Health Policy Briefs
Compiled by Benita M. Dodd
Update on ObamaCare: Florida’s Legislature, not Gov. Rick Scott, will have the final word on whether the state expands Medicaid. And every indication shows that key legislative leaders understand the dangers ahead, according to Grace-Marie Turner and Roy Avrik of the Galen Institute. The two released a paper this month giving reasons that Florida should not expand Medicaid rolls, including that expansion will worsen the cycle of dependency. Under ObamaCare, the federal government is supposed to pay 100 percent of the cost of a targeted expansion of Medicaid for two years, dropping to 90 percent by 2020. The authors note that according to The Heritage Foundation, Medicaid spending will increase dramatically as the federal matching rate for the expansion population begins to drop and as more and more Floridians enroll in the program. The expansion would cost Florida taxpayers $4.1 billion through 2022 – an additional $1.3 billion in 2022 alone. Georgia has already rejected expanding Medicaid rolls, but that’s not stopping ObamaCare proponents from campaigning at the Capitol.
Be careful what you ask for: Before the Affordable Care Act passed, optimism was high that health reform would cure the economy’s woes, Grace-Marie Turner of the Galen Institute writes in The Orange County Register. It hasn’t. Instead, Turner writes:
• Many large firms are replacing people with technology, such as electronic checkout stations and ordering kiosks, and they are putting full-time workers on part time to avoid the health-care penalties.
• Smaller companies are holding back on hiring so they don’t hit the magic number of 50 employees that triggers the employer mandate.
• There are fewer incentives for people to enter the workforce – even if they could find jobs – because they know they can get generous subsidies for health insurance whether they work or not. The Bureau of Labor Statistics reports 8.5-million people left the workforce during President Obama’s first term.
There’s coverage, then there’s access: Twice as many people insured by Medicaid as by private insurance report barriers to primary care and Medicaid patients are twice as likely to visit the emergency department as their privately insured counterparts, according to a study released last year. “Even those Medicaid patients who have primary care physicians – and that is less likely than for people with private insurance – report significant barriers to seeing their doctor,” said study senior author Adit Ginde of the University of Colorado School of Medicine in Aurora, Colo. “Medicaid patients tend to visit the ER more, partly because they tend to be in poorer health overall. But they also visit the ER more because they can’t see their primary care provider in a timely fashion or at all.” Overall, 16.3 percent of Medicaid beneficiaries had one or more barriers to primary care, compared to 8.9 percent of people with private insurance. More than one-third (39.6 percent) of Medicaid patients visited the ER within the last year versus 17.7 percent of privately insured patients.
ObamaCare doesn’t raise health care costs, guns raise health care costs? Gunshot wounds and deaths cost Americans at least $12 billion a year in court proceedings, insurance costs and hospitalizations paid for by government health programs, according to a recent study. Ted Miller, who analyzed 2010 government statistics for the Pacific Institute for Research and Evaluation, found that gunfire deaths and injuries incur a direct societal cost of $32 per gun. A 2012 study by the Vanderbilt Medical Center in Nashville found that 79 percent of gunshot victims in greater Nashville were enrolled in Medicaid. That compared with 45 percent of Medicaid enrollment for all other emergency room patients. Source: USA Today
Less is better: The number of men over age 75 being routinely screened for cancer with a prostate-specific antigen (PSA) test has declined after a 2008 recommendation against the tests. But more than 4 in 10 men in that group still get the tests, a new study finds. Before the recommendation, 47 percent of men over 75 had a PSA test; that has dropped to 42 percent. “There’s a lot of skepticism in the medical community that guidelines don’t work, especially when the guidelines recommend less care,” said David Howard, an associate professor of health policy at Emory University. Howard and researchers from the Atlanta-based Centers for Disease Control and Prevention studied what happened to screening rates after the 2008 recommendation by a task force that said the testing – and resulting biopsies, surgeries and other treatment – was more likely to cause medical harm than to save lives. Source: Kaiser Health News
Focus on rare diseases: The European Commission has announced it will spend $187 million to fund 26 research projects on rare diseases, involving research teams from 29 countries, according to Pharma Times. The goal is to discover effective treatments for metabolic, immune and cardiovascular disorders, among others. The 26 new projects cover a broad spectrum of rare diseases such as cardiovascular, metabolic and immunological disorders. The teams will work on a variety of challenges, including a new “bioartificial” liver support system; treatments for rare kidney diseases; and development of a drug to treat alkaptonuria, a genetic disorder that leads to a severe and early onset form of arthritis, heart disease and disability.
