualifies plans now offered by 1,600 employers to 3 million workers, according to Kaiser Health News. Those employers will have to find a way to cover the higher costs — and some will surely do so by stopping coverage for spouses or part-time workers.
  •  The new rules suddenly treat state high-risk pools as adequate coverage under the Affordable Care Act — a 180 from what the law actually says. When the ACA became law, these plans for people with chronic illnesses were offered in 35 states. Winners will be those who live in the 10 states that haven’t yet phased out their high-risk plans. Losers: the many thousands in 25 states that already gave up their plans to comply with the ACA’s mandates.
  •  The rules tell insurers to give new enrollees a 30-day grace period during which they can continue to use doctors not in their plan’s network. Winners: People who need time to switch to in-network doctors. Losers: Taxpayers — who’ll be obliged to bail out the insurers clobbered with the extra cost.
  •  Speaking of bailouts, Sec. 1342 of the law promises taxpayer-funded bailouts to insurers who lose money selling plans on ObamaCare exchanges. But the bailouts can’t happen unless Congress appropriates the money, something the GOP-controlled Congress won’t want to do. Yet the new Federal Register notices explicitly double down on the administration’s pledge to make insurers whole if losses are bigger than expected.

Fitbit’s not yet a good fit

Just 15 percent of doctors surveyed said that their patients had asked about incorporating their health data from either their wearable fitness trackers (like Fitbit or Jawbone UP) or from their health apps (like Apple’s HealthKit) into their health records. “The patient-led, smartphone-based health care revolution is not knocking at the door of practices across America – at least not according to those doctors,” writes a Forbes magazine health IT contributor, Zina Moukheiber.

The Not-So-Affordable Care Act

Health care insurance is one thing, health care access is another. One in three Americans reports having delayed care in the last year due to costs – a record high since Gallup began asking the question in 2001. A growing number reports delaying care for serious conditions. That number too, is at an all-time high (22 percent). Further, according to Gallup, more people with private insurance put off treatment in 2014 than 2013. “One of the goals of opening the government exchanges was to enable more Americans to get health insurance to help cover the costs of needed medical treatments,” Gallup reports. “While many Americans have gained insurance, there has been no downturn in the percentage who say they have had to put off needed medical treatment because of cost.”

We had to pass it and we still don’t know …

A survey by San Francisco-based Healthline on the Affordable Care Act and the state of health insurance found, among other things, that a quarter of respondents – the equivalent of 59 million Americans – said they have little or no understanding of what ObamaCare involves. Of those, 40 percent are without health insurance and 26 percent are enrolled in ACA plans. Just 32 percent of respondents said they felt ObamaCare would have a positive effect on U.S. health care. And more than half (50.8 percent) said they would forgo treatment because of high costs our coverage limitations. Source: Becker’s Hospital Review

The cost of developing drugs

The cost of bringing a new drug to market is $2.56 billion, according to a report from the Tufts Center for the Study of Drug Development. The figure is more than double the center’s last estimate of an inflation-adjusted $1.04 billion in 2003. The costs of development don’t always end after a drug is approved. The FDA can require new studies to get more data on safety and effectiveness, or the drugmaker can conduct trials to expand use of the medicine. Those post-approval studies add $312 million to a drug’s cost, raising the development price tag to $2.87 billion, according to the study. Source: Bloomberg News

I love old people. I hate Medicare.

Physician Pamela Wible says she stopped accepting Medicare in 2006, even though, “I’m still happy to care for Medicare patients.” Among her reasons: Medicare treats physicians as criminals – guilty until proven innocent; warns patients on their billing statements to turn their physicians in for suspected fraud and demonstrates no transparency in the flow of taxpayer money through the program. “Medicare may reimburse physicians so little that we lose money with each appointment forcing doctors to go bankrupt (or run Medicare mills with ramped up volume and quickie visits to make ends meet),”Wible adds. And if you think Medicare physicians have it bad, guess what? The reimbursement rate for Medicaid patients is even less than Medicare! It’s no wonder Medicaid physicians are declining.

Fixing your broken heart

A 161-patient Phase II clinical trial of a bone marrow cell therapy to promote cardiac repair after a heart attack is showing positive results. Patients who received higher doses of transplanted bone marrow cells had greater improvements in cardiac function and lower rates of serious cardiac and adverse events. The cells were extracted from the patients’ own bone marrow. The study is led by Dr. Arshed Quyyumi of Emory University School of Medicine, in collaboration with NeoStem Inc., a cellular therapeutics company. Source:

Ebola vaccine working

An early-stage trial of 20 volunteers shows GlaxoSmithKline’s experimental Ebola vaccine tolerated and working without serious side effects. The intramuscular vaccine was co-developed with NIH’s National Institute of Allergy and Infectious Diseases. Because it’s unethical to infect human test subjects with the virus, the vaccine contained genetic material from two strains (Zaire and Sudan.) Researchers checked whether the vaccine triggered the production of antibodies and T-cells. Several other Ebola vaccines are also undergoing trials. Source: Reuters

Quotes of note

“[I]t’s always worthwhile to heed the advice of Don Berwick, the founder of the Institute for Healthcare Improvement and a pioneer in making health care safer. A couple of years ago at a meeting of journalists, Berwick told us, ‘Your best protection may be to take someone with you to the hospital and get out quick.’” – Trudy Lieberman

“Our health care crisis is a complicated, multifactorial problem involving health care inequality, socioeconomic factors, cultural norms, inadequate education, issues involving access to care and poor health behaviors. And this is why doctors, pharmaceutical companies, device and technology developers, hospitals and insurance companies will be unable to solve this problem alone. It is also the reason that Congress’ approach to controlling health care spending by making continuous cuts in reimbursements to hospitals and physicians is not going to address the problem, and arguably makes it worse, especially if the traditional U.S. health care delivery system accounts for only 10 percent of the total costs.” – Dr. David C. Pate, “The Problem to be Solved

Benita Dodd is vice president of the Georgia Public Policy Foundation.