How Does Judge Reed O’Connor Feel About (Some) Preventive Services?
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In his Braidwood opinion (here), the Texas Judge, who has previously found the individual mandate under the Patient Protection and Affordable Care Act unconstitutional, describes plaintiffs who “Want the option to purchase health insurance that excludes or limits coverage of PrEP drugs, contraception, the HPV vaccine, and the screenings and behavioral counseling for STDs and drug use. They say neither they nor their families require such preventive care.”
The Judge took note of the existence of skimpy (short term limited duration insurance, STLDI) health insurance plans, pointing out “That insurance companies are offering STLDI plans without preventive care coverage when not legally required to do so indicates that the restricted options in the conventional market are at least partly attributable to the Government’s enforcement of the mandates.”
The Judge finds that Braidwood Plaintiffs object to purchasing or providing coverage for PrEP drugs because they believe that (1) the Bible is “the authoritative and inerrant word of God,” (2) the “Bible condemns sexual activity outside marriage between one man and one woman, including homosexual conduct,” (3) providing coverage of PrEP drugs “facilitates and encourages homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman,” and (4) purchasing coverage of PrEP drugs by purchasing such coverage for personal or business use makes them complicit in those behaviors. Yet, as previously discussed, the ACA forces these Plaintiffs to choose between purchasing health insurance that violates their religious beliefs and foregoing conventional health insurance altogether.”
The Judge asks, “Whether the government has a compelling interest in requiring all private insurers to cover PrEP drugs in every one of their insurance policies,” and concludes that it does not.
DOCTORS, NURSES, AND OTHER HEALTH PROFESSIONALS
Diagnostic Errors Due to Electronic Medical Records
A report (here) in the Journal of Patient Safety notes “EHRs pose risks for diagnostic error throughout the diagnostic process, with most issues involving their incompatibility with providers’ cognitive processing. A structured and systematic model of collecting and reporting on these errors is needed to understand how the EHR shapes the diagnostic process and improve diagnostic accuracy.” An unrelated report in the same journal (here), in April, on malpractice claims, notes “The digital transformation and acceleration of team-based care in medicine have not mitigated the malpractice risks of complex cases with severe injuries and multiple missteps.”
Burnout in Primary Care
AHRQ publishes (here) a primer on burnout in primary care, and steps practitioners might take. “In 2020, 38 percent of physicians in the U.S. reported experiencing at least one of the three dimensions of burnout, and primary care physicians have higher rates of burnout than most other types of physicians. The concern is most acute for females and those under age 55. Other clinicians, such as nurse practitioners (NPs) and physician assistants (PAs), experience similar levels of burnout compared with physicians.”
AAMC Publishes on Physician Specialty Profiles
The Association of American Medical Colleges has published (here) its report on physician specialty numbers and demographic information for 2022. Ten specialties have a majority of practitioners who are women. The study, of approximately 950,000 physicians and physician in training, covered 48 specialties. Thirty-seven percent of actively practicing physicians are women, in specialties from orthopedic surgery (6%) to pediatrics (65%). None of the ten specialties where women are in the majority involve surgery or “procedures,” save only the gyn portion of ob-gyn.
HOSPITALS, NURSING HOMES, AND OTHER HEALTH CARE FACILITIES
No Surprises One Year Later
Georgetown’s Center on Health Insurance Reform reports (here) on the “No Surprises Act” (NSA). The report notes that “Before passage of the law, consumers were most vulnerable to balance billing when they used an out-of-network provider in situations when they could not reasonably choose how they obtained medical services. The reality is that not all medical services are delivered in network. For example, 18 percent of emergency visits and 16 percent of in-network hospital care resulted in at least one out-of network charge for enrollees of large group plans in 2017.”
Thirty-three states took some action against balance billing, followed by the NSA, then by extensive litigation over whether CMS, in its proposed regulations to implement the law, had put a thumb on the scale, in favor of lower insurance payments, and against clinical and institutional providers billing out of network. The status of NSA now: a work in progress, with consumers removed from the conflict, but providers not necessarily happy.
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
That Lock Box
Then Presidential candidate Al Gore in 2000 called (here) for a “lock box” through which the revenues and expenditures of Medicare and the Social Security Act, could flow, safe from the presumed sticky fingers of Congress and the desire of some to use recently increased Medicare taxes for general government purposes.
In the 2022 annual report (here) of the Federal Health Insurance and Federal Supplemental Medical Insurance Trust Funds, the Trustees report the funds are not in a lock box. “Total Medicare expenditures were $839 billion in 2021 . . . The Trustees project that expenditures will increase in future years at a faster pace than either aggregate workers’ earnings or the economy overall and that, as a percentage of GDP, spending will increase from 3.9 percent in 2021 to 6.5 percent by 2096 (based on the Trustees’ intermediate set of assumptions). Under the relatively higher price increases for physicians and other health services assumed for the illustrative alternative projection, Medicare spending would represent roughly 8.6 percent of GDP in 2096. Growth under either of these scenarios would substantially increase the strain on the nation’s workers, the economy, Medicare beneficiaries, and the Federal budget.”
DRUGS & DEVICES
"Strong sales of obesity-diabetes drugs known as GLP-1s could affect insurance companies’ financial results”
The Wall Street Journal reports (here) that Ozempic, Wegovy and Mounjaro have stirred the public imagination on the order of Viagra and Adderall. “Not too much is standing in the way of a new class of obesity-diabetes drugs from becoming one of the biggest blockbusters the pharmaceutical industry has ever seen. Doctors are excited about the potential health benefits, the social-media hype just won’t abate and the weight loss can be dramatic.”
The miracle of other peoples’ money: “There is one major question still looming over this drug class, known as GLP-1s, though: What do insurers, who ultimately foot the bill, think about this new revolution in the treatment of obesity? If this class of drugs can truly surpass $100 billion in annual sales, as many analysts expect, insurers (and ultimately employers and the government) will have to foot the bill.”
At $6,000 per month, there are unlikely to be many cash customers.
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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