Jan. 19: Health market reforms and the ACA

Jan. 19: Health market reforms and the ACA

Primary care is a time-tested, effective means to reduce the prevalence and severity of chronic disease.

Primary care is a time-tested, effective means to reduce the prevalence and severity of chronic disease. But investing in such care has not been a priority in our healthcare system, which has heavily valued specialty doctors and emergency treatments. The Affordable Care Act included provisions for people to have more access to routine preventive care, but the results of those investments won’t show up in improved health outcomes for another few years. The New Yorker’s Atul Gawande says the security of access to routine care, especially for the 27 percent of adults whose pre-existing conditions may deem them uninsurable with an ACA repeal, is reason enough to defend the law.


In the next few months, the worry is whether (Gawande’s son, who has a congenital heart condition) Walker and others like him will be able to have healthcare coverage of any kind. His heart condition makes him, essentially, uninsurable. Until he’s twenty-six, he can stay on our family policy. But after that? In the work he’s done in his field, he’s had the status of a freelancer. Without the Affordable Care Act’s protections requiring all insurers to provide coverage to people regardless of their health history and at the same price as others their age, he’d be unable to find health insurance. Republican replacement plans threaten to weaken or drop these requirements, and leave no meaningful solution for people like him. And data indicate that twenty-seven per cent of adults under sixty-five are like him, with past health conditions that make them uninsurable without the protections.


The ACA eliminated lifetime limits from all health plans, meaning insurers can’t stop paying for an enrollee’s health care expenses after they use a certain dollar amount of services over the life of the policy, a common practice before health reform. These lifetime limits routinely wrecked family finances. This protection is another one of the ACA’s keystones, benefitting people with employer-sponsored and public health insurance alike. Lauren Adler and Paul Ginsburg write for the Brookings Institution:


In crafting a replacement or reforms to the Affordable Care Act, lawmakers should maintain the law’s requirements that plans include an annual out-of-pocket limit and no lifetime limit on benefits in order to provide protection against catastrophic health costs. Otherwise, many with employer-provided or individual market health insurance could see these important safeguards disappear.


“Catastrophic cuts” predicted if rainy-day fund not tapped

A looming special session is unpopular with some lawmakers who believe that Gov. John Bel Edwards has can plug the mid-year gap on his own without calling lawmakers into session. Tapping into the $119 million of revenue available from the state’s rainy-day fund to soften the blow of $304 million in cuts is being met with chatter of resistance among some in the GOP ranks, though they have not released a formal position. Julia O’Donoghue has the latest for NOLA.com/The Times-Picayune:


(Commissioner of Administration Jay) Dardenne said House Republicans won’t be pleased with the other options. Without rainy day fund money, the state would be forced to make “catastrophic cuts” to higher education, hospitals and services for disabled people, he said. Reductions would also be necessary in prisons and in the agency that oversees child protective services and foster care, where Edwards has tried to avoid further reductions. The governor has said he doesn’t think child protective services and prisons can withstand another round of spending reductions without causing problems for public safety.


Gateway to the middle class

It’s no secret that a strong education is the key to lifting families out of poverty and into the middle class. A new study, released this week, shows the critical role played by less-than-elite academic institutions that attract disproportionate numbers of students from low-income backgrounds. In New York City, for example, three-fourths of students who entered City College in the 1990s and hailed from the bottom fifth of the income distribution have made their way to the upper 60 percent. The numbers are similar elsewhere, including at Xavier University in New Orleans. The New York Times’ David Leonhart reports:  


I’ll admit that the new data surprised me. Years of reporting on higher education left me focused on the many problems at colleges that enroll large numbers of poor and middle-class students. Those problems are real: The new study — by a team of economists led by Raj Chetty of Stanford — shows that many colleges indeed fail to serve their students well. Dropout rates are high, saddling students with debt but no degree. For-profit colleges perform the worst, and a significant number of public colleges also struggle. Even at the strong performers, too many students fall by the wayside. Improving higher education should be a national priority. But the success stories are real, too, and they’re fairly common. As I thought about the new findings in light of the other evidence pointing to the value of education, they became less surprising


Price prioritizes physician profits

Donald Trump’s choice to lead the U.S. Department of Health and Human Services, Rep. Tom Price of Georgia, is charged with developing a comprehensive Obamacare replacement that he promised will “beautifully cover everyone” who gained insurance since 2010. But as a third-generation physician, and a lawmaker for 20 years, Price has relentlessly fought to limit healthcare safety net programs, even as nearly 1 in 5 of his fellow Georgians were forced to forego life-saving care. Noam Levey has more in the Los Angeles Times.


According to several of Price’s former medical colleagues, his view reflects a long-standing frustration with limits that insurance programs such as Medicare and Medicaid put on doctors. “He values physician autonomy and having the patient at the center of care,” said Dr. Steven Walsh, an anesthesiologist who began practicing alongside Price more than 30 years ago at …a quiet, …community hospital in Roswell, Ga., where Price still lives. Many of Price’s former colleagues… recalled Price’s extensive efforts to help doctors by limiting malpractice awards, requiring that they are promptly paid and restricting what medical services can be performed by nurses and others without a medical degree. Many physicians are frustrated by the growing list of requirements from insurance programs, including that they report patient outcomes, track costs and use approved electronic record systems. Price’s reaction has been to consistently try to scale back the programs.

Number of the Day

16– number of times LSU’s budget has been cut in the past nine years (Source: LSU President F. King Alexander via Greater Baton Rouge Business Report)