Monthly Archive: July 2017

Health in the U.S. and other rich countries: We pay more in health care but are sicker.

Our health depends on much more than just medical care. Behaviors such as diet, physical activity, and even how fast we drive all have profound effects. So do the environments that expose us to health risks or discourage healthy living, as well as social determinants of health, such as education, income, and poverty.

Source: Health in the U.S. and other rich countries: We pay more in health care but are sicker.

It’s unfortunate that “health care” has been equated with medical care. Health care isn’t medical care. As this article notes, health is what we give to ourselves and support each other in obtaining in order to avoid medical care and to ensure optimal population health status. Good health care makes for less medical care utilization– a big cost driver as the United States grapples with the growing tab of paying for medical care.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Majority Republicans lack votes, time to reform ACA, Medicaid via reconciliation bill

The dispute within the Republican Party over health care widened further Friday as President Trump joined with two conservative senators in calling for an outright repeal of the Affordable Care Act if the party fails to agree on an alternative plan by the end of the July Fourth recess. The reemergence of what has for much of the year been a fringe idea within the GOP revealed not only the party’s philosophical divide over how to revise Obamacare, but also senators’ growing anxiety that they are headed home to see their constituents with little to show them.

Source: Republicans grow increasingly anxious about heading home without a health plan – The Washington Post

The Republicans are back to square one of their years long challenge of repealing the Patient Protection and Affordable Care Act without any Democratic votes. It’s an exercise in the Einsteinian definition of insanity as doing the same thing over and over and expecting a different result. For example, see this article Republicans Divided on Replacement Legislation for Health Reform Law  — from May 1, 2012.

Majority Republicans must understand the limits of their policymaking power. Repeal or a rewrite of the enormous 10 title Affordable Care Act will require bipartisan cooperation and far more time than the remaining three months of the current fiscal year via a budget reconciliation measure that constrains major policy changes under the Byrd Rule. They also are facing strong blowback from constituents worried that attempting rapid and far reaching reform using the budget reconciliation process — including overhauling the five-decade-old Medicaid program — will disrupt their access to medical care.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Deficient economies of scale challenge Nevada non-group market

The scarcity of doctors and medical facilities in vast, thinly populated areas can mean higher costs to insurers. But Nye County, which borders Las Vegas’ Clark County, is one of the state’s largest rural counties — and all four companies will participate there. “It is puzzling to me how carriers are ensuring full county coverage to Nevada’s neighboring states, yet are at a potential loss about how to offer insurance for all but three of Nevada’s counties,” Sandoval wrote the same executives earlier this week. He told them that leaving the exchange vacant in 14 counties will set back years of work to nearly halve Nevada’s uninsured rate.

Source: Governor insists execs work to keep rural Nevadans insured | Charlotte Observer

Nevada Gov. Brian Sandoval is confronting a challenge facing the non-group medical insurance market in states where there are too few patients and providers to make for a viable insurance market. Coverage goes hand in hand with provider networks since without enough providers, coverage isn’t useful. Factoring in overhead, it’s no wonder plan issuers aren’t interested in playing, particularly facing the possible loss of cost sharing subsidies for exchange silver plans.

Even though the Patient Protection and Affordable Care Act pooled entire state non-group populations into a single statewide risk pool, provider networks are by definition local. In less populous areas, it’s possible only statewide integrated payer and provider plans are going to work. Federally Qualified Health Centers may also have to play a larger role in providing primary care in these areas, with the plans covering costlier services provided in more populated parts of a state.

Telemedicine can also play a role in access to consultations with distant specialists and post hospital discharge patient monitoring. But it requires robust advanced telecommunications infrastructure that is typically lacking in less densely populated areas. Here too, the federal government can play a constructive role in financing its construction in areas passed over by private sector providers.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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