By ALLISON BOWLES

Now I have insurance. But I can’t use it. What am I supposed to do? I know this one is long but it’s worth a read if you want to understand issues pertinent to the Affordable Care Act. My personal story illustrates many of the problems with the ACA.

I started taking notes on the Health and Human Services Secretary hearing, and I will share more as I scrutinize the hearing in more detail but let’s start with the breakdowns below and my experience with Obamacare.  Here goes:

These are the breakdowns of who gets what coverage in the United States:

Medicare 18% – 52m

Employer 61% – 178m

Medicaid 22% – 62m

Individual 6% – 18m (exchanges cover 4% of the 6%–these are the people who have been forced onto the Obamacare plans)

Note: this writer is in the BOTTOM of the barrel here (Individual). Most of the individuals in the “Individual” category are either the upper contingent of the working poor, those who work for small businesses like restaurants or family owned grocery stores and the like that don’t provide health insurance benefits (more and more common these days), and/or sole proprietors like myself. Many health care providers are self employed hence we have been forced into the Obamacare exchanges if we are not high earners. High earners won’t buy on the marketplace and will purchase individual plans outside of the marketplace.

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By COURTNEY GILDENGIL and LAURA FAHERTY

On January 10^th, then-President-elect Donald Trump met with Robert F. Kennedy Jr., a vocal skeptic of vaccine safety. Although the details and implications of the session are still unclear, the meeting and several of Trump’s tweets have raised questions among public health experts who wonder what, if anything, Trump might do on the issue as president. A chorus of celebrities and politicians continue to question vaccine safety and propagate a myth linking vaccines and autism, fueled by a fraudulent 1998 article by Dr. Andrew Wakefield that was later retracted.

In 2014, RAND undertook a rigorous and independent systematic review of vaccine safety for all populations, including pregnant women and children. From our review we found that while some vaccines are associated with serious side effects, these events are rare and are far outweighed by the benefits of vaccination. For example, we found evidence that the combined measles, mumps, and rubella (MMR) vaccine is associated with febrile seizures, which are seizures or convulsions that occur when a child has a high fever. But while these seizures are certainly unpleasant and can be frightening for parents to witness, there is no evidence that they cause any long-term harm to children.

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 By YEUNG, MAY and TRUJILLO

How can we gauge whether America is prioritizing health and well-being? Since public attitudes toward health-related topics are widely shared on social media, we gazed into the mirror that is Twitter and tried to answer that question by sifting through 32 million health-related tweets, one of the largest social media samples ever collected for health research.

Posts and conversations on Twitter have the potential to shed light on the public’s views about a seemingly endless array of health-related topics—obesity, exercise and fitness, safe sex, alcohol use, medication adherence and mental health. Accordingly, researchers have turned to social media to better understand these topics.Continue reading…

By ANDY ORAM

Behind many of the economic and political tensions of our time lurks the growing burden of health care costs. Does that claim sound inflated? Consider: when the public complains of stagnating wages, we can put our finger on health care costs as the monster that gobbles up employee compensation. When economists fret over the future burden of Social Security and Medicare (a cry echoed across the world as populations age), we have to recognize the scourge of increased health care costs. Most of the current debates over the Affordable Care Act–a recurring issue during the presidential campaign–touch explicity or implicity on health care costs.

The upward curve in costs became less of a run-away trend during the recession. Although the ACA might take a bit of the credit, most observers attribute the softening of the cost rises to belt-tightening by patients, and perhaps also to lower inflation. Inexorably, though, costs do rise. Small businesses and people on individual plans suffer most–a burden for which the ACA is not responsible, but that it brought to public attention–and the rest of us are bedeviled by rising premiums and deductibles as well. A study found spending increases across the board in 2015 by individual households, businesses, and governments alike. A number of people give up on health insurance because it’s still too expensive and does not end up covering their needs.

Insurers are suffering too, which is why even major companies such as Blue Cross and UnitedHealth are abandoning some markets.

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By DAVID INTROCASO

An elderly patient presents to a physician with symptoms of pneumonia. The physician ignores accepted medical standards of care and chooses to believe the patient suffers from a cold or flu. The patient dies of pneumonia. What evidence informs our beliefs, or how we arrive at our beliefs, is as important as what they are.

In 1877 a Cambridge mathematician and philosopher, William Kingdon Clifford, published an essay titled, “The Ethics of Belief.” 1 In it, Clifford imagined a ship owner “about to send to sea an emigrant ship” that he knew “was old, and not overwell built at the first.” Knowing the ship had possibly become unseaworthy, he realized he ought he to have “her thoroughly overhauled and refitted.” Despite this knowledge, the ship owner succeeds in convincing himself that since the ship had “gone safely through so many voyages and weathered so many storms” it would do so again. If the ship goes “down in mid-ocean and told no tales” what, Clifford asked, shall we say of the owner? “Surely this, that he was verily guilty of the death of those men.” Though the ship owner may have come to believe in the soundness of his ship, “the sincerity of his conviction can in no wise help him,” because the owner, “had no right to believe on such evidence was before him.” “He had acquired his belief not by honestly earning it in patient investigation,” but by “stifling his doubts.”

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By NIRAN AL-AGBA, MD

The Mylan EpiPen debacle may have inadvertently weakened the grip Big Pharma on U.S. lawmakers.  Last week, a bill proposed by Senator Bernie Sanders was narrowly rejected by a vote of 52-46.  Unexpectedly, 12 Republicans and 1 Independent voted with Senator Sanders in favor of allowing pharmacists and distributors to import cheaper prescription drugs from Canada and other foreign countries (something typically favored by Democrats.)  The winds of change are starting to blow in the bipartisan direction when it comes to the pharmaceutical industry.    

