Suit on Health Law Puts Focus on Funding Powers – NYTimes.com

November 30, 2014

In mounting the latest court challenge to the Affordable Care Act, House Republicans are focusing on a little-noticed provision of the law that offers financial assistance to low- and moderate-income people.

Under this part of the law, insurance companies must reduce co-payments, deductibles and other out-of-pocket costs for some people in health plans purchased through the new public insurance exchanges. The federal government reimburses insurers for the “cost-sharing reductions.”

In their lawsuit, House Republicans say the Obama administration needed, but never received, an appropriation to make these payments to insurance companies. As a result, they contend, the spending violates the Constitution, which says, “No money shall be drawn from the Treasury, but in consequence of appropriations made by law.”

via Suit on Health Law Puts Focus on Funding Powers – NYTimes.com.


Crisis In Pharma R&D: It Costs $2.6 Billion To Develop A New Medicine; 2.5 Times More Than In 2003

November 28, 2014

The high nominal prices of new drugs do not compensate for the smaller patient populations that they target. Deloitte and Thompson Reuters estimate that the IRR internal rate of return of R&D spending has dropped in half since 2010, from 10.5 percent to 4.8 percent. Sales of new drugs are not overcoming the loss of patents, weak pricing power for older drugs, or reduced productivity of R&D.

via Crisis In Pharma R&D: It Costs $2.6 Billion To Develop A New Medicine; 2.5 Times More Than In 2003.


Cost Still a Barrier Between Americans and Medical Care

November 28, 2014

One in three Americans say they have put off getting medical treatment that they or their family members need because of cost. Although this percentage is in line with the roughly 30% figures seen in recent years, it is among the highest readings in the 14-year history of Gallup asking the question.

via Cost Still a Barrier Between Americans and Medical Care.


Health-Insurance Site Snags Immigrants – WSJ

November 28, 2014

Legal immigrants are running into fresh problems signing up for insurance on HealthCare.gov, presenting a hurdle in the Obama administration’s efforts to cover more Hispanics.Immigrant groups say people born outside the U.S. who are entitled to private insurance under the Affordable Care Act are having trouble proving their identities to the federal insurance marketplace and uploading documents that demonstrate they are in the country legally. Some also are being routed first to Medicaid, the state-federal insurance for the poor, even though they don’t qualify.The 2010 health law excluded illegal immigrants but extended benefits to certain legal ones. In trying to keep unlawful immigrants out of the system, the enrollment process has made it difficult for lawful ones to get through, immigrant groups say.“A lot of advocates are frustrated,” said Angel Padilla, health policy analyst at the National Immigration Law Center.

via Health-Insurance Site Snags Immigrants – WSJ.


Wyoming Devises Plan to Expand Medicaid – NYTimes.com

November 28, 2014

With a plan released Wednesday by the administration of Gov. Matt Mead, a Republican, Wyoming has become the latest state seeking to expand Medicaid.

The plan would provide Medicaid coverage to an additional 18,000 low-income people, according to the state’s health department. If it wins federal and state legislative approval, Wyoming will join 27 states that have expanded the program under the Affordable Care Act, including nine with Republican leadership.

As several other Republican governors have done, Mr. Mead wants to require some people who receive coverage under the expansion to pay something toward the cost. Under his plan, those earning 100 to 138 percent of the federal poverty level — for a single person, $11,670 to $16,105 a year — would have to pay monthly premiums. The premiums could range from about $20 to $50 a month, depending on household size and income, according to a summary of the plan.

via Wyoming Devises Plan to Expand Medicaid – NYTimes.com.


The Problem With Prostate Screening – NYTimes.com

November 26, 2014

As a result, those physicians who have not examined the data in depth are now treating patients on the basis of deeply flawed data. How flawed? That’s the real issue: Because the authors won’t release their data, we don’t know.

It is imperative that, as part of America’s continuing efforts at health care reform, we develop a declaration of principles about the need for data transparency. Our regulatory bodies must insist that clinical trials, and especially taxpayer-funded ones, be open to scrutiny by independent investigators who have no ties to industry. Hoarding data, especially flawed data, is unacceptable when lives are at stake.

via The Problem With Prostate Screening – NYTimes.com.


NIHCM – Concentration of Health Care Spending Chart Story

November 26, 2014

One percent of the U.S. population accounts for nearly 23 percent of overall health care spending, and 5 percent are responsible for a full 50 percent of spending. In stark contrast, the lowest-spending half of the population generates less than 3 percent of total spending—or only about $234 per person, per year. Any meaningful effort to control spending growth must account for this extreme concentration. This chart story uses newly-released data to take a closer look at the top spenders, noting factors driving their higher spending and examining the persistence of spending patterns over time.

via NIHCM – Concentration of Health Care Spending Chart Story.