The exchanges set up by the health reform law have rebounded, largely thanks to the efforts of UnitedHealth Group’s Optum Insights unit, which has made using the federal exchange websites much easier. A number of state exchanges are still struggling. (WSJ Article) Enrollment, the Administration claims, is over 4 million, but the reality is many of those people have not actually paid for coverage yet. The actual number is probably 3.5 million at most. This is far below the Administration’s and the Congressional Budget Office’s projections. Another reality is that younger, healthier people are not enrolling in the numbers needed to create a sound actuarial pool for participating insurers. UnitedHealth, the savior of the federal exchange functionality, also looks pretty smart for not participating as a plan on those exchanges. And it has become apparent that the administration has eviscerated its own individual mandate through a broad and ambiguous “hardship” definition and other loopholes. Young people are smart and word gets around quickly in the age of social media, so don’t expect them to feel pressured to sign up. Many of the people who did sign up will get subsidies and Medicaid enrollment has boomed, so the federal and ultimately the states’ deficits will also be growing more rapidly. It is not an exaggeration to describe reform, as many predicted, as a disaster, a very expensive disaster which has upended many lives. And the worst may be yet to come when the plans offered on the exchanges have to set premiums for the second year of coverage. And of course, we still don’t have the employer mandate in place.
Research published in the New England Journal of Medicine finds little value in improving outcomes by use of surgical safety checklists.
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Mark Farrah Associates issues its most recent update on large health plan company enrollment and profitability.
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The cost of whole genome sequencing is coming down, but cost, reproducibility, translation and process issues make its routine use for clinical practice unlikely without further refinement and knowledge growth.
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The 2015 Medicare Advantage and Part D Advance Notice and draft Call Letter provide some interesting insights into CMS' views on various topics, as well as reimbursements for those program…
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The annual Pharmacy Benefit Management Institute Specialty Drug Benefit Report highlights trends in this growing category of drugs.
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A new study in the New England Journal of Medicine on treatment options for prostate cancer illustrates the perils of evidence-based medicine.
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The latest survey from the National Business Group on Health and Towers Watson gives further insight on the employer mindset as reform unfolds.
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An article in the Medicare & Medicaid Research Review examines correlates of state-level per capita health spending, finding that income, capacity and share of the elderly are important factors.
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One of the first rigorous studies of the medical home concept, reported in the Journal of the American Medical Association, finds little effect on quality or cost.
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A report from eHealth finds that health insurance on the exchange is costing people substantially more than it did before the implementation of reform.
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Once more into the breach of why there is variability in the cost of care, this time with a report from the National Institute for Health Care Reform, which finds…
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The Agency for Healthcare Research & Quality releases a report on how to best communicate and disseminate information for patients and providers on treatment options.
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A paper from the National Bureau of Economic Research takes an interesting look at the effect of cost-sharing on utilization of health services.
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Health Affairs published yet another piece of research showing wide variation in hospital pricing, probably related to market power and little relation between high prices and high quality.
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