Each year forty percent of enrollees leave the insurance exchanges established by the Affordable Care Act, and this does not even include the numbers who move to different plans within the exchanges during the open enrollment period.
The policy community has gone out of its way to initiate studies that would enhance the business outcomes of the private insurers, almost irregardless of any negative impact on patients. This study on special enrollment periods being initiated by CMS is no exception and may actually violate standards of ethics in research.
One of the reasons given for using high deductibles in health plans is that they supposedly reduce spending by encouraging patients to shop for lower health care prices. Austin Frakt shows us that the impact of price transparency on spending has been relatively trivial.
The scenario here is quite unrealistic, but it ends with Medicare for all, so it’s nice to take a break and fantasize for a moment.
There has been considerable publicity about insured patients facing unexpected medical bills in hospitals and emergency departments because some care was provided by out-of-network professionals even though the facility was within the insurer’s network. This report adds to our knowledge by quantifying the extent of this problem.
We did not have to wait for the incoming, anti-government administration to take over. Yesterday President Obama signed the 21st Century Cures Act. It will reduce government oversight of drugs – allowing on the market products that may not be effective and might even be dangerous.
Superficially this seems to be another boring research paper on health insurance markets. But, without intending to do so, it challenges the fundamental concept that we can improve health care financing by offering individuals choices in a marketplace of health plans – a fundamental concept advanced in the Affordable Care Act.
Katherine Baicker and Amy Finkelstein are correct. Rigorous policy research can provide a beneficial input to the policy making process. But there is the risk that policy science can lead only to minor tweaks in the health care financing system when comprehensive overhaul is an imperative.
The conservatives want to repeal much of the Affordable Care Act (ACA) and replace it with something similar. The centrists want to preserve ACA pretty much as it is. Although the specifics are important since many people could lose their coverage and the effectiveness of health plans could diminish further, in the global perspective we’ll still be left with a highly dysfunctional health care financing system.
Although this AJPH editorial was written a couple of weeks before the surprise results of the presidential election were known, it does not change the message. Curing our heath care deficits will require broad popular mobilization, not just the wishes of a president, no matter his or her intentions.
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