DCMedical News: Tuesday, July 26, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Tuesday, July 26, 2022
ACA Premium Subsidy Extension in Doubt Over $250B Price Tag
Senate action pending: “Reconciliation” has been narrowed down to a likely two-year extension of the American Rescue Plan’s enhanced Affordable Care Act tax credits, and some Medicare drug pricing reforms. A vote in the Senate is expected before Friday when both Houses leave for their August recess.
InsideHealthPolicy reports (here) that “The Congressional Budget Office finds in a new analysis it did for GOP lawmakers that permanently extending the enhanced ACA subsidies would cost $250 billion over 10 years - - around $30 billion more than CBO previously estimated - - but the report also indicates a two-year extension of the subsidies would cost about $34 billion, less than the $40 billion Sen. Joe Manchin (D-WV) mentioned could be used for such an extension.”
In a letter from the CBO to Senate leaders (here), CBO Director Swagel noted that “Under current law, eligible people may use premium tax credits to lower their out-of-pocket monthly premium contributions for health insurance obtained through the marketplaces established under the Affordable Care Act. The credit is calculated as the difference between the benchmark premium for health insurance (that is, the premium for the second-lowest-cost silver plan available in a region) and a specified maximum contribution, expressed as a percentage of income, which is adjusted over time.”
“Section 9661 of ARPA [the American Rescue Plan Act] enhanced premium tax credits in two ways for 2021 and 2022. First, it increased the credit for currently eligible people by decreasing the maximum contribution and removing the adjustment to that contribution. Second, people whose income is above 400 percent of the FPL became eligible for the tax credits for 2021 and 2022.”
More detail: “CBO and JCT [the Joint Committee on Taxation] expect that, on average, the enhanced subsidies would attract 4.8 million new enrollees to the marketplaces in each year over the 2023-2032 period relative to current law . . . the annual credit for a new marketplace enrollee would be $4,980 over the 2023-2032 period . . . if the enhancement became permanent, 2.2 million fewer people would be without health insurance, on average, in each year over the 2023-2032 period, relative to current law [including] . . . a 500,000 decrease in nongroup coverage purchased outside the marketplaces; and a 2.3 million decrease in enrollment in employment-based coverage.”
DOCTORS, NURSES & OTHER HEALTH PROFESSSIONALS
Amazon Buys Brick and Mortar Primary Care: Market Shrugs
“Amazon may well grab a share of the healthcare spending pie. Just don’t expect it to shrink it.” In The Financial Times, columnist Lex (here) compares the shrug at Amazon’s purchase of One Medical to the excitement in 2018 when Amazon, Berkshire Hathaway and JP Morgan set out to show how to do it.
“When Amazon, Berkshire Hathaway and JPMorgan announced in 2018 a joint venture aimed at cutting the cost of employee healthcare, the news wiped off tens of billions of dollars from the market values of leading healthcare companies on the day. Fast forward four and a half years. Amazon on Thursday said it would buy primary care provider One Medical for $3.9bn, including debt. The all-cash deal would add a high-end chain of bricks and mortar doctors’ offices to the retail giant’s portfolio of healthcare services.”
“The absence of a market spasm this time around is telling. For all the talk about Big Tech’s impact on America’s dysfunctional, inefficient and archaic healthcare system, the $4tn-plus a year industry has proved hard to disrupt.”
“Big Tech’s foray into healthcare has only triggered consolidation that conferred more pricing power on the industry. The biggest private health insurers —UnitedHealth Group, Cigna, Elevance Health (formerly known as Anthem) and Humana — collectively made $31.7bn in profits last year. That is 59 per cent higher compared to 2018. Shares in the four stocks are up between 53 per cent to 168 per cent over the past five years.”
The Sick Workforce of Europe: Blame the NHS?
Analysis in The Financial Times (here) shows that the UK is the only developed country in the world where the share of working-age people outside the labor force has continued to rise after the initial pandemic shock. “Uniquely among developed countries, the number of working-age Britons who are neither employed nor seeking work has risen in almost every quarter since the end of 2019, and was higher in the first quarter of 2022 than at any time since the pandemic hit.”
The essay noted that “Chronic illness is the main driver of this stalled labour recovery. Of the roughly half a million Britons aged 15-64 missing from the workforce, two in three cite long-term illness as their reason for not holding or seeking a job.” Moreover, “Britain’s rise in chronic illness predates the onset of the pandemic. With direct impacts of Covid ruled out, the most plausible remaining explanation is grim: we may be witnessing the collapse of the NHS, as hundreds of thousands of patients, unable to access timely care, see their condition worsen to the point of being unable to work. The 332,000 people who have been waiting more than a year for hospital treatment in Britain is a close numerical match for the 309,000 now missing from the labour force due to long-term sickness.”
“Difficulties in accessing primary care will almost certainly be contributing too, since this is the gateway to diagnosis and treatment. Forty seven per cent of Britons now find it difficult to get through to someone at their general practitioner’s practice, up from 19 per cent in 2012, and 27 per cent said they avoided making an appointment this year because they found the process too difficult (up from 11 per cent).”
Two Stories Concerning Radiologist Compensation
Radiology Business reports (here) that “Radiologists are receiving salary offers averaging $455,000 to start a new job in 2022, up from $401,000 in 2021. The 13.5% bounce is independent of signing bonuses and other onboarding incentives. While strong, the radiologist numbers are well off the pace set by the leading specialty in the category, orthopedic surgery. There the average starting salary is $565,000.”
In the same edition (here), the executive director of the Radiology Business Management Association said “CMS couldn’t have picked a worse time to cut Medicare payments to physicians . . . We’re still in the midst of the pandemic, and patients who avoided regular health screenings are returning to doctors’ offices. And it’s that exact moment—when patients need us most—that Congress and the White House decide to introduce disastrous cuts.” This 2023 PFS [Medicare Physician Fee Schedule] “will do incalculable damage to the medical profession,” and “will hurt the most vulnerable populations.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Inadequate Communication Kills
STAT reports (here) on efforts of malpractice insurer CRICO to address failures of communications in hospitals, often identified as the most common cause of adverse patient safety events, and of malpractice suits. “Communication failures were a factor in 30 percent of the malpractice cases examined by CRICO Strategies, a research and analysis offshoot of the company that insures Harvard-affiliated hospitals. The cases — including 1,744 deaths — involve some horror stories that no family, and no medical professional, wants to experience.”
Frank Federico, vice president for patient safety at the Institute for Healthcare Improvement in Cambridge, Mass., called the findings disappointing because they suggest two decades of work has achieved too little progress. “The report cites many challenges, such as heavy workload, hierarchical workplace culture, cumbersome electronic health records, and constant interruptions.”
READING & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
Monkeypox resources, CDC (here), JAMA Patient Page (here).
Side-by-Side Overview of Therapeutics Authorized or Approved for the Prevention of COVID-19 Infection or Treatment of Mild-Moderate COVID-19 (here).
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 27, 28, 29
August, Congress adjourned, no editions of DCMN
September 13, 14, 15, 16, 19, 20, 21, 22, 28, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org