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Affording the Affordable Care Act

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By Christine Eibner

As enrollment in the Affordable Care Act’s (ACA) new health care markets, or exchanges as they are also known, begins, much of the debate over the law is focused on insurance: Who will get coverage? How much will premiums cost? Should our state expand Medicaid? Yet health insurance is not an end in itself.

The point of insurance is to help people get the health care they need at prices they can afford and, in the event of serious injury or accident, to protect them from catastrophically high medical bills. What often gets lost in the debate is how the new law will affect Americans’ ability to buy health care.

While relatively little will change for most people who already get their insurance through employers, an estimated 49 million Americans will be affected by the new law, either becoming newly insured or changing their source of coverage. How will these changes affect consumer health care spending? Will the Affordable Care Act live up to its name?

Of course, ultimately only time and experience will tell. But in the meantime, the law is being implemented, and policymakers and consumers confronting the new health care market are seeking answers about the law’s likely impact, beyond politicized charges and countercharges about whether it will succeed.

Using the COMPARE microsimulation model, my RAND colleagues and I examined how the ACA will affect spending by consumers who are insured for the first time or who change coverage as a result of the law. Specifically, we looked at out-of-pocket spending (spending at the point of sale — copays, deductibles, and coinsurance, which is the fraction of spending not covered by insurance); total spending on health care, which includes out-of-pocket spending plus insurance premiums; and consumers’ risk of high medical care costs.

The analysis focused on 2016, the first year in which penalties for not complying with the individual mandate will be fully in effect, and considered two scenarios: one in which the ACA is fully in place and another that estimates outcomes without the ACA.

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Reports Suggest Exchange Numbers Are Very Low

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By THCBist

“Well, Facebook Wasn’t Built In a Day.” – Unnamed Exchange Developer.

More than 4.8 million users visited Healthcare.gov for the grand opening of the federal health insurance marketplace on Tuesday, according to officials.

It didn’t go quite as planners had hoped. In fact, if there was an unofficial word of the day, it was glitch.

Many users of Healthcare.gov reported long delays and difficulty accessing the federal insurance marketplace,  experiencing “glitches” ranging from error messages to blank pages.  The problems were repeated at state-run exchanges around the country to varying degree, from California to New York.

Pundits like Wonkblog’s Ezra Klein were quick to point out that the political victory the GOP might have gained from the uncertain start was largely lost in the uproar in Washington over the government shutdown, which dominated news reports.

At least one frustrated user chronicled the experience (see related post ‘Descent into Madness: One Man’s Visit to Healthcare.gov, October 1st ). Others took to Twitter to express their outrage or show off their savage or finely-tuned senses of humor.

Users of the federal exchange reported problems including error messages (see above), funky dropdown menu behavior, page freezes, blips, broken links and long page load times — generally either a sign of high volume or inelegantly designed databases.

HHS officials declined to reveal how many people signed up for new insurance plans overall, leading some theorists to speculate that not very many people were able to make it through the process successfully. In point of fact, there were suspiciously few reports of users successfully completing the registration process at all, probably not a very good sign and possibly an indication of a disaster.Continue reading…

How the Federal Government Shutdown Is Hurting Healthcare: Agency by Agency

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By THCBist

The shutdown could not stop the rollout of the state and federal exchanges.

That’s because the Obama administration, sensing a political fight in the offing with Republicans, wisely prepaid the bill for the insurance exchanges and other key components of the rollout.

On the other hand, the fiscal standoff is having a very real impact on the infrastructure that supports healthcare across the United States.   Agencies from the Centers for Disease and Control to the National Institutes of Health have seen their money turned off. Others have seen their staffing levels sharply reduced with non-essential employees furloughed.