Cut the red tape in clinical trials: The Food and Drug Administration regulates medical products, only approving them after “increasingly laborious, expensive, three-phase clinical trials,” former FDA Commissioner Andrew von Eschenbach and University of Chicago professor Tomas Philipson write in Bloomberg News. Here’s how the phases work: Phase 1 trials involve a few dozen patients and focus on safety; Phase 2 trials are larger and look for evidence on optimal dosage and effectiveness; Phase 3 trials are focused exclusively on effectiveness. Phase 3 trials account for about 25 percent of the time and require (on average) three years for completion. “Today, in an era of precision or personalized-drug development, when medicines increasingly work for very specific patient groups, the system may be causing more harm than good,” they argue, proposing that Phase 3 trials be shortened. Among the reasons is that with information technology advances, “Post-market surveillance can and should reduce dependence on pre-market drug screening in Phase 3 trials.” The move would have revenues coming in about three years earlier, encourage innovation and boost the economy, they write.
Sequestration hypochondriacs: Officials are complaining that the across-the-board cuts required in sequestration will hit hard in public health and medical research, both of which have been restricted by years of underfunding or retrenchment. “These cuts are going to have a real impact,” Washington state Health Secretary Mary Selecky said. “In the next six to eight weeks, we’re going to have to say we’re closed on Fridays or we can’t provide this or that service anymore.” Researchers who depend on National Institutes of Health grants also say they’re worried that their work will have to be scaled back. Source: Los Angeles Times
On the other hand: FDA Commissioner Margaret Hamburg announced last month that the FDA’s Center for Drug Evaluation and Research is working on creating a new office of pharmaceutical quality. Hamburg said the new office would not impose any new quality requirements but rather enforce existing quality standards. (Sequestration? What sequestration? Makes one wonder just how they test the quality of those drugs…)
Do wellness programs help or hinder? It depends. They seem to produce a healthier workforce, but it may take time to reduce health care costs for employers. In 2009, per-member, per-month health costs were $705.65 at Community Hospital of the Monterey (Calif.) Peninsula. Then a wellness program was implemented and in 2012, that cost had dropped almost 15 percent, to $602.25 per member per month. “We’re making it easier for employees to [take care of themselves], and it has saved us millions of dollars per year,” said CFO Laura Zehm. BJC, one of Missouri’s largest employers, saw a sharp, rapid drop in hospital visits by workers and their families for costly and chronic conditions after insisting employees in its most popular, generous health plan enroll in wellness initiatives. But outpatient costs, meanwhile, increased almost as much as hospital costs fell. The results, published in the journal Health Affairs, found an estimated 41 percent drop in hospital stays between January 2004 and December 2006 for stroke, heart disease (hypertensive and ischemic), chronic obstructive pulmonary disease and acute pulmonary infections among employees and dependents with health benefits from BJC HealthCare. BJC, based in St. Louis, has 12 hospitals in Illinois and Missouri and adopted a new wellness program in 2005.
Quotes of Note
“Hospitals are dealing with consumers who are remarkably smart, demanding transparency and two-way communication from their health care providers. They also trust brands less: 32 percent of people are more likely to trust a stranger’s opinion on a blog or public forum than a branded advertisement or marketing material, according to a recent DKNewMedia/Forrester survey cited by Forbes. Furthermore, many consumers are coping with increased out-of-pocket health care costs, which make them more likely to shop around for providers.” – Molly Gamble, Becker’s Hospital Review
“Dear Sir (or Madam): “I try every remedy sent to me. I am now on No. 67. Yours is 2,653. I am looking forward to its beneficial results.” – Clara Clemens, “My Father Mark Twain”