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  • $1.1 trillion spending bill and what it means for healthcare in 2014

    By Katie Ni
    Education & Outreach Coordinator, AMSA Health Policy Team

    Last Thursday, the Senate voted to pass the $1.1 trillion spending bill that will fund the government through this September. The bill passed easily in both the Senate and the House-- perhaps with the memory of government shutdown still fresh in representatives’ minds. Here is the short and sweet version of what this year’s budget has in store for health policy:

    1. Funding for the Affordable Care Act will be cut. The ACA will see cut funding in two places: $1 billion will be cut from Prevention and Public Health Fund, and $10 million will be cut from the Independent Payment Advisory Board (IPAB), the panel given the task of making changes to Medicare payment and program rules. IPAB was made to achieve savings for Medicare, but has been denounced by its critics as a “death panel” that will reduce access to care. A cut of $10 million from the IPAB’s former budget of $15 million may limit the board’s capabilities significantly.

    2. The NIH will recover funding lost from sequestration, BUT overall will see a decrease in funding. The NIH will receive $29.9 billion for 2014, which is $1 billion more than its post-sequestration value, but $714 million less than its original 2013 budget. While the research giant will at least be able to recover funds lost from sequestration, it is discouraging to see the government’s deemphasizing of biomedical research, which works on new vaccines and treatments, curing diseases like cancer and diabetes, and other projects that could profoundly improve human health.

    3. Funding for the FDA and CDC have increased. The FDA will receive $2.6 billion in 2014, a near-$100 million increase from its 2013 budget. The CDC will receive $6.9 billion, $369 million more than its 2013 budget. The FDA regulates food, medication, and other consumer products, while the CDC has an important role in monitoring and preventing diseases. Both will impact the health of a huge number of people based on their ability to carry out these tasks, and hopefully the extra funding will be used efficiently to help these important agencies function in the coming year.

    4. Federal funding is banned from being used for most abortions. The bill also bans foreign aid from being used toward abortions, and funds abstinence-only education in schools. Always a controversial topic, it would appear that the pro-lifers have made several gains through this spending bill. Some health plans available under the ACA could continue to cover elective abortion, but in general, this measure will make it more difficult for women to choose an abortion (for reasons other than rape, incest, or medical emergency), especially for women on subsidized health plans.

    For current and future physicians, the cut ACA funding will be the aspect of the spending bill that has the greatest impact. On paper, the spending decrease on the ACA represents a compromise made between the Republican and Democratic parties; however, in practice, the cut programs—reworking Medicare costs and implementing preventative health programs— are projects that have potential to decrease health expenditures in the future. Choosing to cut them now may translate to a net loss down the road. While it is encouraging to hear that Congress has finally successfully compromised on a budget and avoided a second government shutdown-level crisis, the spending bill represents a mixed bag in terms of health policy.

    Additional information/sources:

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  • How we pay for medical care in 2014: Paying for quality and efficiency

    Whitney McFadden
    AMSA Health Policy Chair

    Bodenheimer and Grumbach outlined in their book, Understanding Health Policy: A Clinical Approach, a view of health policy and the faults of our current healthcare system. It seems we are very familiar with the pitfalls of our current system. In order to be clear and not dwell too much on the obvious, our system struggles with overuse and underinsurance/lack of insurance that is being addressed with the Affordable Care Act. Today we pay for healthcare out-of-pocket, with individual private insurance, employment based private insurance, or government financing. Insurance plans for healthcare began in the depression due to unstable payments. Medicare was established to cover the elderly and lower income individuals. Currently physicians are paid in a multi-tier system including fee-for-service, episode illness grouping, capitation (per head fee to general practitioner and specialist), and salary.
    2014 will be a year of new payment methods for healthcare. The sustainable growth rate (SGR) has historically be underfunded requiring congressional intervention to avoid the reduction in payment to medical reimbursement that would make it unsustainable. This year, a bipartisan fix will change payments to value based on measure of better quality and efficiency instead of the current greater volume and intensity of services. Some evidence exists in community clinics that this method has been successful and alternative payment models (i.e. transitional care) have been attempted as possible solutions. McClellan makes the point that we currently do not know how to create a system that is cheaper and rewards improved health outcomes. 

