Research: Consumer-driven health plans help ‘bend the cost curve’

Aesculap-serpentineHow do we reduce unnecessary or wasteful health care spending so that we can increase health care access and reduce the cost of health care? This is a policy question that has vexed policymakers for many years. But new research suggests that market innovations such as health savings accounts paired with high-deductible insurance coverage (collectively referred to as “consumer-driven health plans,” or CDHPs) may hold part of the answer.

The study, just published by the National Bureau of Economic Research, looked at a dataset of 13 million individuals employed at 54 “large U.S. firms” to see how making CDHPs available to employees influenced health care spending and costs. The researchers note that “there is robust empirical evidence” from previous studies that CDHPs “effectively incentivize patients to change their health care use and reduce costs in the first year” by reducing spending between 5 and 24 percent, according to past research. But, they continue, “the effects of CDHPs on spending in the longer term are … ambiguous and the empirical evidence … is limited.”

The researchers also explain how the longer-term CDHP studies also suffer from methodological limitations that make generalizing their results a questionable enterprise. Hence the justification for their study, which looked at health care spending up to three years after CDHPs are offered by employers to their employees and used better data than the previous studies, with a stronger statistical methodology.

The study found “that spending is reduced … in all three years” after an employer in their data began offering CDHPs to their employees. Read more

Major health care reform bills to be heard in committee Wednesday

On Tuesday, two significant health care reform bills came out of the House Rules Committee.

•        SB 164 (1st Subst.) – Access to Health Care Amendments, sponsored by Sen. Brian Shiozawa, is Governor Herbert’s proposed “Healthy Utah” plan.

•        HB 446 – Extension of Primary Care Network and Medicaid Benefits Under Existing 70/30 Federal/State Cost Sharing Amendments is the “Utah Cares” program proposed by Rep. Jim Dunnigan.

The two bills have been assigned to the House Business and Labor Committee, where they will be the only two items on the agenda when the committee meets on Wednesday evening, March 4, at 6 p.m.

Assignment to this committee is consistent with the pattern established several years ago subsequent to the passage by the U.S. Congress of the “Patient Protection and Affordable Care Act,” generally known as Obamacare. And, as I have observed through lengthy personal association with the Legislature’s Health Reform Task Force, health care reform related bills are assigned to and considered by this committee. Recent examples include last year’s HB 141 – Health Reform Amendments (2014) and HB 160 – Health System Reform Amendments (2013). Additionally, it is as appropriate for a bill to go to a committee that interacts with entities that deal with liabilities and costs as it is for a bill to be sent to a committee that interacts with entities that reap benefits associated with proposed legislation.

Sutherland has steadfastly opposed the “Healthy Utah” proposal. The Institute sees significant merit in the proposed “Utah Cares” bill. Readers are encouraged to familiarize themselves with these bills and communicate their views with their elected representatives.

King v. Burwell and Healthy Utah – Sutherland Soapbox, 3/3/15

800px-United_states_supreme_court_buildingThis post is a transcript of a 4-minute weekly radio commentary aired on several Utah radio stations. The podcast can be found at the bottom of this post.

Tomorrow [March 4], a case will be argued before the U.S. Supreme Court that may impact or even derail the viability of Obamacare and Governor Herbert’s proposed Healthy Utah plan, which the Congressional Research Service says will implement Obamacare’s Medicaid expansion provision in Utah.[1] The name of that court case is King v. Burwell.

The King v. Burwell case hinges on how the ACA governs federal subsidies of health insurance premiums, which are currently offered through Obamacare’s insurance exchanges. The plaintiffs argue that the ACA’s plain language says the only legal way for the federal government to subsidize health insurance is through a state-run exchange. If this is true, then the Obama administration has been illegally subsidizing health insurance purchases for millions of Americans enrolled in the federally run insurance exchange. The federal government, on the other hand, argues that the full text of Obamacare makes it clear that they can legally subsidize health insurance in both state and federal exchanges.

