Medical Progress Report 13 | Building a Market-Based Health-Insurance Exchange in New York

Critics (including some opponents of the ACA who nevertheless support the concept of insurance exchanges) are concerned that the exchanges may become overly bureaucratic and impose excessive regulatory or benefit requirements that will restrict consumer choice and drive up costs. They also point to the enormous discretion that the federal government reserves to certify the exchanges, potentially restricting state options in design and implementation. These are legitimate concerns. Overly restrictive exchanges may fail to attract enough insurers to offer consumers and small businesses a wide variety of affordable plans that meet their needs. If an exchange offers only a handful of very expensive options, it may fall short of signing up a critical mass of healthy enrollees, leaving it with a population of very sick (and thus very expensive) subscribers. Over time, that imbalance could make the exchange financially unsustainable.

More at Medical Progress Report 13 | Building a Market-Based Health-Insurance Exchange in New York.

Brookings – Quality. Independence. Impact

Promoting Biomedical Innovation and Economic Value: New Models for Reimbursement and Evidence Development

Sponsored by the Engelberg Center for Health Care Reform at Brookings and the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California

The Brookings Institution | 1775 Massachusetts Ave, NW | Washington, DC. Friday, April 22, 2011.

Videocast at Brookings – Quality. Independence. Impact.

Will Price Competition Lead To Quality Competition? – Health Affairs Blog

If lack of price competition is normally associated with lack of quality competition, could the reverse be true? Do providers who compete for patients on price also compete on quality? There is a lot of evidence that they do.

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Our Obsolete Approach to Medicaid – NYTimes.com

Medicaid in its present, outdated form is unsustainable. Without serious reform, it is unthinkable to add 16 million more people, as President Obama’s health care legislation would do. The White House budget would temporarily pay 100 percent of the costs of new Medicaid enrollees. As a result, many states would expand enrollment, deferring the hard decisions until the federal money goes away.

More at Our Obsolete Approach to Medicaid – NYTimes.com.

Healthcare lobbying cools down one year after reform law’s passage – The Hill’s Healthwatch

The money spent on healthcare lobbying has dropped off considerably from a year ago when Congress was in the midst of the healthcare reform debate, according to disclosure records filed this week.

The main exceptions, as expected, are health insurance plans that are battling to shape an array of pending regulations that seek to overhaul their business model.

More at Healthcare lobbying cools down one year after reform law’s passage – The Hill’s Healthwatch.

Identifying The Use, Cost, and Quality Tradeoff in the Medicare Hospice Benefit | HCFO

The researchers will assess the relationship between use, quality and cost of palliative care across the settings in which this care is delivered, including community-base palliative care, hospital-based palliative care, community-based hospice, and inpatient hospice.

More at Identifying The Use, Cost, and Quality Tradeoff in the Medicare Hospice Benefit | HCFO.

Jean Abraham, Ph.D. | HCFO Grantee Spotlight

Jean Abraham, Ph.D., is an assistant professor in the Division of Health Policy and Management at the University of Minnesota’s School of Public Health.

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How Much Do Hospitals Cost Shift? A Review of the Evidence | HCFO

Policymakers should view with a degree of skepticism most hospital and insurance industry claims of inevitable, large-scale cost shifting. Although some cost shifting may result from changes in public payment policy, it is just one of many possible effects. Moreover, changes in the balance of market power between hospitals and health care plans also significantly affect private prices. Since they may increase hospitals’ market power, provisions of the new health reform law that may encourage greater provider integration and consolidation should be implemented with caution.

More at How Much Do Hospitals Cost Shift? A Review of the Evidence | HCFO.

Regulating the Medical Loss Ratio: Implications for the Individual Market | HCFO

How will the minimum medical loss ratio (MLR) provisions of the Patient Protection and Affordable Care Act impact the individual market for health insurance? Jean Abraham, Ph.D, and Pinar Karaca-Mandic, Ph.D., of the University of Minnesota, sought to provide state-level estimates of the size and structure of the individual market for health insurance and to investigate the impact of the new MLR regulation.

More at Regulating the Medical Loss Ratio: Implications for the Individual Market | HCFO.

HCFO | High Deductible Health Care Coverage: Snapshot of Some Mixed Evidence

For more than 10 years, there has been movement toward placing greater control of health care in the hands of consumers. A hallmark of this change was the introduction of consumer-driven health plans (CDHPs) into the landscape of health insurance. The large body of evidence examining the various components of CDHPs may help inform policymakers who are exploring the advantages and disadvantages of offering high deductible health plans (HDHPs) within states’ health insurance exchanges. While HDHPs are structured in such a way to promote cost savings and protect against the financial burden of a catastrophic medical event, the evidence on the success of these goals is mixed.

More at HCFO.