    One solution is single payer healthcare, which addresses the funding source. However our problems with how payments will be made to increase efficiency would still remain. There are methods by which we can change the way our healthcare dollars are spent, but we will not find those solutions on the national stage. Instead, each clinic and hospital must look at their individual patient population, the diseases they treat, and the access to care in the community in order to develop a system that is financially viable. We would benefit from establishing a medical economics team at every health provider institution to allow for individualized services from technologic tools that we know work well. The team based approach to healthcare that is the foundation for our medical training should extent to healthcare funding. Instead of trying to find the rules that would apply to everyone, we need to establish the framework by which everyone can create their rules, and do it with ease, efficiency, and completeness.

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  • My HealthCare.Gov Experience

    Brandon Sandine
    AMSA Local Health Policy Coordinator

    Amidst the media turmoil surrounding the website, developed to help citizens obtain health insurance through the Affordable Care Act, I decided to try my luck navigating the website and see if the media recounted the experience accurately.

    After opening up the webpage, I was immediately prompted to click the big orange link to begin the application. The new page that appears after clicking the apply link allowed me to choose whether or not I want to finish the application online or by phone. As my experiment was to determine if the website was functional I chose to finish online. The next steps were to create a profile and provide information to determine my financial eligibility.

    Impressively, when it was all said and done, the entire process did not take more than 15-20 minutes and was incredibly simple. Furthermore, before logging off I knew exactly what type of coverage I was eligible for. My hope with all of this is to inform people who have not applied for health insurance due to website issues to know that they can rest assured that progress has been made. My experience with was simple, quick and painless.

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  • ACA Coverage and the New Year

    Whitney McFadden
    AMSA Health Policy Chair

    As medical students, what should we expect for our healthcare system this year?

    The Department of Health and Human Services is closely tracking the number of people signing up for health insurance. This year’s resolution will be to follow how Obamacare is improving the health of our nation. First, 2.1 million Americans have signed up for private insurance in the exchanges and a new 3.9 million were found to be able to access coverage through medicaid. We do not know how many people had to change their current insurance, and how this coverage will affect doctor patient visits. In the end, we want to understand how these changes improve the health of our nation.

    How we prioritize and evaluate the measure of our national health will be a significant issue this year. Obamacare is covering more individuals and in order to measure its success, many are searching for ways to see the impact on healthcare. The National Bureau of Economic Research studied the Oregon Health Insurance Experiment published in 2011 to investigate how health insurance improves health care and outcomes. The study measured health care utilization, out-of-pocket medical expenditures, medical debt, and self-reported physical and mental health in randomly chosen low-income participants who qualified for coverage. The study found that those with coverage had statistically significant changes in their health. Participants were likely to have more healthcare utilization (hospitalizations, outpatient visits, prescription medications), less expenses, and better self-reported health. It seems these will be a few of the outcomes to follow after the ACA is in full swing.

    Listed are some of the noteworthy changes for the 2014 year:
    1. Insurance coverage will not be withheld for individuals with pre-existing conditions or premiums elevated based on age or gender.
    2. Insurance companies must share pricing and benefit information with consumers in a comparative way. 
    3. Private exchanges might be used more in the workplace.
    4. Employer mandate set for 2015 will give small companies time to prepare for covering their employees. 
    5. Price transparency. 
    6. Likely more regulations imparted by HHS.
    7. Insurance companies will begin to limit the number of healthcare providers they cover based better rates. 
    8. States will have the most impact on local price structure (i.e. Medicaid expansion). 
    We will likely see some great improvements in care as individuals access more preventive services, get connected with primary care physicians, and pay less for healthcare. However, some changes remain to be seen. Emergency room visits are not likely to drop off if we use the OHSE as a model, and some insurance plans have already increase their premiums to existing customers covering lost costs for sicker people. Following the progress of our healthcare system over the next few years will be essential to improving our health as a nation. As medical students we can help patients be aware of these changes and the effects on our overall healthcare.