The ramifications of the Supreme Court’s ruling could be quite significant. Politically, if the court rules for the plaintiffs, President Obama would be in the uncomfortable position of having his administration’s implementation of his signature policy achievement ruled illegal. Additionally, to resolve the issue he would have to either convince a bunch of Republican governors and state legislatures to create insurance exchanges, which they oppose, or he would have to negotiate a fix with a Congress that wants to repeal the law outright.

Beyond political ramifications, though, people across the spectrum have pointed out that without the insurance subsidies, the federal exchange would probably cease to function in the 34 states that rely upon it, including Utah. Without federal subsidies, the vast majority of the 11 million federal exchange customers – including more than 100,000 Utahns – will no longer be able to afford health insurance. And without a broad customer base, health insurance providers are likely to pull out of the exchange altogether, potentially leaving few, if any, insurance options for any customers that remain.

Amazingly, with all of these political and policy impacts, the Obama administration has told Congress that they have no contingency plan should the ruling go against them. Read more

Testimony on SB 164 (Medicaid expansion)

sutherland file pictures 007Testimony presented by Derek Monson, director of public policy, Sutherland Institute, on Feb. 11, 2015, before the Senate Health and Human Services Committee of the Utah Legislature regarding SB 164 (Access to Health Care Amendments):

Thank you, Mr. Chair and members of the committee. I am Derek Monson, policy director for Sutherland Institute, and I appreciate the opportunity to present our viewpoint on this important issue to you.

I would like to draw your attention to what we think is a basic policy issue regarding Senator Shiozawa’s bill. That is its impact on the people for whom the Medicaid program was actually designed to serve: disabled Utahns and low-income single parents and children.

Both thoughtful analysis and fact suggest that Sen. Shiozawa’s bill will increase the difficulties and suffering of the more than 300,000 disabled Utahns and low-income single parents and children currently in Medicaid. This is not a partisan or ideological issue. While Sutherland recognizes this problem, so do nonpartisan research organizations that argue in favor of Medicaid expansion, such as the RAND Corporation.

Neither is this just a theoretical question. In Oregon, so many people were added to the ranks of the insured through Medicaid expansion, basically overnight, that doctors and hospitals were forced to “lock out” Medicaid patients and make them “wait months for medical appointments,” as reported by the Associated Press. And in Arkansas, which expanded Medicaid using private insurance subsidies just like Healthy Utah envisions, a legislative committee heard testimony last April from state officials that providers are more “anxious” to serve newly privately insured patients than traditional Medicaid patients.

And why shouldn’t they be? In Arkansas as well as in Utah, the typical private insurance policy pays providers better than Medicaid does. And as basic economics teaches us, people respond to price incentives. The enactment of Healthy Utah clearly says to providers that they ought to prioritize the health care needs of the estimated 89,000 Medicaid expansion enrollees over the needs of the 300,000 single mothers, disabled Utahns and children left behind in traditional Medicaid. Utah’s most vulnerable will find it more difficult to find a doctor, and they will suffer longer waiting in line for needed surgeries and more intensive health care services.

Good public policy, on the other hand, would put traditional Medicaid enrollees on the same health care access footing as Medicaid expansion enrollees and everyone else, rather than excluding them and by so doing making their lives worse. Additionally, good public policy would not say to uninsured Utahns that we intend to care for their needs, only to toss them into the street the moment Washington, D.C., gets jittery about their finances. We don’t think that reflects the Utah values of providing service and helping to our neighbors in need, even when it’s difficult to do so.

In short, if “doing the right thing” means putting Medicaid expansion on the backs of disabled Utahns, single mothers and their children, then this is the bill for you. If, on the other hand, you think that serious public policy proposals should recognize and address the negative impacts they are likely to have on Utah’s most vulnerable, then I would encourage you to not vote in favor of SB 164 until it at least includes some attempt to address this critical issue.

Thank you.

