DCMedical News: Thursday, January 10, 2019
DCMedical News-DCMN
Washington, D.C.
Thursday, January 10, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
THE BIG STORY IN HEALTH CARE: Big interest in public option/single payer/universal coverage legislation.
Congressional Interest in Single Payer Health Supported by Poll: 80% of Democrats and 60% of Republicans appear to support a taxpayer-funded national health plan, according to a Politico/Harvard poll (here). Harvard pollster Professor Robert Blendon cautioned that the support is not necessarily “Medicare for all,” in which “everybody in America has the same card,” but, rather, a public option or choice.
The House of Representatives is preparing for a hearing on the issues, beginning with Budget Committee Chairman John Yarmuth’s letter to the Congressional Budget Office (here) requesting “a report on the design considerations that policymakers would confront in developing proposals to establish a single-payer system in the United States.” Yarmuth asked for details on a demonstration, eligibility and coverage, cost-sharing requirements, what role, if any, private insurers would play, and whether other public programs would continue to exist independently. Yarmuth also requested perspective on payment to providers and methods used to contain costs, as well, of course, as financing of the system. Yarmuth wrote that he was not asking for CBO’s estimate of the effects of any particular proposal, but rather “a qualitative assessment of how the choices with respect to major design issues would affect such spending.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
More on New Physician Payment Models: A paper in JAMA Cardiology (here) outlines responsibilities of primary care physicians and cardiologists in the care of patients with cardiovascular disease. “Multispecialty professional fee capitation (MPF) is a payment model that bundles professional fees for participating clinicians with an established longitudinal patient care relationship.”
Nurse Practitioner (NP) Supply in Low Income and Rural Areas: Growing faster than primary care physician (PCP) supply, and growing in lower income and rural areas where physician supply is declining. A study in JAMA (here) found as follows: “From 2010 to 2016, the number of primary care NPs increased from 59,442 to 123,316, and the number of PCPs increased from 225,687 to 243,738. The number of NPs per 100,000 population increased by a mean of 15.3 (95%CI—Confidence Interval--14.1-16.4) in the highest income quartile to 21.4 (95% CI, 19.9-22.8) in the lowest income quartile. In contrast, physician supply remained relatively constant. Overall, NP supply increased more than physician supply (annual change, 3.0 vs −0.02, respectively; difference of 3.1 [95% CI, 2.8-3.3] per 100,000 population per HSA [Health Service Area]; P < .001). By 2016, NP supply was 33.1 (95% CI, 30.9-35.2) per 100,000 population in the highest income quartile and increased to 41.1 (95% CI, 38.7-43.4) in the lowest income quartile, whereas physician supply declined from 75.1 (95%CI, 71.6-78.6) in the highest income quartile to 52.0 (95% CI, 49.9-54.1) in the lowest income quartile. Similar trends were observed in metropolitan, urban, and rural HSAs.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Chinese Health Insurance Market Growth: Beginning to look like American health insurance. A profile in the Financial Times (here) indicates that health insurance has become the fastest insurance growth segment in China, with premiums rising 23% in 2018. The out-of-pocket share of total spending (which the FT calculates at 11% for the U.S.) is over 30% in China (down from 60% in the year 2000), and over 60% in India. Despite premium growth, profitability has not followed, with “average payout” (‘medical loss ratio’) 80% of premiums. The fastest growing health insurance segments are “critical illness plans,” lump sum payments in the event of illness (analogous to early days of Aflac, cancer insurance and similar now-historic products in the U.S.). Major challenge: monopoly medical care, with “The outsized market power of Chinese public hospitals [making] it nearly impossible for insurers to negotiate prices or treatment protocols.”
Medicare For America: Centrist progressives Rep. Rosa DeLauro of Connecticut and Rep. Jan Schakowsky of Illinois jump start with “Medicare For America” (here). In this plan, existing private health insurance plans could remain in place, or employers would fund the “MFA.” Current government programs would also be incorporated in Medicare For America. DeLauro is the incoming chair of the Appropriations Subcommittee on Labor, Health and Education, Schakowsky a deputy whip. The skeletal plans call for (a) employers to contribute 8% of payroll to MFA, (b) premium subsidies up to 600% of federal poverty guidelines, (c) financing through repeal of the 2018 tax cut.
Live Long and Be Healthy: Governing magazine reports (here) that “The cost of retiree health care is spiraling out of control. In just two years, according to a recent S&P Global Ratings report, unfunded retiree health-care liabilities across the 50 states increased by $100 billion to now just under $700 billion.” One solution offered in the article: put money into health reimbursement accounts to enable employees to buy supplemental insurance on private exchanges, whether or not the employee is on Medicare.
DRUGS AND DEVICES
Snowy, Bucolic Vermont Backdrop for a You-Tube Event on Controlling Drug Prices: “Bernie Sanders (I-Vt.) and Reps. Elijah Cummings (D-Md.), Ro Khanna (D-Calif.), Peter Welch (D-Vt.), Joe Neguse (D-Co.) and other cosponsors in the House and Senate hold a press conference to announce a legislative package that would drastically reduce prescription drug prices in the United States,” 11:30 a.m. today, at https://www.youtube.com/watch?v=dq4-CVnKH5U.
New Finance Committee Chair Senator Charles Grassley held a conference with reporters in which he expressed his thoughts about drug prices (e.g., supports importation), although he said he also supported the current Part D plan negotiations for drug prices (“I don't want to mess with the government negotiating prices with the private sector.")
READINGS & REFERENCES
“FDA 2018 Year in Review (and a Few Thoughts on 2019),” American Health Lawyers Association, here.
“The Hidden Systems That Explains How Your Doctor Makes Referrals,” The Wall Street Journal, here.
“New Congress Will Hold Historic Hearings on Expanding Social Security And Medicare,” Forbes, here.
“The Future of Health Services Research,” National Academy of Medicine, here.
U.S. House of Representatives: Members at https://www.house.gov/representatives, Committees and Members at https://www.house.gov/committees
U. S. Senate: Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
Publication dates are the regularly scheduled days the House or the Senate is in session.
Remaining January publication dates: 11, 14, 15, 16, 17, 18, 28, 29, 30, 31
February publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28
March publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.