Obamacare Is Experimenting on Us (Does That Make Us Frankenstein or Fusilli?)

(Photo by Joe Raedle/Getty Images)

Obamacare is a large, unwieldy law. Despite its complexity, most people are familiar with its most important elements. They know it created a marketplace where people can shop for healthcare insurance; many are even aware that the cost of that insurance is subsidized for people with lower incomes. Others realize that Obamacare encouraged states to expand Medicaid. And of course, almost everyone has heard of the now defunct individual mandate which required people to purchase insurance or face a tax penalty.

But most Americans probably aren’t aware of what, in the long run, could turn out to be the most impactful part of the Affordable Care Act. The crafters of the ACA recognized that the science of healthcare delivery hadn’t advanced far enough to identify the best ways to improve healthcare quality while lowering healthcare costs. So, lawmakers set a slew of experiments in motion, designed to test ways of accomplishing these goals.
Results of those experiments have been coming out of the lab lately, raising the question of what kind of creatures Obamacare has been creating—are they like Frankenstein’s monster, terrifying but misunderstood? Are they like Edward Scissorhands, loved by suburban moms until they realize how dangerous he is? Or are they like a less renowned creature—Fusilli Jerry, the pasta stick figure that Kramer made for Jerry Seinfeld on that eponymous 1990s sitcom?
I side with the latter, because I view the Obamacare experiments as a type of pasta-flinging exercise. People at CMMI, the federal agency in charge of running these experiments, have been cooking up a bunch of ideas, throwing them into a pot, pulling them out one at a time, and then flinging them against a metaphorical wall to see which ones stick—which ones are ready for public consumption. Some relatively recent studies serve as a good introduction to what Obamacare has been cooking up for the American healthcare system.
(To read the rest of this article, please visit Forbes.)

Bait and Switch: The Sneaky Way Your Employer Just Passed Healthcare Costs onto You

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If you get health insurance through your job, beware: you might be picking up more of the cost of your medical care than you realize. With increasing frequency, employers are directing their workers to the kind of high deductible, high out-of-pocket insurance plans that leave workers financially responsible for a surprising portion of their healthcare expenses.

Not long ago, having insurance coverage meant your costs were largely covered. Americans could count on their employers to offer health insurance plans that covered the vast majority of their healthcare expenses. What’s more, employers even chipped in generously to cover a good chunk of people’s monthly premiums. As a result, Americans with good jobs could live their lives unafraid that they would be financially devastated by an unexpected acute illness.

But this generosity came at an increasingly unaffordable cost for American companies, with the price of health insurance threatening their bottom line. In response, companies have looked for ways to get their workers to pick up more of the tab.

Enter high out-of-pocket health plans.
On the surface, these plans look like bargains, because they cost less each month than other plans. When signing up for insurance, many people are attracted to these plans, knowing they will have less of their take home pay diverted to an insurance company. But then they discover that even a minor illness can turn that bargain to a burden.
(To read the rest of this article, please visit Forbes.)

Everyone Agrees Obamacare Prices Have Been Rising Rapidly (But Everyone Is Wrong)

(Photo by Joe Raedle/Getty Images)

It has been well publicized that premiums for Obamacare insurance plans have been rising at a disturbing rate. Local news is filled with reports of 21.5%36.3% and even higher price hikesPresident Trump complained in February that Obamacare premiums “have increased by double and triple digits,” even remarking that premiums in Arizona “went up 116% last year alone.”

