White House Seeks to Limit Health Law’s Tax Troubles – NYTimes.com

January 31, 2015

Obama administration officials and other supporters of the Affordable Care Act say they worry that the tax-filing season will generate new anger as uninsured consumers learn that they must pay tax penalties and as many people struggle with complex forms needed to justify tax credits they received in 2014 to pay for health insurance.

The White House has already granted some exemptions and is considering more to avoid a political firestorm.

Mark J. Mazur, the assistant Treasury secretary for tax policy, said up to six million taxpayers would have to “pay a fee this year because they made a choice not to obtain health care coverage that they could have afforded.”

via White House Seeks to Limit Health Law’s Tax Troubles – NYTimes.com.

Debate Heightens Over Measuring Health-Care Quality – WSJ

January 31, 2015

“Measurement fatigue is a real problem in hospitals,” said Scott Wallace, a visiting professor at Dartmouth’s Geisel School of Medicine. “But, to me, the only metric that matters is, did you get better?”

As of last year, 33 federal programs asked providers to submit data on 1,675 quality measures, according to a government count. State, local and private health plans use hundreds more.

This year, many of the federal pay-for-performance programs carry financial penalties. Hospitals and doctors stand to lose millions in Medicare payments for missing filing deadlines or improvement benchmarks in programs that track hospital-acquired infections, readmissions and electronic-record use.

In all, about 80% of traditional Medicare spending is already tied to such pay-for-performance programs. HHS Secretary Sylvia Burwell said Monday the agency wants that to increase to 90% by 2018. She also set a goal of having 50% of Medicare spending in alternative payment models, in which providers are accountable for quality and the cost of care for groups of patients.

via Debate Heightens Over Measuring Health-Care Quality – WSJ.

Obama to Lay Out $215 Million Precision-Medicine Plan – WSJ

January 31, 2015

A human genome can be sequenced for as little as $1,000, down from $400 million 15 years ago. Increased computing power means researchers can sort through reams of sequencing data and health records to find patterns linking specific genes to diseases.

Drugs that would attack these new genetic targets promise to modify the course of diseases, if not cure them, researchers say. But there would still be years of work to develop the drugs and prove they are safe and effective.

“This is a very important and necessary first step, but it is not sufficient,” said Jeffrey Leiden, chief executive of Vertex Pharmaceuticals Inc. After the cystic-fibrosis gene was discovered in 1989, it took Vertex until 2012 to get approval for the first drug treating one genetic mutation involved in the disease.

via Obama to Lay Out $215 Million Precision-Medicine Plan – WSJ.

GOP Lawmakers Weigh Contentious Tactic to Dismantle Health Law – WSJ

January 31, 2015

A growing number of congressional Republicans want to use a contentious budget procedure to dismantle the Affordable Care Act, according to senior lawmakers and aides involved in discussions over the strategy.

A final decision could be weeks if not months away, but Republican lawmakers and aides say there is broad enthusiasm for using the process known as reconciliation to try to repeal the 2010 health-care law and potentially replace it with a GOP alternative. Another contender, looking less likely now, is using the process for a tax overhaul.

“There is some skepticism about using it for taxes because we’d actually like to get [a tax deal] with the presidential signature,” Senate Majority Whip John Cornyn (R., Texas) said Thursday.

via GOP Lawmakers Weigh Contentious Tactic to Dismantle Health Law – WSJ.

Tennessee’s Plan to Expand Medicaid Doesn’t Add Up – WSJ

January 31, 2015

Mr. Haslam’s plan would make eligible for Medicaid an additional 400,000 Tennesseans earning about $16,000 a year, as well as an additional 125,000- 150,000 who are already paying for health insurance through their employer. Enrollees would have two options: traditional Medicaid with meager premiums and copays, and a so-called private option under which they would receive a subsidy to pay for insurance through their employer.

Certain provisions in his Medicaid proposal—such as requesting enrollees contribute toward their own coverage and offering premium assistance—have led Mr. Haslam to sell it as “market-driven” and “outcome-based.” Yet, these provisions are already available in the Medicaid program. Despite this free-market gloss, there is nothing fundamentally different between Mr. Haslam’s plan and the type of Medicaid expansion ObamaCare architects envisioned in 2009.

Insure Tennessee faces many of the same pitfalls as any expansion of Medicaid, and includes some additional problems of its own. Here are five important things to know

via Tennessee’s Plan to Expand Medicaid Doesn’t Add Up – WSJ.