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  • The Physicians’ Proposal

    By Brandon Sandine
    AMSA Health Policy State and Local Policy Coordinator

    It’s a simple proposal! And amidst the growing financial and human burden that our current healthcare system induces, it’s the most equitable and economically sensible proposal of all. Everybody in, nobody out. This was the idea that two emphatic physicians concluded some 25 years ago would help alleviate the growing health insurance disparity, and the problems that are associated with lack of insurance, in our country.

    Today the ranks of Physicians for a National Health Program (PNHP) are significantly larger than it was 25 years ago. Yet their realization is still the same. Our country desperately needs to improve access to medical care, for all of its residents, by implementing a universal health insurance program. While national healthcare reform has recently occurred, primarily through The Patient Protection and Affordable Care Act (ACA), approximately 30 million Americans will still remain uninsured. As such, it is imperative that the single-payer agenda passes into legislation.

    At the recent PNHP annual convention this was exactly the focu of discussion. Content at the convention introduced new and old members to changes that the ACA will have on their clinical practice, to how would the House of Representatives Bill 676 - single-payer health insurance - function in our country. For me, an aspiring future physician, it was profoundly influential to see primary care physicians, cardiologists and neurosurgeons all in one room agreeing that their career had fell short of their ideological expectations. Yet, they all knew that a national single-payer healthcare model would significantly decrease the problems most often cited, and increase their personal satisfaction in being apart of healthcare in America.

    This year’s convention was a short reprieve from the daily stresses of the classroom. However, I left with newfound empowerment. Past PNHP president Dr. Claudi Fegan led the concluding remarks from the convention with our paradigmatic slogan, “EVERYBODY IN, NOBODY OUT!”

    If you would like to learn more about Physicians for a National Health Program check out this link. For further information on H.R. 676 read this

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  • Is Healthcare a Right Yet?

    By Vanessa Obas
    AMSA Health Policy Committee - National Policy Coordinator

    Beneath the haze of the government shutdown, the Affordable Care Act (ACA) finally began its open enrollment for government-subsidized health insurance, and the implementation of the law has proven as difficult a road as its passage. In recent weeks, low and middle-income individuals and families experienced technical difficulties and outages with the federally-organized website that has hindered many from enrolling in insurance plans. What’s more, many states, like my home state of Florida, have tried their hand at impeding plan enrollment in their opposition to the ACA. For instance, personnel have been trained to help Americans understand the health care law and navigate the marketplaces. However, in Florida, these navigators have been banned from working on the grounds of county health departments, restricting access to the already-limited number of navigators in the state.

    The passage of the ACA demonstrated that the U.S. accepted what many developed countries had recognized long before: health care as a right not a privilege. Yet, the obstacles created by states like Florida, and the shortfalls of the federally-run website, serve as reminders of the still-existing difficulty in achieving healthcare access for all. The success of open enrollment matters to millions of Americans – insured and uninsured. Many will find themselves needing to drop their existing, inadequate health care plans by January and enroll in plans that meet the newly established minimum standards of coverage. And, of course, there are the millions of Americans looking to the marketplace as their opportunity for less-expensive health care coverage. We can only hope the issues with enrollment will be addressed as even more citizens will need coverage during this period of open enrollment.

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  • The Government Shutdown is Over. What’s Next?

    By Katie Ni
    AMSA Education and Outreach Health Policy Coordinator

    After 16 days of government shutdown, Congress finally voted to raise the debt ceiling and reopen federal agencies, with the support of many Republican Congressmen. The government is now being funded through January 15, and federal employees have at last returned to work and have been promised backpay for their days spent at home.

    So what’s next? Is all well and good in the United States? Well, the debt limit story is not over, but simply postponed. Enforcement of the debt limit will resume on February 7, 2014, setting the stage for another debt conflict next spring. In the meantime, the shutdown resolution deal created a budget conference committee to hash out a long-term spending plan by December 13. Also, Congress must proactively vote to disapprove extending the debt limit, in contrast to the previous voting structure with votes to raise it. Known as the McConnell Rule, this provision takes the debt limit off the table as a bargaining chip in future negotiations; the only way the debt limit would NOT be increased would be if Congress decides to actively prevent it, and has the two-thirds majority needed to overcome a Presidential veto.

