Health Policy News and Views
Compiled By Benita M. Dodd
Yes, but …I: Ever the optimist, Chuck Lauer, former publisher of Modern Healthcare, has a list of things to remember about the Affordable Care Act. He predicts that the “snafus” over the ObamaCare exchanges eventually will be sorted out, “and more than 20 million people who were formerly without health care insurance will be insured.” On the down side, however, he adds: “But it seems clear that many of the plans will be fairly restrictive, and people won’t have as much choice of provider. Out-of-pocket spending will surely increase. At the same time, funding for disproportionate care is being slashed. Safety-net hospitals fear the outcome. This is the $64 billion question: Will the newly insured make up enough of the losses from reimbursement cuts to allow hospitals on tight margins to survive?” (Gosh, could this be the reason for the recent support for Medicaid expansion by the Georgia Hospital Association, which serves more than 170 hospitals?)
My boss at the Georgia Public Policy Foundation, Kelly McCutchen, proposed a solution to the reimbursement concern way back in APRIL! Read it here:
Yes, but … II: On the eve of the passage of the Affordable Care Act, “virtually every Democrat who appeared on TV to defend it had one and only one message to offer: people were being discriminated because of pre-existing conditions,” John Goodman points out in his latest health blog. “And how many of those people are there? Well, for the first three years under the law, anyone denied insurance because of a pre-existing condition was able to enter the new (ObamaCare) risk pools and pay the same premium a healthy person would pay. How many did that? About 107,000. That’s out of a U.S. population of approximately 314 million!” But, Goodman adds, “It now appears that as many as 10 million people will lose their individual health insurance policies as of January 1. To put this number in perspective, the administration’s goal for next year is to sign up 7 million people. We could actually end 2014 with more people uninsured than there were at the end of 2013.”
Yes, but … III: The poor, sick and uninsured may be the winners under the Affordable Care Act, The Washington Post reports, but the losers appear to include some relatively healthy middle-income small-business owners, consultants, lawyers and other self-employed workers who buy their own insurance. “Many make too much to qualify for new federal subsidies provided by the law but not enough to absorb the rising costs without hardship. Some are too old to go without insurance because they have children or have minor health issues, but they are too young for Medicare.”
Fewer defenders in the war on superbugs: Swiss drugmaker Roche will pay up to $548 million for an experimental antibiotic, marking a rare foray by a major pharmaceutical firm into the battle against so-called “superbug” infections found in hospitals, according to Reuters. The World Health Organization has warned of the growing public health threat from drug-resistant superbugs. There are 25,000 deaths each year in the European Union alone due to antimicrobial resistance, according to Roche. More than 2 million people are infected by drug-resistant germs each year in the United States, and 23,000 die of their infections, according to the Centers for Disease Control and Prevention. But the problem is not yet widespread enough to attract major investment by most top pharmaceutical companies, and many are even cutting back research into antibiotics.
Too much of a good thing: You may be aware that sleeping too little can increase your risk of serious and chronic health problems. But did you know that too much sleep can also boost your risk for disease? New research shows that both sleeping too much and sleeping too little are linked to elevated risks of chronic disease in middle-aged adults. A large-scale study conducted by the Centers for Disease Control and Prevention found that both insufficient and prolonged sleep are associated with a range of serious and chronic conditions, including diabetes and cardiovascular disease. For the purpose of their investigation, researchers defined too little sleep as six hours or less per night. Too much sleep was defined as 10 hours or more per night, and optimal sleep duration was in the range of seven to nine hours. They found “short sleep” was more common than “long sleep,” but that both short and long sleep durations were linked to elevated risks of chronic disease.
Shorter patents = less R&D: Proposals to shorten the patent-protection period for biologic drugs from at least 12 years to seven years would discourage biotech firms and their investors from spending a huge amount of money in research and development, resulting in fewer biologic drugs in the future, writes Jacqueline Northcut, president and CEO of BioHouston and CEO of the Texas BioAlliance. For drugmakers, a seven-year protection period would make it unfeasible for biotech firms to recover their investments, Northcut writes in the San Antonio Express-News. “A mere five out of every 5,000 compounds devised will ever make it to clinical testing,” Northcut points out. “The testing process itself takes, on average, at least seven years. And after all that, only one in five drugs tested on humans will ever make it to pharmacy shelves.The biologic development process is, unsurprisingly, extremely expensive. Including the cost of drugs that fail, the average cost to bring a new drug to market is $1.2 billion. In 2011 alone, the biotechnology sector spent $49.5 billion in research and development.”
Hope for Hepatitis C: Bristol-Myers Squibb Co. has filed with Japanese health regulators seeking approval of its experimental all-oral combination of hepatitis C treatments, the U.S. drugmaker said last week. The submission with Japan’s Pharmaceutical and Medical Devices Agency marks the first time that any drugmaker has filed for approval of a hepatitis C treatment regimen that does not include either of the standard older treatments: the injected, difficult-to-tolerate interferon, or ribavirin, a pill. The overall cure rate in the 222-patient study was 84.7 percent, according to the data to be presented next week at the American Association for the Study of Liver Diseases (AASLD) meeting in Washington.
More hope for Hepatitis C: A Phase III trial program shows that faldaprevir is highly effective in a broad range of patients with hepatitis C virus, Pharmatimes reports. The study, reported by Boehringer Ingelheim, evaluated faldaprevir in combination with interferon and ribavirin. The study found that 84 percent of patients with no prior treatment were able to shorten the total time on treatment from 48 weeks to 24 weeks and 83 percent of these patients achieved viral cure. Interim results showed that 74 percent of patients with HCV/HIV co-infection had undetectable HCV four weeks after treatment ended.
About hepatitis C: Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States; approximately 3.2 million people are chronically infected, according to the Centers for Disease Contraol and Prevention. Up to 70 percent of those newly infected typically show no symptoms or become mildly ill. Up to 85 percent of those infected develop chronic liver disease. Infected individuals can transmit the disease to others and are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection.
Downward spiral: In the third quarter of 2013, Moody’s Investors Service downgraded 10 nonprofit hospitals and health systems and upgraded eight. Downgrades have outnumbered upgrades in each of the first three quarters in 2013, according to a Moody’s report. So far in 2013, there have been 30 hospital downgrades compared with 18 upgrades. Roughly $10.3 billion of debt has been affected by downgrades, while only $4.8 billion of debt has been affected by upgrades. Moody’s analysts attributed the continuing trend to reduced patient volumes as hospital admissions shift toward observation stays and the rise of high-deductible health plans. As patients shoulder more of the financial burden for their own health care, the result is more bad debt for hospitals. Source: Becker’s Hospital Review
Electronic medical records: Just 3 percent of community hospitals have not yet acquired an electronic medical record (EMR) system. Forty percent have an EMR system fully implemented and the remaining 57 percent of hospitals have acquired an EMR system and are partway through the implementation process. Of the hospitals that have acquired a system, 18 percent spent more than $20 million, 19 percent spent between $10 and $19.9 million, 25 percent spent between $5 and $9.9 million and 38 percent spent less than $5 million. Of this outlay, just 19 percent of respondents expect to recover more than 65 percent through federal “meaningful use” incentive payments, 40 percent expect to recover more than 50 percent, 63 percent expect to recover more than 30 percent and 37 percent expect to recover less than 30 percent. Source: Becker’s Hospital Review
Quotes of Note
“It’s far more important to know what person the disease has than what disease the person has.” – Hippocrates
“Good health and good sense are two of life’s greatest blessings.” – Publilius Syrus
“Whatever.” – Kathleen Sebelius