If the cost of buying insurance were really rising this rapidly, we’d have a reason for bipartisan agreement that the Obamacare insurance experiment is a failure. But the rise in Obamacare premiums isn’t even close to the magnitude we are hearing about from reporters and politicians. And it is not because of fake news or dishonest discourse. It’s because everyone is looking at what’s for sale rather than what’s being sold.
Not sure what the heck I’m talking about? Then consider the Nike Mag 2016, a sneaker touted as “sensing the foot and lacing itself,” because, you know, it is so exhausting to tie your own shoes. Nike made less than a hundred pairs of these battery-powered, motor-driven sneakers, which now sell for an average of $26,000 a pair.
Suppose, for purposes of illustration, that before the Mag came to market, Nike had five lines of basketball shoes on the market. They sold for an average price of about $200. Then in 2016, it brings out the Mag. If healthcare reporters and politicians commented on these shoes, they would tell you that Nike prices have risen more than 2,000%. That’s because they’d be calculating the average price of Nike’s shoe offerings, as if people bought an equal number of each type of shoe. If you have five varieties priced at around $200 and one that’s priced at $26,000, you’ll have an average price of over $4,000.
But that’s an insane way to describe the price of Nike basketball shoes. To know how much their basketball shoes cost, on average, we need to know what shoes people actually buy. With hundreds of thousands of people buying the $200 sneakers and a handful of people buying $26,000 sneakers, the average price of Nike’s shoes won’t be much more than $200.
(To read the rest of this article, please visit Forbes.)

The Biggest Problem with Obamacare? People Didn’t Know What the Law Accomplished!

Obamacare dramatically reduced the number of people in United States who lack health insurance. Reduced as in: brought the proportion down to historical lows. Yet very few Americans knew this about the law, which is part of the reason why so many people didn’t like Obamacare. Here’s evidence to back up that connection, from the Kaiser Family Foundation:

Hard to like a law that hides its best features.

The Primary Care Doctor Is Not In

In a clever study, secret shoppers called primary care offices in an attempt to make a new patient appointment. People with Obamacare insurance, or “marketplace plans” in the below figure, had a hard time finding appointments. But so did people with traditional insurance.

But there’s a bigger takeaway, one slightly obscured by the misleading y-axis, that doesn’t go all the way up to 100%. So here’s my over-simplified version of the study results:

That’s right – only 30% of people were able to make a doctor’s appointment.
Unacceptable!

Repealing Obamacare Could Close Your Local Hospital

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Last spring and summer, the Republicans stumbled in their efforts to repeal and replace Obamacare. But they might try a new approach later this year. If they do, expect to hear more debates about what their replacement plans mean for chronically ill Americans. People with pre-existing conditions might get priced out of insurance. People without insurance might delay important medical care, and suffer accordingly. These are serious problems, and Republicans ought to explain what they will do to avoid harming so many people.
But lest you think it is only the poor and downtrodden who will be harmed by this legislation, consider what will happen to your favorite local hospital. Without paying customers – i.e. people with insurance – it is going to lose money. That means even if you are not at risk for losing your insurance, you might lose the ability to go to your neighborhood hospital.
Consider the impact of Medicaid cuts on hospitals. Some Republicans already refused to expand Medicaid under Obamacare. If Republican healthcare legislation becomes law, those states that already expanded will probably be forced to contract their programs. That is going to cost hospitals lots of money, in the form of uncompensated care. When people without insurance become grievously ill, hospitals are required to provide them with emergent care, even if they have little chance of being reimbursed for that care.
(To read the rest of this article, please visit Forbes.)

A Surprising Way Health Insurance Might Save Your Life

Rep. Raul Labrador (R-ID) speaks with members of the media at Trump Tower December 12, 2016 in New York. / AFP / KENA BETANCUR (Photo credit should read KENA BETANCUR/AFP/Getty Images)