It doesn’t take a wild imagination to imagine potential deadly consequences if something goes wrong. If for example, flu season strikes early or a drug recall  is needed.  Much of the pain will be felt over time.  As the shutdown drags on, you can expect problems that are brewing under the surface to become much more visible …

Here’s a review of what’s happening:

Centers For Disease Control and Prevention
Funding for monitoring of disease outbreaks turned off. Lab operations sharply scaled back. 24/7 operations center to remain online.  With some scientists predicting a severe 2013-2014 flu season, this is cause for concern …

National Institutes For Health
Enrollment in new clinical trials suspended, impacting thousands of patients suffering from serious diseases. No action on grant proposals. Minimal support for ongoing protocols.

Food and Drug Administration
Food safety inspections sharply cut back. Monitoring of imports eliminated.  Oversight of production facilities curtailed, again potentially an issue with flu season on the way.The good news? Because drug approvals are funded by industry “user-fees” FDA approvals of new drugs will continue.

Centers For Medicare and Medicaid Services
Key ACA related operations intact.  The bad news for docs and patients – claims and payment processing expected to continue but with slower service than usual. With purse strings tight, this is likely to become more of a problem as shutdown drags on. In the unlikely event that a shutdown continues for more than a month, the impact on physician practices could be much more serious.

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Descent Into Madness: An Account of One Man’s Visit to Healthcare.gov October 1st

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By Tony Jewell

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As the owners of small businesses, my family has been curious to learn how much insurance would cost us once the Affordable Care Act kicks in – and what our choices of networks, providers and whatnot would be.

With the arrival of the October 1 open enrollment period, my first computer stop was healthcare.gov to begin comparison shopping among the four ACA plans vs. the COBRA plan that we have through the end of 2014.

Here’s how it went:

October 1, 2013

7:30 a.m. – I first encounter the Health Insurance Marketplace waiting room.

7:33 a.m. – The drop-down boxes on the security questions aren’t working.

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Who Knew That Blood, Sweat and Tears Could Start a Health Care Revolution?

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By Peter H. Diamandis, MD

The staid world of diagnostic testing is about to undergo a major disruption with huge advances in sensors and sensing technologies that live in or on our bodies, within our homes and offices, and even within our computers and networks.

Today we’re witnessing a massive shift in who will collect and control diagnostic and other health information. For the first time, as people and patients, we will have control over what we measure, when we measure it, and who has access to our personal data. This is made possible by a new generation of revolutionary biosensors that contain the power of clinical lab instruments in packages that are light, small, wireless and highly efficient.

This is a new world of sensors: they can be body-attached, monitor our immediate personal environment, or even work as pure software apps that extrapolate data from our health records. Using simple, non-invasive methods to take samples of tiny amounts of blood, traces of skin tissue, breath droplets or an image of the inner eye are just some of the new methods emerging. It is exciting to consider that several of these multifunctional sensors, working in concert with powerful mobile handhelds, offer us extraordinary data collection and diagnostic tool sets that will put us in touch with our health in ways never imagined before.

These advances in health sensing, available any time and anywhere, are game changing. A continuous stream of personalized health data will transform how doctors interact with their patients to address and solve health challenges. More importantly, it puts patients at the center of the care process. Personalized data means that specific therapies or drugs will be more effectively delivered and controlled, allowing doctors to fine-tune treatments and watch incremental physiological changes as they occur.

This technology will also disrupt the clinical diagnostics business by moving testing from specialized (and expensive) labs to pharmacies and then ultimately to our homes.

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My Worst Night as a Doctor

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By Rob Lamberts, MD

My worst night as a doctor was during my residency.  I was working the pediatric ICU and admitted a young teenager who had tried to kill herself.  Well, she didn’t really try to kill herself; she took a handful of Tylenol (acetaminophen) because some other girls had teased her.

On that night I watched as she went from a frightened girl who carried on a conversation, through agitation and into coma, and finally to death by morning.  We did everything we could to keep her alive, but without a liver there is no chance of survival.

Over ten years later, I was called to the emergency room for a girl who was nauseated and a little confused, with elevated liver tests.  I told the ER doctor to check an acetaminophen level and, sadly, it was elevated.  She too had taken a handful of acetaminophen at an earlier time.  She too was lucid and scared at the start of the evening.  The last I saw of her was on the next day before she was sent to a specialty hospital for a liver transplant.  I got the call later that next day with the bad news: she died.

