Featured Post
February 26, 2020
Last week LDI hosted a day-long conference on Medicare for All & Beyond. Our goal was to participate in one of today’s most pressing conversations in health care—how to expand health insurance to the 28 million people in the United States who are currently uninsured. We welcomed close to 300 people from across the spectrum to participate in this conversation, to consider the critical questions underlying today’s debate, and to look in depth at the challenges we face in expanding insurance coverage in our country. The conference gave us all plenty to mull over.
This month’s issue of Mayo Clinic Proceedings features two new articles on the obesity paradox -- the finding that overweight/obesity confers a survival advantage. Skeptics argue that confounding masks the true causal relationship between weight and mortality. A key culprit cited is reverse causality, which refers to the fact that an individual’s weight may be a reflection of illness. Are we mixing up cause and effect? My recently published work attempts to address reverse causality and to explain why findings of weak or inverse associations between excess weight and mortality are so prevalent in the literature.
Cross-posted with the Field Clinic blog
"The success of Obamacare always rested on getting enough 'young invincibles' to enroll in exchanges." This sentiment, shared by both ACA critics and advocates alike, was restated by Scott Gottlieb in a Forbes opinion piece, that suggests lack of interest by this group. Is this trend, if factual and permanent, a threat to the success of health reform? In my view, the answer is no. Having more young healthy people buying coverage on the exchanges will improve the wellbeing of some people, and it would also improve the cosmetics of the program, but the program really does not need them to do most of what it was intended to do
The Obama administration is floating a proposal to allow “auto-renewal” of ACA insurance plans. This means that the roughly 8 million people that signed up for Obamacare insurance will be automatically renewed in the same insurance plan next year (open enrollment starts again in November) unless they choose a different one.
This would make the experience of Obamacare enrollees similar to most workers “auto-renewed” each year by their employers. When employers auto-renew their workers – it keeps more workers covered, reduces the burden on employees to re-enroll every year, and makes it administratively simple for employers. The same logic holds true for the Obamacare marketplaces. If every consumer had to re-enroll every year, some would forget, many would be annoyed, and the system would be stressed more than it needs to be. Keeping the same plan also makes it easier to keep the same doctor.
LDI Executive Director Dan Polsky discusses the limited impact the ACA has had, thus far, on patient volume, and contrasts that with the potentially dramatic impact it can have on people previously uninsured. Read the entire interview on athenahealth’s Health Leadership Forum.
Cross-posted from the Philadelphia Inquirer, "Field Clinic" Blog
There are many reasons to be concerned about this week's Supreme Court decision that the Affordable Care Act's mandate requiring employers to pay for coverage of a wide range of contraceptive methods violated another federal law protecting firm owners' religious freedom. Passionate counter-arguments have already been made involving issues of privacy, gender equity, reproductive autonomy, and the biologic mechanisms of specific contraceptives. But we can also challenge the Supreme Court for its inability to understand basic principles of economics.
What is your race? That might not seem like a difficult question to answer. It’s easy enough to just check a box, right? You would think that something that has been associated with your genes wouldn’t change throughout your life. But it does, sometimes drastically, as you become more aware of what it means to check one of those boxes. It can also change as the politics surrounding Race (with a capital R) change.
Newly-published studies by Senior Fellows Mark Neuman, Jeffrey Silber, Rachel Werner, and colleagues have direct implications for the management of hip fractures, which afflict more than 300,000 older adults each year.
The first study, published earlier this week in JAMA Internal Medicine, focuses on outcomes in a particularly vulnerable and understudied population: long-term residents of nursing homes, who are at twice the risk of sustaining a hip fracture as community dwellers.
The second study, published yesterday in JAMA, compares surgical outcomes in hip fracture patients receiving general anesthesia vs. regional (i.e., spinal or epidural) anesthesia. This is an extremely well-done retrospective cohort analysis of more than 56,000 hip fracture patients over 50 in New York State hospitals over a seven-year period. It features an innovative “near-far” instrumental variable match that paired patients who lived at different distances from hospitals that specialized in regional or general anesthesia.
Cross-posted with the Field Clinic blog
The Obama administration has given employers a reprieve from the mandate that they offer their workers insurance at low employee premiums or pay a penalty. As things now stand, enforcement is postponed until 2016. But should the mandate ever come back?
Even strong supporters of the Affordable Care Act are divided. David Blumenthal of the Commonwealth Fund thinks the mandate on employers is needed to compel them to honor their “shared responsibility” to pay their workers’ premiums. Tim Jost, a professor at Washington and Lee University and a leading backer and interpreter of the complex ACA rules, thinks the mandate has too many adverse side effects and should be “repealed and replaced” by something else. Commonsense Americans may wonder why, if we can get by without the employer mandate for next two years, we ever need it.
Cross-posted with the Field Clinic blog
We help several groups of Americans to obtain health insurance through a series of separate programs. Medicare helps seniors. Medicaid helps people in families with low incomes. And now the Affordable Care Act provides subsidies to many with low and moderate incomes for purchasing coverage in private insurance exchanges. (Middle and upper income people receive a massive subsidy for purchasing group insurance through the tax exclusion of premiums that, in my opinion, defies rational explanation.)
We see each of these groups as deserving help from higher income taxpayers, but we treat them in very different ways. In the exchanges, subsidy recipients in most states enjoy a wide range of insurance plan choices that vary both in the extent of required out-of-pocket payments and in the limitations imposed on provider networks. The subsidies remain the same regardless of whether one chooses a generous plan with a high premium or a plan with a lower premium that includes high deductibles and strict limits to network doctors and hospitals. Consumers have a wide range of choices but with a floor in the form of minimum mandated benefits.