Medicaid: A disconnect between debate and reality, Sutherland Soapbox, 2/3/15


Photo: Caremate

Photo: Caremate

This post is a transcript of a 4-minute weekly radio commentary aired on several Utah radio stations. The podcast can be found at the bottom of this post.

I want to discuss a topic of significant political news reporting this week: how should Utah deal with Medicaid expansion, as allowed and encouraged by Obamacare.

The proposals for expanding Utah’s Medicaid program being considered by the Utah Legislature are varied, including a plan for full Medicaid expansion using the traditional Medicaid program; Governor Herbert’s alternative plan for full Medicaid expansion under Obamacare using private health insurance; and the Health Reform Task Force recommendation to avoid Obamacare altogether and opt for a targeted expansion to the “medically frail.”

The defining feature of the debate can be summed up in one word: “complexity.” Health care generally is an extremely complex policy issue – whether morally, fiscally, economically or politically. Add to that the fact that we’re talking about health care for low-income Utahns, and the fact that the debate stems from an unpopular law named after a liberal sitting president, and the complexity and difficulty increases exponentially.

It should come as no surprise then that finding the right way forward has been hard to come by. Simply put, there is no easy answer to the question of Medicaid expansion. For our part at Sutherland, we think the federal involvement and restrictions on Medicaid policy make this herculean task nearly impossible, because the feds shoot down the ideas that hold the most potential to generate support.

But an even bigger problem with Medicaid policy and debate is the misguided focus on all sides about what Medicaid is and should be. First and foremost, Medicaid is and should be a response to poverty in society – an anti-poverty program, not a health care program. Another way of putting it is that we created Medicaid in the first place because poverty made health care unaffordable for some, not as a response to issues of public health.

But Medicaid policy and debate ignores this fundamental issue. Instead of trying to address the poverty of the poor, the debate focuses on improving health care for the poor. As a result, Medicaid policy obsessively focuses on the symptoms of the problem, such as access to doctors, payment rates for providers and costs to taxpayers, rather than on the problem itself, which is that poverty makes needed health care inaccessible and unaffordable for low-income Utahns. This disconnect between political debate and human reality drives much of the complexity of Medicaid policy debates, as liberals intuitively understand and focus on the symptoms of poverty and conservatives intuitively understand and focus on the problems created by programs like Medicaid.

A big part of the solution is to recognize and accept that Medicaid should be an anti-poverty program, not a health care program. The latter approach means that Medicaid will be a failure as policy if all it does is provide health care coverage to low-income Utahns, while doing little or nothing to help them get out of poverty. What’s more important, this new approach is likely to be better for society and the common good on all levels.

It is better morally because Medicaid will actually improve the lives of poor Utahns, by helping them get the education, life skills and networks they need to rise out of poverty, rather than naively assuming we’ve solved their problems by cutting a check for their medical bills. It is better fiscally because it provides a financial commitment from taxpayers that lasts only until an individual or family rises out of poverty, rather than an unending entitlement that adds to federal deficits and eats up ever-larger portions of state budgets. It is better economically because it means helping low-income Utahns become more prosperous and economically productive, while limiting the economic resources required to get and keep them in that position. And it is better politically because both liberals and conservatives are voicing understanding of the need to address poverty.

So what does this approach mean for dealing with Medicaid expansion today? It means Utah should focus on a minimal expansion of the current flawed approach to Medicaid, such as the targeted proposal for the medically frail, and then get back to the drawing board to reform Medicaid into a program that uses health care to combat poverty. Only then will we get a Medicaid program that is actually solving real problems, rather than just chasing after the next symptom.

For Sutherland Institute, I’m Derek Monson. Thanks for listening.

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Vaccination: the debate that shouldn’t exist

measlesVaccines have fallen victim to their own success. They have worked so incredibly well that no one remembers the reality of the diseases that vaccines have kept at bay, and instead too many people, out of fear, focus on a very few bad outcomes.

The granddaddy of the anti-vaccine accusations, the infamous Wakefield study from 1998 – which claimed a link between the MMR (measles-mumps-rubella) vaccine and autism – was a fraud.