The saddest thing about both of these kids is that they both thought they were safe.  The handful of pills was a gesture, not meant to harm themselves.  They were like most people; they didn’t know that this medication that is ubiquitous and reportedly safe can be so deadly.  But when they finally learned this, it was too late.  They are both dead.  Suicides?  Technically, but not in reality.

For these children the problem was that symptoms of toxicity may not show up until it is too late.  People often get nausea and vomiting with acute overdose, but if the treatment isn’t initiated within 8-10 hours, the risk of going to liver failure is high.  Once enough time passes, it is rare that the person can be cured without liver transplant.

According to a recent ProPublica investigation, acetaminophen overdose is the #1 cause of liver failure in the US. And  between years of 2001 and 2010, 1567 people in the U.S. were reported to have died by accidentally overdosing.

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I Oppose Obamacare. I Support the Affordable Care Act.

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By KENNY LIN, MD

Today, more than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.

Let me admit that I’ve never had particularly warm feelings toward President Obama. I think his foreign policy is a mess. The trillions in debt that the U.S. has run up over the past 5 years will hurt my generation and future generations, and if Republicans can be faulted for their fantasy that the federal budget can be balanced exclusively through spending cuts, Obama has sustained the Democratic fairy tale that raising taxes on “millionaires and billionaires” is all that is necessary to pay the skyrocketing bills.

On multiple occasions during my time in government, the President had no qualms about squashing science and scientists for political convenience. He is a perpetual campaigner, preferring theatrical gestures to the backstage grunt work of governing. And for all of his rhetorical gifts when preaching to the choir, he’s been one of the least effective persuaders-in-chief to have held the office.

And so, naturally, I oppose Obamacare. I oppose a government takeover of health care that includes morally repugnant death panels staffed by faceless bureaucrats who will decide whose grandparents live or die and make it impossible for clinicians to provide compassionate end-of-life care. I oppose the provision in Obamacare that says that in order for some of the 50 million uninsured Americans to obtain health insurance, an equal or greater number must forfeit their existing plans or be laid off from their jobs.

I oppose the discarding of personal responsibility for one’s health in Obamacare. I oppose Obamacare’s expansion of the nanny-state that will regulate the most private aspects of people’s lives.

It’s a good thing that Obamacare, constructed on a foundation of health reform scare stories, doesn’t exist and never will.

Instead, the Affordable Care Act (which I support) is based on a similar law in Massachusetts that was signed by a Republican governor and openly supported by the administration of George W. Bush. It achieves the bulk of health insurance expansion by leveling the playing field for self-employed persons and employees of small businesses who, until now, didn’t have a fraction of the premium negotiating power of large corporations that pool risk and provide benefits regardless of health status.

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Washington In Crisis: ONC Announces That It Will Not Tweet Or Respond to Tweets During Shutdown

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By THCBist

The U.S. government shutdown continues to claim victims.

The latest is HealthIT.gov, the website designed to help doctors and hospitals make the transition to electronic and make better use of health information technology – a key component of Obamacare’s drive to transform healthcare.

The Health Information Technology Office of the National Coordinator posted a brief announcement on the site informing visitors to HealthIT.gov that “information … may not be up to date, transactions submitted via the website may not be processed and the agency may not be able to respond to inquiries until appropriations have been enacted.”

Officials also sent a tweet saying that the ONC regrets to inform us that while the shutdown continues it will “not tweet or respond to tweets.”

This struck THCBist as slightly odd.

After all, if you’re looking for an inexpensive way to communicate with the public in a pinch, Twitter seems like the perfect choice.  We get that government websites are ridiculously expensive things to run. Blogs are considerably cheaper.  Operating a Twitter account — on the other hand — is almost free.  Our brains were flooded with scenarios.  How much could the ONC possibly be spending on Twitter? And for that matter, didn’t the Department of Defense originally invent the Internet to allow for  emergency communication during times of national crisis? Doesn’t a fiscal insurrection by cranky Republicans qualify?

