Checking Up On Health: January 26, 2016

Health Care News and Views
Compiled by Benita Dodd

Happy New Year!




The Legislature’s back in session; the presidential candidates’ ranks are thinning and you’re probably wondering whether there’s anything worthwhile amid the rhetoric.

Governor Nathan Deal has made it quite clear that Medicaid expansion is not on his agenda, and it’s a wise move. First, why would you spend scarce state dollars on able-bodied individuals? Second, why would you force low-income Georgians into a program that is dogged by poor outcomes and low physician participation? Third, as I wrote recently in a commentary, there are opportunities in Georgia to expand health care options without expanding Medicaid.

For example, the 2010 health law, which requires that most people have insurance, identifies direct primary care as an acceptable option. Because it doesn’t cover specialists or emergencies, consumers still need a high-deductible health plan, but you get lower-cost coverage by combining the health plan premiums and the monthly direct primary care fee. Think of it like a fitness club or AAA membership: you can use your DPC physician’s services as much or as little as you need, with limitations listed upfront

Under the Gold Dome: Among the health care bills under consideration for the current legislative session is the Right To Try Act, which I wrote about recently; repealing the certificate of need program – a sorely needed, long-overdue free-market reform for Georgia; scope-of practice expansion that would enable dental hygienists to administer anesthesia under direct supervision of a dentist and enable dental hygienists to conduct screenings without supervision in a safety-net setting; and a Patient Compensation Act that would establish an alternative to malpractice litigation

Downsizing the numbers: As the deadline to enroll in a health plan under the Affordable Care Act nears (January 31), the Congressional Budget Office has cut by 40 percent the expected number of ObamaCare enrollees – from 21 million in 2016 down to 13 million.CBO estimates 11 million people a month, on average, will receive subsidies this year, not 15 million. According to The New York Times, “In the last two years, actual enrollment has fallen short of projections, in part because people who signed up failed to pay their share of premiums or found coverage elsewhere.” Consumers who don’t get health insurance this year will have to pay penalties to the IRS unless they qualify for an exemption. Still, the penalties are less than the premiums so many take their chances…

Insurer UnitedHealth, for example, reports it has recorded $720 million in losses from health insurance products sold through new markets set up under ObamaCare and may pull out this year. Not only have the enrollees it added “tended to use more medical care,” but “some people are signing up for coverage, getting care and then dropping their policies.” Numerous policy analysts warned this would happen: Why pay for care while healthy, especially if the insurers are obliged to take you on when you’re ill?

CBO outlook: The Congressional Budget Office’s report offers some startling numbers. Read the 15 key takeaways from Becker’s Hospital Review. Medicaid spending increased by 16 percent, or $48 billion, last year. Spending on Medicaid increased by 14 percent in 2014. CBO expects spending to increase by 8.8 percent in 2016. The CBO projected total enrollment in the Medicaid program will increase by about 2 percent this year. Can you say “unsustainable”?

Costs, charges and payments are all different in how they influence health care costs under ObamaCare. Becker’s Hospital Review shares a list of 40 things you should know about health care costs. “Hospital charges are essentially their list prices for medical services, which are different from hospitalization costs or the actual payment insurers, patients or the government make to hospitals in exchange for the services.” You should read it. Something that may be a shocker to you: A “nonprofit” hospital isn’t necessarily cheaper. The average cost per inpatient day in 2014 was $2,346 at nonprofit hospitals, compared to $2,289 per inpatient day the year prior; at for-profit hospitals in 2014 it was $1,798, up slightly from $1,791 per inpatient day in 2013.

As for Medicaid spending in 2014? Sixteen percent of national health care spending was attributable to Medicaid in 2014. Medicaid spending grew 11 percent, reaching $495.8 billion, a faster increase than the 5.9 percent growth in 2013 and fueled by coverage expansion under ObamaCare. Medicaid spending on hospital care hit $168.4 billion, up 7.6 percent from 2013 and Medicaid spending on physician care jumped 22.8 percent to $64 billion. Medicaid spending on prescription drugs, meanwhile, soared to $27.3 billion, up 24.3 percent from 2013.

Groupon dental care?: African-Americans, Latinos, millennials and men expressed the strongest interest in using “daily deal” sites to save on dental services, according to a new consumer attitudes survey on dental care. Men and consumers with a high school education or less were more likely to say they have negotiated or would consider negotiating a discount. The survey by Fair Health found the likelihood of an individual visiting the dentist is related to household income: Consumers from households with an income of less than $35,000 are more likely to rely on an emergency department compared with consumers from higher-income households.

Palliative care and David Bowie: . We’ve had some giants in the celebrity world go quietly into the night in this first month of 2016: David Bowie, Alan Rickman, Glenn Frey and Dan Haggerty. Each death surprised us; they each kept their health battles private. It’s a trait worthy of admiration in this era of sharing everything on social media and in the public eye. Two things worth noting. One is the speculation about what contributed to Frey’s death (read on) and the other was an open letter to David Bowie from a British palliative care physician, Dr. Mark Taubert.

I confess I had to google “palliative care.” Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness, with the goal of improving quality of life for both the patient and the family.

First, the letter to Bowie: “Your death at home. Many people I talk to as part of my job think that death predominantly happens in hospitals, in very clinical settings, but I presume you chose home and planned this in some detail. This is one of our aims in palliative care, and your ability to achieve this may mean that others will see it as an option they would like fulfilled. The photos that emerged of you some days after your death, were said to be from the last weeks of your life. I do not know whether this is correct, but I am certain that many of us would like to carry off a sharp suit in the same way that you did in those photos. You looked great, as always, and it seemed in direct defiance of all the scary monsters that the last weeks of life can be associated with.”

About Glenn Frey: The Eagles’ Web site said the musician died of rheumatoid arthritis, colitis, and pneumonia. Talking to The Wrap, Eagle’s manager Irving Azoff said the colitis and pneumonia were side effects from the medications Frey was taking for rheumatoid arthritis (RA), which he had for more than 15 years. RA is an autoimmune disease, unlike osteoarthritis, and causes painful inflammation (and deterioration) of the joints when the immune system sees the joints as the enemy and attacks. Some treatments calm the inflammation but affect the body’s immunity and ability to stave off other infections, according to the Arthritis Foundation’s news blog. “While current RA treatments greatly improve the quality of life, reduce permanent joint damage and perhaps extend the life expectancy for people with RA, they are not trivial drugs … They can have serious side effects. For example, by suppressing the immune response that causes tissue damage, they also increase susceptibility to infections, including pneumonia.”

Quotes of Note

“Analysts said ObamaCare will chase more workers out of the labor force over the next five years, adding pressure to an economy still struggling to spring to life more than seven years into the Obama recovery.” – Steven Dinan, Washington Times

“Will there be an Uber for health care? Articles are split. The truth is there will be an Uber for health care. It just isn’t here yet. Expect it to be widely available in the next decade and as a result, people will get expert medical care that is more convenient, less expensive, and accessible.” – Dr. Davis Liu

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