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-- An attorney subscriber
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20 Matching News Items |
| 1. |
Single-Payer Health Care: Opportunities and Vulnerabilities
JAMA Forum 
Mar. 15, 2018
"A bigger government role in the health system could bring down prices, but those prices represent income to hospitals, physicians, and drug companies, which they will fiercely resist reducing. People may not have to pay premiums or anything at the point of service, but they will pay higher taxes. The absence of deductibles or copays would remove financial barriers to accessing needed care but could also result in more unnecessary care."
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| 2. |
ACA: The Health Care Law That Continues to Escape Death
JAMA Forum
Nov. 20, 2017
"On an average daily basis, total sign-ups are up 60% over the start of last year's open enrollment period, and sign-ups among new consumers are up 53%.... One possible explanation for this apparent success is the peculiar math resulting from the termination of cost-sharing subsidy payments to insurers."
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| 3. |
Has Obamacare Become Trumpcare?
JAMA Forum
Aug. 8, 2017
"[O]pen enrollment for the ACA's marketplaces begins November 1, and insurers have to decide by late September whether they will participate. There are a host of actions the administration could take to make it successful. [1] Provide clarity around the rules ... [2] [Maintain] outreach and consumer assistance ... [3] [Encourage] insurers to participate ... [4] [G]ive states flexibility to experiment through Medicaid waivers and ACA waivers under section 1332 of the law."
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| 4. |
Where Does the Health Insurance Premium Dollar Go?
JAMA Forum
Apr. 27, 2017
"Much more troublesome is the 18 cents per premium dollar reported to cover the insurers' 'operating costs.' These include the cost of marketing, determining eligibility, utilization controls ... claims processing, and negotiating fees with each and every physician, hospital, and other health care workers and facilities. These operating costs are about twice as high as are the overhead costs of insurers in simpler health insurance systems in other countries."
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| 5. |
The Partisan Divide on Health Care
JAMA Forum
July 27, 2016
"Now that the party platforms for the 2016 campaign are written and posted online, we can see that Republicans and Democrats are as far apart on health care as they have been for quite some time. Platforms are never implemented as written, and not all candidates endorse every plank in them. However, they signal which issues are important to the parties and, broadly speaking, what candidates aim to do about them."
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| 6. |
Reports of Obamacare's Demise Are Greatly Exaggerated
JAMA Forum
Apr. 28, 2016
"UnitedHealthcare was initially cautious in its participation in the ACA marketplaces, but became more aggressive recently, offering coverage in 34 states in 2016. However, the company's plans were often not competitively priced, with UnitedHealthcare offering 1 of the 2 lowest premium plans in only 35% of the counties where it participated ... The company's inability to compete on price may be because its historical strength has been in the employer-based health insurance market, which values broad networks of doctors and hospitals. In the ACA marketplaces, narrower networks have been a primary way in which insurers keep costs and premiums low."
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| 7. |
Regulatory Attempts to Control 'Surprise' Medical Bills
JAMA Forum
Feb. 3, 2016
"New York's surprise medical bill law is ground-breaking, as much for its approach to resolving payment disputes between insurers and physicians as for its protection of patients. Pennsylvania's insurance commissioner recently proposed a similar approach. A proposed federal regulation would ... [protect] patients in plans offered in the ACA's marketplaces from higher out-of-network cost sharing, but not from balance billing. By excluding protection from balance billing, the federal proposal avoids having to enter the thicket of setting standards for how much out-of-network physicians should be paid."
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| 8. |
Why the Ruckus Over the Cadillac Tax?
JAMA Forum
Oct. 15, 2015
"The tax would no doubt encourage insurers and employers to find efficiencies and negotiate more aggressively with hospitals and clinicians. But market incentives to do that already exist, even if they are somewhat muted by the tax subsidy for employer-provided insurance. It is fanciful to think that premiums can be reduced substantially, and that growth over time can be kept in line with general inflation, without reducing the amount of health benefits provided to workers."
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| 9. |
Hospital Consolidation Isn't the Key to Lowering Costs and Raising Quality
Austin B. Frakt, in JAMA Forum
Nov. 12, 2014
"[L]arger size is neither a necessary nor sufficient condition for hospital systems to trim waste and enhance quality. In fact, studies show that greater competition, not consolidation, is more likely to hold down costs and lead to better care.... Smaller institutions can implement inexpensive but highly effective quality improvements, such as surgical checklists, as well [as] if not better than larger organizations can."
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| 10. |
How Well Is the ACA Working?
Larry Levitt, in the JAMA Forum
July 9, 2014
"[T]here is still plenty that remains unknown about the ACA, and it will take years for the law to fully play out and to get a complete evidence-based reckoning of how it is working.... The preponderance of the evidence, however, suggests that insurance is now more affordable on average than it was before the ACA's implementation ... A large tracking poll from Gallup shows that the percentage of adults who say they are uninsured is down from 17.1% in the fourth quarter of 2013 to 13.4% today."