Back in May, an angry constituent asked Congressmen Raul Labrador why he voted for the Republican House Healthcare Bill, that the constituent claimed would cause people to die for lack of Medicaid funding. The Freedom Caucus member shot back with a now infamous retort: “Nobody dies because they don’t have access to healthcare.” Amidst backlash over what he now describes as an inelegant statement, Labrador tried to clarify his remarks: “I was trying to explain that all hospitals are required by law to treat patients in need of emergency care regardless of their ability to pay, and that the Republican plan does not change that.”
But Labrador forgot to mention that, although hospitals are required to treat emergently ill patients regardless of ability to pay, they are also allowed to bill those patients for that care. That means people without insurance often find themselves either avoiding emergency rooms altogether, or driving long distances to hospitals known for being more forgiving of medical debt. Labrador overlooked the life-threatening risks that financially strapped people take to keep out of medical debt.
Insurance sometimes saves lives by enabling people to get emergency care close to home, without fear of financial insolvency.
This travel-and-die phenomenon is not what most insurance enthusiasts think about when they say insurance improves health. Instead, they talk about how insurance makes people more likely to receive the primary care that prevents life threatening illnesses – mammograms and colonoscopies; blood pressure pills and flu shots. They point out that patients with insurance are more likely to see doctors when they start developing worrisome symptoms. With insurance, the cost of a cardiology appointment no longer stands in the way of getting that “heartburn” checked out. In short, insurance improves health and saves lives by being the difference between whether or not people receive lifesaving medical care.
(To read the rest of this story, please visit Forbes.)

Obamacare Insurance Premiums – Not Growing Too Fast

Here’s a picture from a New England Journal of Medicine article showing that in 2015 and 2016, Obamacare premiums grew more slowly than private insurance premiums rose before the law came into effect:

New England Journal of Medicine
New England Journal of Medicine

The Obamacare markets are new and unsettled. But so far they aren’t leading to runaway inflation. But what will happen to these markets if the Republicans are able to repeal and delay? Cue the ominous movie music!

How Companies Can Save Millions on Healthcare Benefits (without Harming Employees)



The free market is supposed to be efficient. Yet employers are throwing away hundreds of millions of dollars, by not giving their employees intelligently designed healthcare benefits that encourage them to shop for affordable lab tests.
Right now, when your doctor orders a CBC (complete blood count) and a basic chemistry panel (checking your sodium, potassium and other fun chemicals), you probably walk down a hallway and get your blood drawn, or maybe you go to the nearest testing site. A pleasant nurse draws several vials of blood from your arm, and eventually you and your employer get a bill in the mail for the cost of your tests. You probably don’t shop around for prices. Yet those tests might cost $30 at one laboratory and more than $100 at another. Who pays that extra $70? A good chunk of that tab will be picked up by your employer, which ultimately makes it harder for your boss to give you a raise. And some of the cost might be on you, with a copay or a charge to your deductible.
There’s got to be a better way.
(To read the rest of this article, please visit Forbes.)

If Trump Wants to Do Better than Obamacare, He Better Pay Attention to This!



Donald Trump says he can improve upon the Affordable Care Act – promising to get everyone in the country “a much better healthcare plan at much lower cost.”
If that’s really what Trump wants to do, he should pay attention to one of the problems with Obamacare – the subsidies to purchase insurance might have been too stingy.
Let me explain. Before Obamacare, most people got insurance either with the help of their employers, or the government (if they qualified for Medicare or Medicaid). But some people had to buy insurance without such help, and the price of such coverage was usually – how do I say this nicely? – insanely expensive! Insurance companies charged extremely high prices for such policies, because they knew that many people shopping for such individual insurance were doing so because they were too sick to work, meaning their healthcare expenses would be higher than average.
Obamacare tried to make this kind of individual insurance more affordable. (They named it the Affordable Care Act for a reason!) The ACA accomplished this affordability, in part, by establishing insurance exchanges, which gave insurance companies a larger number of costumers to spread risk across, making it potentially easier for them to lower prices. In addition, Obamacare provided subsidies to people who otherwise could not afford insurance. The subsidies are quite generous for people with incomes close to the federal poverty level, and gradually diminish, dwindling to zero for people who make more than four times the federal poverty level. In other words, if someone’s family has an income near the federal poverty level, they get a lot of money to help them buy insurance. If a family makes 350% of the federal poverty level, they get a smaller subsidy. And if they make 450% of the federal poverty level, they don’t get any subsidy at all.
(To read the rest of this post, please visit Forbes.)
 

PeterUbel