NBER: Addressing the Opiod Epidemic: Is There a Role for Physician Education?

August 8, 2017

We find that where a doctor received his/her initial training matters in terms of predicting how likely they are to prescribe opioids: physicians trained at the lowest ranked US medical schools prescribe nearly three times as many opioids per year as physicians trained at the top medical school. This striking inverse relationship reflects two factors: (1) physicians from lower ranked medical schools are more likely to write any opioid prescriptions; and (2) conditional on being an opioid prescriber, physicians for lower ranked medical schools write more opioid prescriptions on average. This prescribing gradient is particularly pronounced among GPs. Our results demonstrate that if all GPs prescribed like those from the top ranked school, we would
have had 56.5% fewer opioid prescriptions and 8.5% fewer deaths over the period 2006 to 2014.

Full text: http://www.nber.org/papers/w23645.pdf

Much of Rural Nevada Left With Zero ObamaCare Options in 2018 | Fox News Insider

August 8, 2017

Anthem announced it will back out of Nevada’s ObamaCare market next year, leaving most rural Nevada counties without a single ObamaCare insurer in 2018.

The insurance company also plans to cut its Georgia presence in half, and has already withdrawn from Ohio, Indiana, Wisconsin, and much of California.

“This is a significant blow to the state’s individual market,” Nevada Gov. Brian Sandoval (R) said in a statement. He added that he is “frustrated and disappointed” by Anthem’s “surprise and abrupt decision to leave the healthcare exchange.”

As many as 868,000 people nationally could lose coverage next year if the insurance companies planning to leave the Affordable Care Act markets do so. Seventeen counties nationally, 14 of them in Nevada will completely lose options in the Affordable Care Act next year.

Source: Much of Rural Nevada Left With Zero ObamaCare Options in 2018 | Fox News Insider

The Republicans’ Budget Mess | RealClearPolicy

August 4, 2017

On health care, the president has made it clear that he does not care what is in a bill to repeal and replace Obamacare, so long as he can say he achieved that goal. At various points, he was for the House repeal-and-replace plan, for the clean “repeal-and-delay” bill that Republicans passed in 2015, and for Senator Mitch McConnell’s last-ditch “skinny repeal” plan, which really was just a repeal of the tax penalties enforcing the Affordable Care Act’s individual mandate. When the Senate bill failed last week, it was clear that even if a bill did ever emerge from a House-Senate conference, it couldn’t pass in the Senate with major Medicaid reforms or with any real replacement of the major subsidy provisions of the ACA. Republicans are now saying “we were so close” to achieving victory, but the “skinny repeal” plan was the only thing that came close. And that shows the GOP is not, in fact, close to agreement on a workable plan to replace the ACA.

Source: The Republicans’ Budget Mess | RealClearPolicy

Why 2018 could lead to more Medicaid expansion – Axios

August 4, 2017

It’s never too early to start thinking about the upcoming 2018 elections. And while a lot of the focus so far has been on the House, a handful of hotly contested gubernatorial races could have higher stakes for health care — specifically, for the Affordable Care Act’s Medicaid expansion.

A raft of open governors’ races next year will give Democrats a chance to replace some of the most stridently anti-expansion governors in the country — and, if they win even a few of those races, the chance to cover millions of currently uninsured people even as the Trump administration drags its heels on so much of the ACA.

Source: Why 2018 could lead to more Medicaid expansion – Axios

NIHCM – After Changing Insurance Carriers, Do Patients Change Physicians and Use Emergency Departments More?

August 1, 2017

What This Study Found

  • Visits to new primary care physicians (PCPs) increased significantly for patients changing insurers relative to patients staying with the same insurer.
  • For patients initially covered by Medicaid, the monthly rate of visits to new PCPs increased by an average of more than 200 percent after changing insurers, and their rate of visits to new specialists rose by almost 50 percent.
  • For patients initially covered by private insurance, changing carriers was associated with a nearly 50 percent increase in new PCP visits while visits to new specialists fell slightly. The overall decline in new specialist visits was caused by lower use among patients who faced higher deductibles after changing plans.
  • These average utilization changes reflected larger changes in use shortly after the insurance switch that diminished over the subsequent year.
  • The rate of ED visits increased significantly for Medicaid patients in the month of their insurance transition, relative to levels seen in the four to twelve months before the transition, but quickly returned to baseline levels.

Source: NIHCM – After Changing Insurance Carriers, Do Patients Change Physicians and Use Emergency Departments More?

President Trump Now Fully Justified In Cutting Off Illegal Cost Sharing Reduction Payments

August 1, 2017

As rightly determined by federal district judge Rosemary Collyer back in May of 2016 in a strong 38-page opinion, the payments by President Obama (and President Trump) were and are illegal.  Insurers receiving them have effectively been receiving stolen funds. The Constitution prohibits drawing any money from the Treasury except “in Consequence of Appropriations made by Law.” Congress has enacted various statutes making it a crime to pay money from the United States Treasury for which no appropriation exists.  It’s real simple. Congress never appropriated any money for this program. And the efforts to twist other appropriations into CSR appropriations are, as even some ACA supporters have the courage to admit, pretty lame. This is why Judge Collyer actually enjoined the payments from being made, although she had enough modesty to hold off activating the injunction until there was time to resolve an appeal. That appeal has been pending, now, for more than a year, without any action being taken.

Source: President Trump Now Fully Justified In Cutting Off Illegal Cost Sharing Reduction Payments

Trump Killed Obamacare Repeal | National Review

August 1, 2017

There are a lot of reasons the GOP failed, but the most important was the lack of a president who knew what he was doing.

Source: Trump Killed Obamacare Repeal | National Review