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| 11. |
The Individual Mandate Penalty May Be Large Enough Over Longer Term
JAMA Forum
Jan. 29, 2013
"Insurers may be correct that the penalties in the first 2 years will be too low, but it is harder to make the case that the fully phased-in penalties will be too low. Our best evidence comes from Massachusetts, where a very similar mandate and penalty scheme have been in place since 2007. Because of these provisions, overall coverage in the state is high (about 96% insured) and the associated degree of adverse selection is very low."
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| 12. |
Changes in Hospital Adverse Events and Patient Outcomes Associated with Private Equity Acquisition
JAMA Health Forum
Dec. 26, 2023
"Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections.... These findings heighten concerns about the implications of private equity on health care delivery."
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| 13. |
Pharmacy Benefit Manager Pricing and Spread Pricing for High-Utilization Generic Drugs
JAMA Health Forum
Oct. 27, 2023
"In 2021, Medicare Part D spent $11.8 billion for 690 million claims ... representing 5.5% of all Part D spending ($216 billion) in 2021. The $22.50 was distributed as follows: $9.18 (40.8%) represents PBM gross profit; $3.87 (17.2%), pharmacy gross profit; $2.71 (12.0%), wholesaler gross profit; and $6.73 (29.9%), manufacturer revenue."
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| 14. |
Comparison of Prices for Commonly Administered Drugs in Employer-Sponsored Insurance Relative to Medicare
JAMA Health Forum
Feb. 15, 2023
"ESI plans paid more than 30 times as much as Medicare per unit of midazolam and more than 20 times as much for ondansetron in 2020. Five other top use drugs had ESI prices more than 200% higher than Medicare prices ... The ESI markups were not clearly associated with the presence of biosimilars or approval year."
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| 15. |
Medical Costs of Substance Use Disorders in the U.S. Employer-Sponsored Insurance Population
U.S. Centers for Disease Control and Prevention [CDC], via JAMA Health Forum
Jan. 24, 2023
"In this economic evaluation of 162 million non-Medicare eligible enrollees with employer-sponsored health insurance in 2018, 2.3 million had an SUD diagnosis. The annual attributable medical expenditure was $15 640 per affected enrollee and $35.3 billion in the population; alcohol-related disorders ($10.2 billion) and opioid-related disorders ($7.3 billion) were the most costly."
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| 16. |
Pharmacy Benefit Managers and the Federal Trade Commission: A Relationship Gone Sour
JAMA Health Forum
Jan. 11, 2023
"On June 7, 2022, the [FTC] announced its decision to launch an inquiry into the business practices of pharmacy benefit managers (PBMs).... This is not ... the first time that the FTC crossed paths with the PBMs. Earlier encounters offer a useful window into the evolving PBM market and the associated policy challenges. This Viewpoint offers a reminder of why PBMs emerged in the first place, why they have amassed such alarming influence, and how they positioned themselves as powerful actors within the prescription drug distribution system."
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| 17. |
Comparison of Estimated 'No Surprises Act' QPAs and Payments to In-Network and Out-of-Network Emergency Medicine Professionals
JAMA Health Forum
Sept. 19, 2022
"In this cross-sectional study of [over 7 million] US commercial insurance claims, mean in-network and out-of-network payments were 14% and 112% higher than [qualified payment amount (QPA)] estimates, respectively. Mean out-of-network payments were higher among self-funded plans than fully insured plans and among physicians vs. nonphysicians."
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| 18. |
The Inflation Reduction Act Is a Foot in the Door for Containing Health Care Costs
Larry Levitt, via JAMA Health Forum
Aug. 25, 2022
"[As] momentous as this legislation is, it goes only so far. Negotiation of drug prices in Medicare will apply initially to a limited number of drugs ... Plus, negotiation does not take effect until well after a drug receives approval from the [FDA] (9 years for small-molecule drugs and 13 years for biological products). Also ... negotiated drug prices will not apply to private insurance plans outside Medicare."
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| 19. |
Assessment of Patient Preferences for Telehealth in Post-Pandemic Health Care
JAMA Health Forum
Feb. 9, 2022
"[M]ost respondents were willing to use video visits in the future but, when presented with the choice between an in-person or a video visit for nonemergency care, most preferred in-person care. Willingness to pay for preferred visit modality was higher for those who preferred in-person care, and those who preferred video visits were more sensitive to out-of-pocket cost."
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| 20. |
Surprise Medical Bills Are Ending, but Controversy Continues
JAMA Health Forum
Jan. 20, 2022
"The main controversy over surprise billing legislation was never over the surprise bills themselves. Rather, the controversy was over determining how much insurers should pay for out-of-network care once patients are held harmless.... [It] is likely that the ban on surprise billing will in fact tilt the scale of market power away from physicians and hospitals and toward the payers of health care."
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