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3 posts from October 2016

10/24/2016

The ACA's Little Discussed But Very Intriguing State Innovation Waiver Provision: A Conversation with Stuart Butler (October 24th)

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Section 1332 of the Affordable Car Act allows states to propose Affordable Care Act-comparable state insurance programs.   Programs would need to meet certain criteria in order to win federal waiver authority.   One state currently considering a wavier is Colorado, i.e., Colorado voters will be asked to approve a state constitutional amendment that would create in part, a financing plan that would provide universal health care to all eligible Colorado residents.       

During this 20 minute conversation Dr. Butler discusses the genesis of Section 1332, why states (blue and red) would be motivated to submit a waiver, the benefits of such waivers, how the next administration might revise current 1332 regulations and state efforts to date, for example, Colorado under its ColoradoCare initiative. 

Dr. Stuart Butler is a Senior Fellow in economic studies at the Brookings Institution.   He is also currently an Adjunct
Professor at Georgetown, a Visiting Fellow at the Convergence Center for Policy Resolution, a member of the editorial board Butler headshot jpegof Health Affairs, a member of the Board on Health Care Services of the Institute of Medicine and of the Advisory Group for the Academy of Medicine's Culture of Health program.   Prior to Dr. Butler spent 35 years at the Heritage Foundation.   Among other previous positions he was an Institute of Politics Fellow at Harvard and a member of Housing Secretary Jack Kemp's Advisory Commission on Regulatory Barriers to Affordable Housing.  Dr. Butler was educated at St. Andrews University in Scotland where he received his undergraduate degree in physics and mathematics, his Masters of Arts in economics and history and his Ph.D. in American economic history.  

Dr. Butler's JAMA Forum essay, noted during this conversation, is at: https://newsatjama.jama.com/2016/09/14/jama-forum-action-on-the-aca-next-year-maybe/

See also Dr. Butler's most recent November 30th JAMA Forum essay titled, "Repeal and Replace Obamacare: What Could it Mean?"  At: https://newsatjama.jama.com/2016/11/30/jama-forum-repeal-and-replace-obamacare-what-could-it-mean/.

 

10/15/2016

Methods to Stabilize the State Health Insurance Marketplaces: A Conversation with Jack Hoadley (October 13th)

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UnitedHealth Group and other major health care insurers' participation in state health insurance marketplaces has caused increasing concern Affordable Care Act-created state marketplaces are becoming unstable.  Moreover, this means health care insurance consumers will have little or possibly no choice in selecting an insurance provider.  For example, in 2016 30 percent of counties throughout the US had only two insurers participating in state marketplaces (10 percent of counties had one). Beyond consumer choice, the absence of marketplace competitors threatens premium affordability.   Creating new and stable insurance marketplaces, that is by definition challenging to accomplish, has been made additionally difficult by Congressional Republican opposition to the ACA's risk corridor program, that along with risk adjustment and reinsurance, is designed to mitigate unavoidable plan financial losses in trying to appropriately price premiums for a population with an unknown health history.             

During this 25 minute conversation Professor Hoadley discusses contributing factors to state marketplace instability and
moreover four methods by which the insurance marketplaces can be stabilized: a "fall back plan;" state participation requirements; extending risk corridors and reinsurance; and, methods to improve marketplace enrollment. 

Dr. Jack Hoadley is a Research Professor at Georgetown University's Health Policy Institute where he studies health financing Hoadley portrait 1 topics including drug pricing, out-of-pocket costs and the dynamics of insurance making decisions.   In 2015 Professor Hoadley was reappointed to a second, three-year term as a Medicare Payment Advisory Commissioner (MedPAC) member.  Prior to his work at Georgetown, Dr. Hoadley held staff positions at DHHS, i.e., within the Assistant Secretary for Planning and Evaluation (ASPE) office, at MedPAC, the Physician Payment Review Commission and at the National Health Policy Forum.   Professor Hoadley has published widely on health care financing and pharmaco-economics topics and has provided testimony to numerous federal Congressional and other government panels.  He earned his Ph.D. in political science. 

Jack Hoadley and Sabrina Corlette's August 2016 paper, "Strategies to Stabalize the Affordable Care Act Marketplaces: Lessons from Medicare," is at: http://www.rwjf.org/en/library/research/2016/08/strategies-to-stabilize-the-affordable-care-act-marketplaces.html.

10/02/2016

"ACO Performance Year Three: What Happened And What Does It Mean?" (October 1st)

Listeners may recall last October 26th I posted a summary of Accountable Care Organization (ACO) performance year two (PY2) results that was published by Health Affairs on their blog.  This essay, that appears on "The Health Care Blog," summarizes ACO performance year three (PY3) results.  PY3 results were not much different than PY2, e.g., 29% of ACOs in 2015 (v. 26% in 2014) earned shared savings, success was again largely due to comparatively higher financial benchmarks and there was again no correlation between quality performance and financial success.  

The essay is at: http://thehealthcareblog.com/blog/2016/10/01/aco-performance-year-three-what-happened-and-what-does-it-mean/