A project of the Galen Institute

Issue: "Quality/Access"

More Plans Setting Spending Limits For Some Medical Services

Michelle Andrews, Kaiser Health News
Tue, 2014-10-21
"Aiming to contain health care costs, a growing number of employers and insurers are adopting a strategy that limits how much they’ll pay for certain medical services such as knee replacements, lab tests and complex imaging. A recent study found that savings from such moves may be modest, however, and some experts question whether “reference pricing,” as it’s called, is good for consumers. The California Public Employees’ Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees and their families, has one of the more established reference pricing systems. More than three years ago, the agency began using reference pricing for elective knee and hip replacements, two common procedures for which hospital prices varied widely without discernible differences in quality, says Ann Boynton, CalPERS’ deputy executive officer for Benefit Programs Policy and Planning."

Ask Your Doctor About Obama's Affordable Care Act

Jason Fodeman
Investors.com
Mon, 2014-10-20
"You shouldn't judge the Affordable Care Act based on headlines or by listening to politicians or talking heads. I tried for a while, but only heard wildly conflicting stories that seemed to have little basis in reality. Instead, you should ask someone who actually deals with the law on a daily basis — a doctor, for instance. The Physicians Foundation did exactly that in its "2014 Survey of American Physicians," which was released last month. The survey, which reached over 80% of doctors in the U.S. and elicited responses from some 20,000, is doctors' collective report card on the Affordable Care Act's first four years. The grades aren't good. Only 25% of doctors give it an "A" or a "B" grade. Nearly half ( 46%) give it a "D" or an "F""

Why doctors give Obamacare a failing grade

Jeffrey Singer
The Hill
Sun, 2014-10-19
"The Physicians Foundation made shockwaves last month when it released its 2014 Survey of America’s Physicians. The survey’s top-line finding: Of the 20,000 doctors surveyed, almost 50 percent stated that Obamacare deserves either a “D” or an “F.” Only a quarter of physicians graded it as either an “A” or a “B.” Count me among the discontented. Obamacare has harmed too many of my patients. It has done so by disrupting the doctor-patient relationship and thereby worsening the quality of patients’ care. This is the heart and soul of medicine, as I have learned in in my 33 years as a practicing physician. The doctor-patient relationship is critical for positive health outcomes because it allows both parties to work together to identify and ultimately treat medical problems. Simply put, a relationship of trust and continuity is essential to our professional mission."

4 Rules for Replacing Obamacare

James Capretta and Lanhee Chen
Poilitico
Fri, 2014-10-17
"Republicans are in a strong position as the midterm election approaches. They are nearly certain to retain control of the House of Representatives in the next Congress and may pick up a few seats to add to their majority. They are also poised to make gains in the Senate, perhaps even adding the six seats necessary to take control of the upper chamber—and maybe more. The mere possibility of full Republican control of Congress in 2015 is leading some to wonder what Republicans would do if they found themselves in such a position come January."

Big jump for PreferredOne premiums

Christopher Snowbeck, Minneapolis Star-Tribune
Fri, 2014-10-17
"Sticker shock awaits thousands of people with health coverage through PreferredOne, the top seller on the MNsure exchange during its first year. The Golden Valley-based insurer said Wednesday that its individual market subscribers will see an average premium increase next year of 63 percent due to high claims costs. “Given the volatility of the individual marketplace due to the first year of the [federal health law], this increase is a significant step at stabilizing our rates and plans for the years to come,” the company said in a statement."

Mars and Venus on Medicaid

John Graham
Forbes
Thu, 2014-10-16
"I will be covering Medicaid Health Plans of America’s annual conference in Washington, DC from October 26 to 28. So, I thought I’d prepare for it by reviewing the research on health outcomes for patients on Medicaid. What a tangled web! According to evidence cited by Forbes opinion editor and Manhattan Institute Senior Fellow Avik Roy, “patients on Medicaid have the worst health outcomes of any insurance program in America – far worse that those with private insurance and, strikingly, no better than those with no insurance at all. “ On March 10, 2011, the Wall Street Journal published a column by Forbes contributor and American Enterprise Institute Resident Fellow Scott Gottlieb, MD, which concluded that “Medicaid coverage is worse than no coverage at all.”"

Utah Gov Gary Herbert's Obamacare Expansion Won't Work -- And Neither Will Its Enrollees

Jonathan Ingram, Nic Horton and Josh Archambault
Forbes
Thu, 2014-10-16
"The Obama administration and liberal activists hope that Gov. Gary Herbert (R-UT) will be the next governor lured into Obamacare expansion on the false promise of flexibility and free money. Herbert says he is nearing the end of negotiations with the federal government and wants to call a special session for the legislature to sign off on the Obamacare expansion plan. Unfortunately, most of the details of the plan remain a mystery. He’s given a few snippets of information here and there, but has thus far not released a detailed proposal. Utah is often seen as a national leader for its values of helping individuals help themselves. Yet, Medicaid expansion undermines that very value system. Governor Herbert’s Obamacare expansion efforts are disappointing for the many unintended consequences that will follow in the state, and in light of his very strong position against Obamacare in the past.

Will Obamacare's State Exchanges Be Ready for Year 2?

Briana Ehley
Fiscal Times
Thu, 2014-10-16
"With just one month to go until the start of Obamacare’s second open enrollment period, state and federal officials are being cautiously optimistic about their health exchange websites—assuring the public that there won’t be a repeat of last year’s technological nightmare.Speaking to health reporters last week, Health and Human Services Secretary Sylvia Burwell touted the newly revamped Healthcare.gov as a vast improvement over last year’s website—which was plagued with technical glitches.Related: Millions Wasted on Broken Obamacare State WebsitesBut when asked about how some of state exchanges that had trouble last year are shaping up, Burwell hesitated and said HHS is monitoring them on a state-by-state basis."

Administration Signals Doubts About Calculator Permitting Plans Without Hospital Benefits

Jay Hancock
Kaiser Health News
Thu, 2014-10-16
"Insurance consultants were shocked recently to learn that Obama administration rules allow large companies to offer 2015 worker health plans that don’t include hospital benefits. Now the administration is concerned too. Treasury Department officials are preparing to reverse course on an official calculator that permits plans without hospital coverage to pass the health law’s strictest standard for large employers, said industry lawyers who have spoken to them. These sources expect the administration to disallow such coverage by the end of the year."

A maze to opt out of Obamacare individual mandate

Thu, 2014-10-16
"There are dozens of ways to escape Obamacare’s individual mandate tax — but good luck figuring that out come tax season. Tens of millions of Americans can avoid the fee if they qualify for exemptions like hardship or living in poverty, but the convoluted process has some experts worried individuals will be tripped up by lost paperwork, the need to verify information with multiple sources and long delays that extend beyond tax season. “It’s not going to be pretty,” said George Brandes, vice president of health care programs at Jackson Hewitt, a tax prep firm. “Just because you theoretically qualify for hardship, or another exemption, doesn’t mean you’re going to get it.”"

ObamaCare Watch Weekly

* indicates required

View previous campaigns.

Check out Jim Capretta's new book.

ObamaCare Primer