Today's News and Commentary

About health insurance

Trump administration plans to delay any changes if the ACA loses in court: “The Trump administration, with no viable plan for replacing critical health benefits for millions of Americans, plans to seek a stay if a federal appeals court invalidates all or part of the Affordable Care Act in the coming weeks — and may try to delay a potential Supreme Court hearing on the matter until after the 2020 presidential election, according to current and former administration officials.”

Pre-Existing Condition Prevalence for Individuals and Families: If the ACA is entirely invalidated, the provision that prohibits exclusion of pre-existing conditions will be eliminated. This Kaiser Family Foundation study estimates how many people could be turned away when they apply for insurance.
”Consistent with our previous analysis, we estimate that 27% of nonelderly adults have a declinable health condition, which is about 53.8 million people in 2018. We further estimate that 45% of nonelderly families have at least one nonelderly adult member with a declinable health condition. Finally, we update our state-based estimates of the prevalence of declinable pre-existing conditions with the most current data available, showing that the share of non-elderly adults with pre-existing conditions ranges from 22% in Colorado to 37% in West Virginia.”

Private equity has inflated US medical bills (Financial Times- subscription required): The thesis of this article and the referenced research paper is that private equity investments in physician practices have led to increased billing, including so-called “surprise medical bills.”

About the public’s health

Waste in the US Health Care System Estimated Costs and Potential for Savings: Authors of this research looked at the literature on waste in the US healthcare system and focused on: failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud and abuse, and administrative complexity. The conclusion was that “the estimated cost of waste in the US health care system ranged from $760 billion to $935 billion, accounting for approximately 25% of total health care spending, and the projected potential savings from interventions that reduce waste, excluding savings from administrative complexity, ranged from $191 billion to $282 billion, representing a potential 25% reduction in the total cost of waste.” See Table 2 for estimates by domain. See also the excellent editorial analysis.

Trump issues proclamation to deny visas to immigrants who can't pay for health care: The headline speaks for itself.

Australia Just Had a Bad Flu Season. That May Be a Warning for the U.S.(NY Times- subscription required): Based on the earlier appearance of influenza in Australia this year, the director of the influenza division of the Centers for Disease Control and Prevention said . “…the best move is to get the vaccine right now.” Check the CDC website for more detailed recommendations.

Scientist Who Discredited Meat Guidelines Didn’t Report Past Food Industry Ties (NY Times- subscription required): The lead author in this study had ties to the food industry that should have been reported. The technicality is that the ties fell just outside of the time period for which he was questioned. The authors still claim their conclusions were valid, i.e., meat consumption has not been proven to have deleterious health consequences.

Potentially preventable intensive care unit admissions in the United States, 2006 - 2015: Recall that costs of care are a function of price volume and intensity. This article deals with the latter feature. This research found that an “appreciable proportion of US ICU admissions may be preventable with community-based interventions. Investment in the outpatient infrastructure required to prevent these ICU admissions should be considered as a complementary, if not alternative, strategy to expanding ICU capacity to meet future demand.”

Healthcare mergers and acquisitions

10 healthcare deals that made headlines this year: Not all of these combinations succeeded. Each one had its unique set of circumstances and warrant their own case study discussions.