U.S. Healthcare needs a revolution ; ‘the shot heard round the world’ often refers to the opening shots of the American Revolution in 1775.  The Big Pharma lobby is holding the American people hostage with their exorbitant ransom demands.  Last summer, Mylan Pharmaceuticals, led by CEO Heather Bresch, overplayed their hand.  Mylan came under fire for a 400% price increase in the EpiPen two-pack.  This device is considered life-saving for children and adults with anaphylactic reactions to various food, insect, or environmental insults.  Ms. Bresch insisted the significant price increase ($600-$700 for a medication which costs pennies) was justified due to the more ergonomic appearance of the delivery device and improved safety profile.  Her miscalculation seems to have indirectly incited the war on Big Pharma by angering the public, the media, and the government simultaneously. 

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By ROBERT LASZEWSKI

On Friday night the administration issued an executive order giving Trump administration appointees enormous flexibility in modifying how the Obamacare individual health insurance market works.

Specifically, President Trump has given his administration the power “to waive, defer, grant exemptions from or delay the implementation of any provision or requirement of [Obamacare].”

The administration has not been clear about just exactly what it is they now want to do.

Their action raises a basic question: Why grant this flexibility if it is not their intent to materially change the way Obamacare works in the individual health insurance market?

Every Republican I know of thinks that Obamacare is failing and unstable––particularly because the plans it offers consumers are especially unattractive to working class and middle class people who can only buy individual health insurance that complies with Obamacare rules. Maybe some of these Republicans know this because that is what I have been saying for three years.

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By MARGALIT GUR-ARIE

It has come to pass. President Donald J. Trump. Are you scared? Are you planning to “resist” the policies you imagine President Trump will pursue by tweeting furiously with clever hashtags galore? Would you prefer to move my fastidious quotation marks from “resist” to “President”? This is after all, the first President in a very long time to take office without the blessings and financial support of established “world order” leaders. It must be rather disconcerting to proceed without clear guidance from our betters, especially seeing how well they served us over the last decades, and particularly when it comes to affordability of health care in America.

Are you binge-watching the Obamacare drama playing on America’s center stage these days? Are you tweeting and retweeting every shred of information that proves Obamacare is a huge success, and its repeal will mean certain death for millions? Or are you busy proclaiming your faith in free markets, the (undemocratic) government of Singapore, or the charitable nature of Americans in general and doctors in particular?  Is President Obama your tragic hero, or your shifty villain? Is President Trump your great liberator (although he promised not to do anything you really want), or the Grinch who will steal health care (although he promised to preserve everything you really like)? Are you not entertained? Pass the bread, please.

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President Trump and Obamacare

By SAURABH JHA, MD

Healthcare reformers, like the wives of King Henry the 8th, have a thankless job. In a curious inversion of the Tudors, President Trump, who has promised to make healthcare great again, finds himself in the same predicament as the King’s sixth wife who knew what she had to do, just didn’t know how she could do it any differently. Dr. Mark V. Pauly (MVP), Professor of Economics at the University of Pennsylvania, believes President Trump’s options are neither exhaustive, nor exhausted.

The Interview

SJ: I’m quoting from your book Healthcare Reform without side effects “with community rating…doors are open for political and special interests to lobby…Imagination will be stifled…political rent seeking will be rampant.” When I read this paragraph I checked the publication date of your book. It was not 2016. It was 2008 – before the passage of the ACA.

MVP: Unfortunately, the book wasn’t published soon enough before the ACA.

SJ: What, in a nutshell, is the problem with the ACA?

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By JONATHAN HALVORSON

My quick take [edited to be slightly less quick]:

Section 1 is warming up the idea that administrative actions will be taken without waiting for any new legislation to reduce the application of ACA penalties and take the teeth out of regulations. This could include freely offering “hardship” exemptions from the individual mandate, though that would frighten insurers and would tend to reduce the number participating on the Exchanges.

Section 2 further sets the stage for the non-enforcement or the creatively flexible enforcement of the individual mandate, employer mandate, and any other requirement/tax/penalty in the ACA.

Section 3 appears to be about making it easier for states to get 1332 and 1115 waivers. Or, probably more accurately, the standards for granting waivers will change dramatically. States will be given more ability to attach strings to Medicaid, and some QHP requirements will also likely change to fit the Republican philosophy that having more “skin in the game” is in the public interest. How a waiver would fare if it reduced cost sharing and instead sought to save money by setting lower provider and pharma fees is another matter entirely.

Section 4 sets the stage for selling insurance across state lines, weakening the power of state insurance regulators. If a major player like Anthem or United decides to embrace this idea, it could set off a race to the bottom on benefits. (If that happens, which state will be the health insurance version of South Dakota or Delaware?) This would be both a public health and public relations nightmare, so I don’t think that cross-state insurance regulation and sales will ultimately spread widely.

Section 5 acknowledges that when changing regulations is needed to do what the administration wants to do, they will need to follow proper procedure (which means it will take more time).

More to come.

Jonathan Halvorson edits the New Economy section for THCB and is a senior consultant with Sachs Policy Group. FD: As a consultant Jonathan works with startups, providers and health plans, advising clients on policy issues, strategic direction and related topics.