    As for the Affordable Care Act, the shutdown was never able to stop the implementation. On October 1st, the health insurance marketplace website was made available for residents of 36 states. The release of was accompanied by technical difficulties that hampered many users’ efforts to enroll in a plan; these glitches are still being worked out. However, about half a million users have successfully completed applications for insurance plans through the site since October 1st, and the open enrollment period will continue until next March. Congress relaxed the deadline for enrollment as it holds a hearing today for the contractors hired to develop the ACA websites. The Republican-led House will host the hearing scheduled to address the failures of the implementation and develop solutions to prevent problems with future enrollment

    While a major crisis has been averted with the ending of the government shutdown, many issues remain, including the budget conference, the debt ceiling, and the full implementation of the ACA. We hope the past month’s events will discourage Congressional stalemates in the future, and encourage bipartisan cooperation that will prevent a repeat shutdown next year.

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  • Historic Day!! #GetCovered

    Today is a historic day! People can now enroll in health care coverage in the Affordable Care Act insurance exchanges! Coverage will begin on January 1, 2014 but you must sign up by December 15th. 

    No doubt you’ve been starting to hear about the new Health Insurance Marketplace, a key part of the health care law, the Affordable Care Act (ACA). The ACA will expand coverage to millions of uninsured people through health insurance marketplaces that will be open for business on October 1st. But you probably still have questions. Like what is the Marketplace, and can you and your patients really get health insurance? Your patients will have questions too. And we’ve got answers for you and your patients.

    What is the Marketplace and where do I find it?

    Starting this fall, Health Insurance Marketplaces will help eligible patients buy new health insurance plans that fit their needs and their budgets. The Marketplace is kind of a one-stop shop for consumers to research, compare, and buy different plans. The marketplaces are not private insurance companies or government-run health plans. The Marketplace will be open from October 1, 2013 through March 31, 2014. If you sign up by December 15, 2013 you will have coverage starting January 1, 2014.

    Marketplaces are state-by-state, so find yours here.

    Have more questions? Find more information here

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  • One step forward two steps back

    Whitney McFadden
    AMSA National Health Policy Coordinator

    Ran Tao
    AMSA Associate National Health Policy Coordinator

    The pace of progress is slow and incremental undermining of the ACA have begun. The Energy and Commerce Committee passed a piecemeal bill last week (H.R. 1206) to amend an important component of the ACA regulating insurance company profits. 

    The new bill adds another layer of complexity to the medical loss ratio (MLR), a measure created by the ACA to monitor the percentage of premiums spent on medical coverage vs. administrative overhead. Currently the ACA mandates insurance companies to have a MLR of 80%, that is 80 cents of every dollar must be spent on medical claims and improving quality of care. However, the infrastructure of insurance companies is a delicate balance, one that rests on making enough profit to pay administrators and insurance brokers alike.

    The original ACA policy proclaimed insurance broker and agent commission covered by the 20% allocated for administrative costs. It takes no expert to see that this shift in money balance will greatly restructure insurance company administration and force them to look critically at the business model. In the meantime, the house has decided to take on this burden and change the policies initially created to protect the patient. Insurance broker commission will no longer come from the 20% dedicated to administrative costs. This will shift the burden of cost to the other 80%, taking more money away from actual healthcare and putting it back in the pockets of the company itself.

    The question then becomes, how much value does the ACA place on protecting patient premiums for medical care? If the solvency of insurance companies depends on changing this 80/20 balance, then we must either re-evaluate our definition of MLR or the way we are providing health coverage.

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  • SCOTUS: Day 2

    Check out C-SPAN's coverage of the Supreme Court Hearings. 

    Today, the Court will hear testimony regarding the individual mandate portion of the law, which requires virtually all Americans to obtain health insurance or pay a fine. The law goes into effect on January 1, 2014. The Court will consider whether the individual mandate is in fact constitutional.

    What do you think? Does Congress have the power to enact a law requiring everyone in the United States to buy health insurance?

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