Proposition 45 doesn’t create a single payer system; it creates a single overseer system. By explicitly giving the Insurance Commissioner authority over rates and benefits, Proposition 45 gives this elected official implicit power over everything relating to health plans in California. This includes what treatments carriers cover—or don’t cover, what doctors and hospitals are in—or out—of a carrier’s network, what insurers spend on marketing and distribution, and virtually everything else but what colors are in the carrier’s logo. And a creative Commissioner could probably find a way to control that as well.The ability to leverage explicit powers to expand control over other items isn’t idle conjecture. I’ve seen it done in other contexts.
The solution to the SGR mess, then, may be simpler than convoluted formulas and political horse-trading. The Medicare Advantage program can serve as a “baseline” for physician reimbursements. For instance, traditional Medicare can take the second-cheapest MA plan in each county across the country, and base physician payments on that plan’s reimbursement schedule, plus any penalties/bonuses required under the program. This would eliminate the bureaucracy of the federal government trying to determine how much physicians should be paid, and for what. Plans in the private sector are clearly already figuring this out, and there’s no sense in reinventing the wheel.But this doesn’t have to happen all at once. Indeed, it would make sense to test such an approach before implementing it across the board. Medicare could pick, at random, a set of counties where reimbursements would be based on private plans for a set period of time. Quality and cost data could then be analyzed to determine whether this method is worth it.
It’s no secret that the price transparency movement has picked up speed and become increasingly complicated for all stakeholders. Though over 30 states have passed or proposed legislation to increase price transparency, and released median prices for specific services, many supporters of price transparency have pushed for more detailed data. Specifically, all amounts paid to every provider, for every service, so prices and trends can be tracked more definitively.
This past March, Health Care Incentives Improvement Institute HCI3 and Catalyst for Payment Reform CPR released their second annual Report Card on State Price Transparency Laws. Forty-five states failed and only two were awarded a B.
With these types of developments in mind, the George Washington University’s online master of public health, MPH@GW, recently released Illuminating Health Care Prices: Organizations to Watch, which profiles 14 organizations helping to achieve greater healthcare price transparency through policy as well as various initiatives, resources and tools. Since price transparency is a primary or subsidiary goal for myriad organizations and companies, the list isn’t intended to provide a comprehensive view of the price transparency landscape, but rather to explain the multifaceted hurdles and triumphs of the movement by taking a deep dive into the work that several of these organizations are doing.
Last year, open enrollment in the health insurance exchanges started October 1. This year the start date has been pushed back to November 15. That would be acceptable if there were some administrative or economic reason for the delay. But there appears to be none–other than a desire to keep voters from knowing much about this year’s round of choices before they have to vote.
About 19 states have already required insurers to announce next year’s premiums. Even with that information, people who expect a subsidy will be in the dark until they determine the second lowest price Silver plan–that’s the benchmark for determining subsidies. If that premium goes up, everybody’s subsidy rises. If that premium goes down, everybody’s subsidy falls. Most people won’t be able to do the required calculation on their own. Investor’s Business Daily has determined the net effect for a moderate income individual in various cities. See the chart. The results aren’t pretty
In last night’s U.S. Senate debate in New Hampshire between incumbent Jeanne Shaheen D. and challenger Scott Brown R., Shaheen uttered a flat-out, bald-faced lie: that Obamacare doesn’t cut Medicare spending to pay for its expansion of coverage to the uninsured. It’s a talking point that a number of Democratic Senate candidates—and their enablers in the lefty blogosphere—have been clinging to. And it’s embarrassingly dishonest.
Medical Progress Report 18 | Health Savings Accounts Under the Affordable Care Act: Challenges and Opportunities for Consumer-Directed Health PlansOctober 18, 2014
Initial skepticism from HSA advocates was understandable; but based on our current research, it appears that the Obama administration was true to its word and that HSAs at least for the moment remain widely accessible on public exchanges. The report finds that, far from becoming obsolete under the ACA, high-deductible plans are widely available—98 percent of uninsured Americans have access to at least one HSA-eligible plan. Moreover, these plans also make up about 25 percent of total offerings on Obamacare exchanges. We also found that they remain significantly less expensive than traditional plan designs, offering savings of about 14 percent, on average.
Nonetheless, our analysis indicates that it remains difficult for consumers to identify HSA-eligible plans and that much more could be done to simplify their administration and educate exchange consumers on their advantages and limitations.
Loyal readers know that I have been critical of the claim that the health care systems of other countries are superior to our own. But this is one area where some other countries outperform us in spades. As I wrote at the Health Affairs blog:
- In Germany and Austria, a cash payment is made to people eligible for long-term care — with few strings attached and little oversight on how the money is used.
- In England and the Netherlands, the disabled and the elderly manage their own budgets, choosing the services and providers that meet their needs.
via The Right To Die.