Featured Post
December 2, 2020
As the Supreme Court mulls yet another challenge to the constitutionality of the Affordable Care Act (ACA), we have new evidence of the law’s positive impact on young adults, who were allowed to stay on their parents’ insurance until age 26 under the Dependent Coverage Provision (DCP). The ACA helped young adults with cancer maintain continuous coverage, which is key to maintaining access to cancer treatment.
In a recent retrospective cohort study, my colleagues and I found that cancer patients who turned 19 in 2010-2012 (who were eligible to stay on their parents’ insurance) were 15% less likely to lose coverage than those who turned 19 in 2007-2009, before the ACA. We used commercial claims data to identify about 2,800 young adults with a cancer diagnosis between 2000 and 2015, and compared them to their peers prior to the ACA’s implementation. We matched the two groups on cancer type, diagnosis date, and clinical characteristics, and compared time to loss of insurance over 5 years.
October 8, 2015
News reports indicate that consumers may see some welcome changes when they enroll or re-enroll in a health insurance plan on HealthCare.gov on November 1. They should expect to see an upgraded web site with new tools to help them window shop and choose the best plans for them. Several of these tools are ones that we have recommended based on a study of young adults’ experiences on HealthCare.gov and tracked over the first and second enrollment periods.
October 2, 2015
In a letter to Congress, health economists from across the political spectrum, including many LDI Senior Fellows, stress the importance of the Cadillac tax as an essential tool for controlling health care costs. They warn that if it were to be repealed, without an alternative policy in place to serve this function, the ACA will fail in its aim of bringing down skyrocketing health care costs.
September 29, 2015
In an NBER working paper, Penn LDI colleagues Mark Pauly, Adam Leive and Scott Harrington found that a large portion of non-poor (measured by income above 138% of the poverty level) who gained coverage now have a higher financial burden and lower welfare (well-being) than when they were uninsured. The authors call this extra burden a “price of responsibility” for complying with the individual mandate to purchase coverage.
To evaluate the change in financial burden and welfare, the authors compared the out-of-pocket payments made by uninsured people before the ACA with premiums and out-of-pocket payments made after gaining coverage. The authors also estimated the positive effects of health coverage, such as higher use of services and protection from catastrophic medical bills. Even so, the model found that non-poor adults who went from uninsured to insured were paying higher premiums (even with subsidies) and, surprisingly, more out-of-pocket fees. While the burden was lower for those with lower incomes, because of subsidies for premiums and co-pays, the burden across all levels of income was positive – meaning that the average non-poor adult who gained insurance under the ACA had a higher financial burden after purchasing insurance. The authors estimated that subsidy-eligible people with incomes below 250% of the poverty threshold likely experience welfare improvements that offset the higher financial burden, depending on assumptions about risk aversion and the value of consuming more medical care. However, even under the most optimistic assumptions, close to half of the formerly uninsured (especially those with higher incomes) experience both higher financial burden and lower estimated welfare.
September 25, 2015
With a price tag of $1,000 per pill and $84,000 for a 12-week course of Sovaldi (sofosbuvir), Gilead Sciences prompted widespread concern about whether its new treatment for hepatitis C (HCV) would bankrupt public and private payers. These concerns were particularly significant for state Medicaid programs, which face both limited state budgets and high HCV prevalence among beneficiaries. Today in the New England Journal of Medicine, LDI Fellow Joshua Liao and colleagues describe early Sovaldi utilization patterns by Medicaid programs in 2014, the first full year after its approval, and report widespread variation across states.
September 25, 2015 [cross-posted from the Field Clinic]
Praluent, a new cholesterol-lowering drug for people who need more than a statin, has been priced at about $40 a day by its suppliers, Regeneron and Sanofi. This compares to about $8 a day for Crestor, the most recent statin on the market, and pennies a day for generics. The introduction of a blockbuster drug at a budget-buster price has thrown Express Scripts, CVS/Caremark, and other drug insurers into the throes of serious anxiety. They warn that widespread use of the new medication at this price could bump up drug spending by as much as a third, which translates to $100 billion annually nationwide.
Is Praluent worth it? A new study has estimated the value of the benefits it provides relative to alternative treatments. It concludes that, if patients value the health benefits (as measured by improvements in both survival and quality of life) at $100,000 for a healthy year of life, the value would be only about 25% of the price. Some commentators have called for political pressure to lower prices and possibly even regulation, based on the results of this study. But that is the wrong conclusion.
September 23, 2015
Enhancing access to primary care is a key component of a patient-centered medical home (PCMH). But little is known about how PCMH status affects the availability of appointments for new patients. In a new analysis of “secret shopper” data, LDI Senior Fellows Jaya Aysola, Karin Rhodes and Daniel Polsky found that PCMHs were 1.26 times more likely to offer a new appointment and 1.36 times more likely to schedule an after-hours appointment than other primary care practices, with no differences in average wait time for a new appointment.
Along with being Interim Chair of the Department of Medicine at the University of California and ranked by Modern Healthcare as the most influential physician-executive in the U.S., Robert Wachter, MD, is the author of 250 articles and 6 books, the latest of which has become a New York Times Best Seller. Entitled The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age, the book is being hailed across the country as the most compelling one yet written on its subject. We spoke with Wachter about the accomplishments and unexpected consequences of health IT, the process of writing the book, and new ideas that might deserve more attention from health care leaders and policymakers.
September 16, 2015
Expanding health coverage and reducing disparities in uninsured populations is an important part of the Affordable Care Act (ACA). Will this ensure access to health services as well as improve the health of minority populations? That’s less clear.
Setember 11, 2015
Summer is officially over and Penn, not to mention Congress, is back in session. If your summer didn’t include following every twist and turn of health policy, here’s some of the research and debate that you may have missed.
September 3, 2015
A new study by LDI Senior Fellow Carolyn Cannuscio and colleagues, including Senior Fellows Rosemary Frasso, David Grande, and Zachary Meisel, examines how a behavioral economics intervention can encourage young adults to carry their epinephrine auto-injectors.
August 25, 2015
Hospital observation, instead of admission, is increasingly common for Medicare beneficiaries. This distinction is important because it means that the hospital stay is not covered by Medicare Part A, and it may mean higher out-of-pocket costs, according to a new study.
August 24, 2015 [cross-posted with US News]
Medicare is going in multiple directions at once. On the one hand, it is trying hard to move away from fee-for-service payments to doctors, where each tiny service has its own code and its own payment, and instead, toward more bundled payment or even payment of a fixed amount per person per month to accountable care organizations. On the other hand, the government just proposed, in response to pressure from organized physicians, a new code and a new doctor payment in traditional Medicare for end-of-life counseling. Somewhat oddly, Medicare will currently pay for such a session, as soon as you go on Medicare, but (thankfully, perhaps) few 65-year-olds are expecting an end to their life anytime soon. And so the benefit often goes begging. The new rules would allow you to claim the benefit anytime you feel you need it.