About insurance
Dems unveil plan to build up ObamaCare as Trump steps up attacks: Continuing commentary on yesterday’s top story, Democrats announced their plans to shore up the ACA in the face of the Justice Department’s plan to support legal action to nullify the entire law. The plan focuses on 1) abolishing “skinny plans, ” which offer fewer benefits at lower prices and 2) adding financial support in the forms of tax credits for more people to offset premium costs. (The skinny benefit plans are just another way of excluding people with high cost, pre-existing conditions.) Those two measure could be accomplished within existing laws. Another part of the Democratic proposal is reinstating support for out of pocket expenses. That action is more problematic since it was never part of the ACA and would require Congressional action to allocate funds for that purpose.
All this talk is moot, however, since the Republican Senate is not likely to pass Democratically-sponsored legislation.
What Happens if Obamacare Is Struck Down? .Because the ACA touches so many areas, the answer to the title’s question is complex. This article is a great summary of the consequences if the ACA goes away.
Read the article (NY Times but appears to be open access)
Centene and WellCare to Combine to Create a Premier Healthcare Enterprise Focused on Government-Sponsored Healthcare Programs: Just when you thought the insurance market was taking a breather, the consolidation continues.
Stanford Health Care Joins Sutter Health | Aetna Network: Network expansion is also continuing- even in California.
Medacta, Geisinger pilot program to cover all future costs for plan members with knee replacement: This venture is a real breakthrough in quality guarantees for payers. Usually these guarantees on healthcare products have covered replacement of the product itself (in cases of devices) and/or costs the patient incurred because of the failure (for medications). This venture will also cover the hospital replacement costs which insurance companies have to pay. The catch is the patient must be part of Geisinger health plan and have services through Geisinger providers.
How is Value-Based Care Changing Cancer Treatment Decisions?: Value-based payments are in effect or being proposed across the healthcare field. This survey (displayed in nice graphical form) provides oncologists’ opinions about this payment method. The biggest obstacle, no surprise, is pharmaceutical costs. The only way to craft reasonable bundles of care is in an environment of relatively stable prices. With many new treatments and modalities coming to market, such methods are not possible.
Read the survey results
About the public’s health
New York county, declaring emergency over measles, seeks to ban unvaccinated from public places: Unvaccinated children are kept away from school as the method of enforcing public health measures. In the wake of 153 cases of measles in Rockland County, NY, a 30-day state of emergency has been declared that bans unvaccinated children from all enclosed public places, including schools, houses of worship, and shopping malls. Enforcement may be difficult but officials see the action as sending a serious public message about the importance of vaccinations.
FDA proposes mammography rule to provide women with breast-density information: Women with dense breast tissue often have problems getting accurately read mammograms. The fault lies with the limits of the technology, which can either miss cancerous tissue or falsely give the impression of an abnormality. The FDA is proposing a rule that would require “mammogram providers to notify women with dense breasts about how the condition could affect the accuracy of their mammograms and recommend they talk with their doctors about whether they should have additional tests to check for cancer.”
Read the article (Washington Post but appears to be open access)
Debate about birth of new neurons in adult brains extends to Alzheimer’s disease: As the population ages, Alzheimer’s disease has become a public health issue- to afflicted individuals as well as the family and caregivers. Treatments have focused on preventing or reversing the accumulation of proteins in nerve cells that are the hallmark of the disease.
This new research provides another possible route of attack. It was formerly thought that new brain cells cease to form at a young age. It has now been found that adults who normally age will continue to produce new cells in the hippocampus (though at declining rates). But new formation is markedly reduced in people who are developing and who have fully developed Alzheimer’s disease. Perhaps focusing on this abnormality will hold greater promise for prevention and cure of this devastating condition.
Read the article (This article is an editorial in Nature and is open access. The original research is by subscription)
About pharma
Purdue agrees to pay $270 million to Oklahoma to resolve OxyContin lawsuit: In the ongoing story about the origins of the opioid epidemic, the manufacturer of OxyContin has agreed to pay the state of Oklahoma to settle a suit over its role in promoting use of these drugs. It will undoubtedly be the first of such payments to governmental entities and individuals.
Dignity Health and Shields Health Solutions Bring Affordable Medication and Services to Patients with Complex Chronic Illnesses: Pharma costs and availability have caused hospital coalitions to manufacture their own generic drugs. But high costs are really driven by specialty pharmaceuticals. So Dignity Health is partnering with a specialty drug company to get a handle on costs and continuity of care. The center of these activities will be a hospital-based specialty pharmacy at Dignity Health‘s St. Joseph’s Hospital and Medical Center in Phoenix, which will support all of the system’s locations. [Dignity Health and Catholic Health Initiatives have recently united as one ministry: CommonSpirit Health™.]
White House, Pelosi in talks on drug pricing legislation: One issue that has bipartisan support is addressing high drug costs.
Read the article
About devices
Device-Safety Experts To FDA: Make Data Public: This article is an update on a previous story in this blog. Many safety device failures have not been made available to the public because of an alternative reporting pathway in the FDA. Read the story for a good refresher on this issue and what is proposed to remedy the problem.