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 arecent 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.
(Reproduced from the Human Capital blog with permission of the Robert Wood Johnson Foundation, Princeton, N.J.)
Monday, October 6, is National Child Health Day.
Many Americans may not know that children born in the United States are less likely to survive to their fifth birthday than children born in other high-income peer countries. The United States falls at the bottom of the Commonwealth Fund’s recently released “Mirror, Mirror” report, ranking last out of 11 countries for infant mortality.
In what promises to be a stimulating and thought-provoking afternoon on October 7th LDI will host Avik Roy, Senior Fellow at the Manhattan Institute and the Opinion Editor at Forbes, who will talk about health insurance premium “rate shocks” attributable to the Affordable Care Act.
Sovaldi, the $84,000 Hepatitis C drug developed by Gilead Sciences, has sparked controversy while marching toward worldwide sales set to exceed $11 billion in 2014. The blockbuster drug’s price is the main sticking point in the debate: critics argue that the cost is unsustainable and will cause payers to restrict treatment for the estimated 3.2 million patients in the United States who live with Hepatitis C, some of whom will develop liver complications.
Gilead has responded by emphasizing the improvement over the current standard of care – the treatment cures the disease in most patients and has a shorter course than other therapies on the market – and the long-term savings to the health care system from preventing end-stage liver disease and liver transplants.
What are the payers saying? A webinar on September 24th from life sciences research and consulting firm Evidera outlined current and potential payer strategies to prepare for the impact of Sovaldi and its yet-more-expensive successors.
The Affordable Care Act has generated carrots and sticks for hospitals to reduce readmissions. New delivery models offer incentives in terms of shared savings for health care systems that provide high quality, coordinated care. Meanwhile, a readmission penalty has taken effect, and hit safety net and teaching hospitals hard. While increased referrals to home health care from hospitals might lower readmission, there is wide variation in home health agencies’ ability to keep patients safely in their homes, and out of the hospital. Here I report on an IOM workshop on home health care now in progress, as well on a new study linking outcomes with the work environment of home health agency nurses.
A new analysis by LDI and Urban Institute Senior Fellows suggests that newly covered Medicaid recipients' best bet for getting a primary care appointment is at a Federally-Qualified Health Center (FQHC). Those findings come as questions continue to arise about the health system's ability to meet higher demands for primary care. For instance, Pennsylvania's newly expanded Medicaid program will make 300,000 uninsured adults newly eligible for coverage in 2015.
One measure of the success of the health insurance marketplaces is how well they promote stable insurance coverage between plan years. On first glance, auto-enrollment seems like a good way of promoting that goal in the upcoming open enrollment period. But the process, as now designed, could create many unhappy customers who don’t understand what their out-of-pocket premiums will be. Here’s why.
Pennsylvania may finally expand its Medicaid program under the Affordable Care Act but not the way the drafters of the law had envisioned. And not exactly the way Governor Corbett envisioned it either. Some aspects of the Governor’s “Healthy Pennsylvania” plan received federal approval this week. The plan expands eligibility for Medicaid but makes changes to the program.
In a new Data Brief, we take a nuanced look at 2014 premiums and choices faced by rural residents on the health insurance marketplaces, compared to their more urban counterparts. Prior to the ACA, many rural areas had high premiums and little competition among insurers. Did the ACA change that? The answer, it turns out, depends on the state.
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.
"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.