Category Archives: politics

The CO-OP program, 5 years later

by Allan Joseph

Most PM readers can remember the heated debate over the public option that took place half a decade ago (!) during the ACA’s drafting — and are well aware that there is no public option in the law. What many don’t remember, however, is what was put into the law instead of the public option — the Consumer Operated and Oriented Plan program, or the CO-OPs.

I’ve been working with Dr. Eli Adashi, the former medical-school dean here at Brown, for some time now looking into the CO-OP program, which is a fascinating, under-studied provision of the law. We published a Viewpoint in JAMA that went online this week (ungated) that summarizes the CO-OP program and looks towards its future. Go take a look!

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Allan Joseph is a second-year medical student at the Warren Alpert Medical School of Brown University, where he is pursuing an MD/MPH. You can follow him on Twitter @allanmjoseph.

What are tomorrow’s policy problems?

by Allan Joseph

In a few weeks, my institution is hosting the AMA’s Northeast-region meeting for medical students who are interested in policy and advocacy, among other topics. I’ve been asked to give a presentation on the policy problems of the future, and ways for the attendees to prepare for those problems and to help shape their solutions.

I thought I’d take an informal poll to help guide my talk. So what do you see as the biggest healthcare policy problem of the next 1 year, 5 years, 10 years, and/or 25 years? What can medical students do to prepare for them, and how should physicians shape the solutions?

Send me your answers to any or all of those questions via email, on Twitter, or in the comments below.

Thanks!

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Allan Joseph is a second-year medical student at the Warren Alpert Medical School of Brown University, where he is pursuing an MD/MPH. You can follow him on Twitter @allanmjoseph.

Friday News Dump: Wonkbites

by Adrianna McIntyre 

Just a few wonkbites to go with your Halloween candy hangover. 

  1. A modest proposal. Apparently the CEO of eHealth Inc.—the parent company of ehealthinsurance.com, the largest online seller of health insurance—has offered to “take over the shopping and enrollment process in all 36 federal exchange states — without cost to the taxpayer.” According to the article, the Administration has not offered a response. eHealth and other online brokers have contracted with the feds to play a role in the federally-facilitated exchanges, but having the corporation take on broader responsibilities that require interfacing directly with the data hub seems an unlikely development.
  2. Curing the doc fix. The Senate Finance and Ways and Means committees have drafted a proposal to repeal the Medicare “doc fix” (the sustainable growth rate, to use the vernacular) and freeze payment rates. They would replace it with a value-based program aiming to reward quality over quantity, increasing efficiency in the program. The draft language is light on details, and also seems heavy on incentives for positive behavior, without penalizing practices that are inefficient or of subpar quality.
  3. The trouble with patient satisfaction. Patient perspectives matter, and they’re a useful tool in assessing care quality. But metrics designed to measure satisfaction suffer from a number of shortcomings, not the least of which is conflicts that emerge with patients who exhibit drug-seeking behavior.
  4.  Whatever. Secretary of Health and Human Services Kathleen Sebelius testified before Congress on HealthCare.gov’s October woes. GIFable moments ensued. If 10+ images isn’t your style, here’s the hearing summarized in a single GIF.

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Adrianna is a graduate student in public policy and public health at the University of Michigan.
Follow her on Twitter at @onceuponA or subscribe to the blog.

Friday News Dump: Wonkbites

by Adrianna McIntyre 

There’s more to the news cycle than the shutdown and exchange glitches (but not much).

  1. Is Connecticut enrolling enough bros? While enrollment data for federally facilitated exchanges is sparse (read: nowhere to be found), states setting up their own marketplaces have been more generous. Connecticut reports that nearly a third of their successful applicants have been under 35. If that trend holds, it’s not quite up to par with the Administration’s target; they’ve said they want 2.7 million of the anticipated 7 million enrollees to be young adults—that’s closer to 40%.
  2. Docs dubious of exchanges. A new survey of physician group practices found that majority did not favor the ACA’s exchanges. This sentiment seemed to hinge on uncertainty about how the new insurance products will work, and whether their reimbursements would be competitive. Still, twice as many of the surveyed docs said they were planning to accept the new plans than nix the new customers altogether.
  3. Diagnosis: miscommunication. Though patient safety has improved over past years and decades, it’s still far from perfect. A recent analysis suggests that delays and misdiagnosis in the outpatient setting are pretty much a communication issue—with other providers, labs, etc.— even in the VA, which has a robust EMR system.
  4. The repeal effort that’s just kind of “meh”. A halfhearted effort to repeal the medical device tax has encountered support and resistance from both sides of the aisle. While the tax may not be a stellar policy move, it can’t be repealed without making the ACA more expensive—unless Congress finds other offsets. Repealing it without finding revenue elsewhere would be capitulation to special interests, and could lead to other stakeholders demanding that Congress heed their whims, too.
  5. Preferably before I fly into DC tomorrow. Too much to ask? open_letter

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Adrianna is a graduate student in public policy and public health at the University of Michigan.
Follow her on Twitter at @onceuponA or subscribe to the blog.

Friday News Dump: Wonkbites

by Adrianna McIntyre 

  1. A new study calls fears of rate hikes “overblown.” The nonprofit, nonpartisan Rand Corporation released a report this week on the impact of the Affordable Care Act on premiums. Among other things, the study found that premiums for small businesses (defined here as less than 100 employees) will see premiums 6% lower than they would be without the ACA. Important caveat: that’s overall, and will vary by company and employee.
  2. A “broccoli mandate” might have lowered osteoarthritis. Recent research out of England suggests that sulforuphane, something that occurs naturally in broccoli, Brussels sprouts, and cabbage, might prevent or delay the cartilage destruction of arthritis. (Note that this is not me endorsing a broccoli mandate—friends can attest that I’m hardly a fan of the vegetable.)
  3. The Michigan Senate finally voted on—and passed—a Medicaid expansion bill. The state House passed legislation several months ago, but the Senate put off a vote until after the summer recess. After some brief procedural shenanigans and a last-minute amendment, the bill was approved Tuesday night. The House must concur with the amendments and then receive Governor Snyder’s long-promised signature. After that, my home state will still require a waiver from HHS to proceed, which could face complications.
  4. Fixes for the “unbanked.” One implementation concern that is less politically-fraught—and commensurately less discussed—is that many low-income individuals don’t have checking accounts, which could complicate premium payments (insurers might prefer direct bank transfers). The Obama administration announced Wednesday that exchange plans will be required to accept prepaid debit cards, cashier’s checks, and money orders, in addition to paper checks and direct transfers.
  5. Why drink caffeine when you can just absorb it? I can hardly criticize caffeine-junkies without being a pot, kettle, or both. I’m not sure I’m interested in trading my morning coffee ritual for “Sprayable Energy, though: you spray it directly on your skin, where it’s absorbed into your system. The FDA doesn’t regulate caffeinated products yet—there’s been recent discussion changing that—but this seems similar to caffeine “patches” that have been on the market for a while, without major incident.

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Adrianna is a graduate student in public policy and public health at the University of Michigan.
Follow her on Twitter at @onceuponA or subscribe to the blog.