Obamacare’s Enrollment Increase: Mainly Due to Medicaid Expansion

January 29, 2015

Third quarter 2014 health insurance enrollment data show continuation of two trends during the first and second quarters—increasing Medicaid enrollment and declining enrollment in employer plans. However, while individual-market enrollment increased substantially in both the first and second quarters, it declined by 357,000 during the third quarter. The net result was 160,000 fewer Americans with health insurance. For the first nine months of 2014, individual-market enrollment grew by 5.83 million, but 4.93 million individuals lost employer coverage—offsetting 85 percent of the individual-market gain. Thus, the net increase in private health insurance for 2014 is so far 893,000 individuals. During the same period, Medicaid enrollment grew by almost 7.49 million. Taken together, the number of Americans with health insurance increased by 8.38 million during the first nine months of 2014, but growth in Medicaid accounted for 89 percent of that gain.

via Obamacare’s Enrollment Increase: Mainly Due to Medicaid Expansion.

Up to Six Million Households to Pay Penalty for Skipping Health Insurance – WSJ

January 29, 2015

The U.S. government estimates as many as six million households may have to pay a penalty for not having had health-insurance coverage last year as required under the Affordable Care Act, officials said Wednesday.

About 150 million taxpayers are expected to file returns during the coming tax season, said Mark Mazur, assistant secretary for tax policy at the Treasury Department. The tax-filing process this year is expected to be trickier because Americans will, in some cases, have to pay a penalty or get smaller refunds because credits they received to offset insurance premiums were too large.

Up to 20% of tax filers—or about 30 million—who weren’t insured for most or any of last year likely will request and receive an exemption from the penalty, officials said. Many exemptions can be applied for during the tax-filing process.

via Up to Six Million Households to Pay Penalty for Skipping Health Insurance – WSJ.

‘Moonshot’ Medicine Will Let Us Down – NYTimes.com

January 29, 2015

But for most common diseases, hundreds of genetic risk variants with small effects have been identified, and it is hard to develop a clear picture of who is really at risk for what. This was actually one of the major and unexpected findings of the Human Genome Project. In the 1990s and early 2000s, it was thought that a few genetic variants would be found to account for a lot of disease risk. But for widespread diseases like diabetes, heart disease and most cancers, no clear genetic story has emerged for a vast majority of cases.

Age, sex, body weight and a few simple blood tests are much better predictors of Type 2 diabetes, for example, than a genetic score based on how many snippets of “risky” DNA you have. And the advice for those at risk to exercise more and eat more healthfully remains the same.

via ‘Moonshot’ Medicine Will Let Us Down – NYTimes.com.

The Goal Was Simplicity; Instead, There’s a Many-Headed Medicaid – NYTimes.com

January 29, 2015

The Affordable Care Act was supposed to simplify Medicaid’s myriad programs across the country to provide a more uniform medical safety net for poor Americans in every state.

It hasn’t worked out that way. In fact, Medicaid programs now vary more widely state to state and even within states than they did before. Some states have scaled back their Medicaid programs, while others have expanded to new groups of people. Among those that have expanded, many are pursuing new policy experiments instead of expanding their existing programs. This may result in confusion — for administrators and clients alike.

via The Goal Was Simplicity; Instead, There’s a Many-Headed Medicaid – NYTimes.com.

3 Problems With Indiana’s Medicaid Expansion

January 29, 2015

It’s official: Indiana has given in and adopted Obamacare’s Medicaid expansion. Before jumping into the weeds of Indiana’s Medicaid expansion agreement with the Obama administration, it is important to realize the agreement still fails some basic principles of reform.

First, it adds more people on to the Medicaid rolls, not fewer. The Indiana plan puts 350,000 more Hoosiers on to the overstretched welfare program. Reform should be grounded in reducing Medicaid dependence, not increasing it.

Second, it requires more government spending, not less. The Indiana plan will increase Medicaid spending by having the federal taxpayers pick up 90 percent of the costs. Again, reforms should aim to reduce government spending, not increase or merely shift it.

Third, it makes the road to repeal of Obamacare harder, not easier. The Indiana plan offers the Obama administration another big gain in expanding Obamacare in the states. Just as the states have clearly rejected Obamacare’s exchanges, states should equally clearly reject this administration’s relentless Medicaid expansion.

via 3 Problems With Indiana’s Medicaid Expansion.