Fallout for the National Health IT Program

While federal officials have issued repeated assurances that the shutdown will not impact the Obamacare rollout, it does look as though there will be a fairly serious impact on the administration’s health IT program.  If HHS sticks to script, only 4 of 184 ONC employees will remain on duty during the shutdown. That makes it sound like activities are going to have to be scaled back just a bit.

If you’re counting on getting an incentive payment from the government for participation in the electronic medical records program, you may be in trouble — at least until the stalemate is settled.  Although ONC has not yet made an official statement,  presumably because the aforementioned Twitter channel has been disabled, leaving the agency unable to speak to or otherwise communicate with the public, going by the available information in the thirteen-page contingency plan drafted by strategists at HHS, it is unclear where the money will come from.

This could be bad news for electronic medical records vendors counting on the incentive program to drive sales as the Obamacare rollout gets officially underway.

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HealthTech Challenge Aimed at Reducing Readmissions

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HFII logoA new international challenge has finally arrived, and not a moment too soon! The Henry Ford Innovation Institute (HFII) has partnered with Health 2.0 to launch the HFII HealthTech Challenge. The challenge encourages innovators in over 25 countries to address avoidable hospital readmissions through mobile-health and IT solutions. $50,000 in prizes and up-to $100,000 in technology development support will be awarded to the best solutions.

The HFII HealthTech Challenge aims to reduce avoidable readmissions of patients with exacerbations of chronic conditions, like pneumonia, COPD, and congestive heart failure. Rising readmissions penalties strain private insurers and capitated health systems. Not to mention, patients and providers are inadequately prepared to manage complicated medical conditions post-hospital discharge.

Open to the international community, this Challenge invites innovators in over 25 countries to compete for $50,000 in prizes. The five best finalist will be awarded $10,000 each. These teams will then compete for a chance to receive an offer of a rapid commercialization investment, consisting of up-to $100,000 for technology development, up-to 9 months of product development support and clinical validation within the Henry Ford Health System, technology and business support from HFII’s commercial partners, and access to world-class mentors and experts across a variety of fields. Throughout the development period, the winners will receive exposure to capital investors that can provide additional funding to fuel the growth of these technologies.

Check out the challenge details at www.healthtechchallenge.com, and make sure to stay tuned with us for all your HealthTech Challenge needs!

Submissions are due January 3, 2014.

Announcing the Winners and Finalists of the RWJF Hospital Price Transparency Challenge!

RWJF

With the Health 2.0 Fall Conference underway, we’re excited to to announce the winners of the Robert Wood Johnson Foundation (RWJF) Hospital Price Transparency Challenge! The Foundation launched the RWJF Hospital Price Transparency Challenge on June 3, 2013 at the Health Datapalooza tasking innovators to build tools and visualizations that can enable consumers to make more informed decisions based on recently release CMS hospital inpatient and outpatient pricing data.

This challenge was broken into two categories: the Visualization Category and the Apps & Tools Category. The Visualization Category tasked innovators to build interactive or static visualizations that can better display aspects of the pricing data like regional patterns or differences by procedure while the Apps & Tools Category challenged teams to create a tool or app that allows users to analyze and potentially leverage the data for purchasing decisions or to negotiate hospital bills.

The foundation received a tremendous response from the technology and design community, with over 130 total submissions received for both categories. Health 2.0 is thrilled to announce the results!

Interactive Visualization Category Winners:

Static Visualization Category Winners:

For the applications/tools category, five finalist were chosen out of 85 submissions! It was a close race, no doubt. These teams won $5,000 each, and are now tasked with building out their conceptual designs into real applications! The five finalists were:

  • Consumer Reports by Chris Bailey
  • Haberham Health by Jacob Byrne
  • Nerdwallet Health by Christina LaMontagne
  • ProcedureTap by Tony Webster
  • ReferMe by Arjun Ohri

Learn more about the challenge HERE and stay tuned for results from Phase II of the Apps & Tools Category of the challenge that will be announced at the mHealth Summit in December!

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