Unfortunately it gave rise to an anti-vaccine movement, sped on its way by well-meaning parents (and others) with the best of intentions. Alarmed by the rise in autism cases, they looked for ways to reduce the chances of their children being affected by this disorder – especially if they already had family members with autism.

As the mother of an autistic 13-year-old, I empathize utterly. I’ve read many books, considered different treatments, and agonized over what I might possibly have done during pregnancy and birth to trigger autism in my son.

But fraudulent and misguided “science” has resulted in real harm. Resources that had to be spent in debunking this study and its fallout are resources that could not be used to direct scientific research into far more promising avenues. Who knows how much this unnecessary disaster has delayed real answers? How much time, money, effort and emotion have been wasted on this rabbit trail … and how much harm has it caused by casting aspersions on vaccines?

I fear that if parents choose not to vaccinate their children, the choice will ultimately be taken away from everyone. Don’t give the government a reason to mandate vaccinations. Be smart enough to do it of your own volition – and out of compassion for not-yet-vaccinated infants and the very few who really are medically unable to get vaccines.

Medicaid expansion: The moral question — Sutherland Soapbox, 1/6/15

Photo: Caremate

Photo: Caremate

This post is a transcript of a 4-minute weekly radio commentary aired on several Utah radio stations. The podcast can be found at the bottom of this post.

As things stand today, the 2015 Legislative Session is just three weeks away. And while many important issues will be addressed, one that is likely to have more significance and long-term impact than most is the issue of Medicaid expansion.

The question of if, when, and how to expand Utah’s Medicaid program is important on multiple levels. But today I want to focus on the moral level.

The question of Medicaid expansion is important on a moral level because we are talking about the moral imperative we have as human beings to help our neighbors in need gain access to basic health care services. Simply stated, our moral impulses and reasoning will not allow us to sit by and let people suffer needlessly, and history has shown that if civil society and the marketplace are unwilling or unable to step up to provide basic health care for everyone who needs it, the government will. Hence we have one of Utah’s more conservative governors in recent memory proposing to expand Utah’s Medicaid program to the fullest extent under the rules of Obamacare, in the form of the Healthy Utah plan.

In fairness, some supporters of Healthy Utah object to its being called a “full Medicaid expansion” under Obamacare. But when you propose to cover the full Medicaid expansion population with coverage that is comparable in scope to traditional Medicaid, and a main purpose of doing so is to qualify for more generous federal funding offered for full Medicaid expansion, then the simple fact is that you have proposed a full Medicaid expansion plan.

In any case, the supporters of Healthy Utah regularly invoke a moral argument in favor of Medicaid expansion: namely, that we cannot sit by and do nothing to help the 60,000-plus uninsured Utahns that Obamacare has let fall through the cracks. Now that is an important moral consideration, but an incomplete one.  Read more

Health care and a history of misleading the public

President Lyndon B. Johnson

President Lyndon B. Johnson

The government has a long history of misleading the public in order to pass legislation it wants.

For instance, in the 1960s President Lyndon Johnson pressed his allies in Congress to suppress the true cost of his big health care legislation, Medicare and Medicaid, in order to garner enough support to get it passed.

According to taped conversations, President Johnson, speaking with Senator Ted Kennedy in 1962, describes how suppressing costs was vital to passing his bill, because if voters and their representatives in Congress knew how much the bill would actually cost over the long term they would be outraged,

A health program yesterday runs 300 million, but the fools had to go to projecting it down the road five or six years. And when you project the first year, it runs 900 million. Now I don’t know whether I would approve 900 million the second year or not. I might approve 450 or 500. But the first thing Dick Russell comes running in, saying my God, you’ve got a billion dollar program for next year on health, therefore I’m against any of it now. Do you follow me?

Not surprisingly, the projections the government made were wildly off. In 1967 the House Ways and Means Committee predicted Medicare would cost $12 billion in 1990. The actual cost was $98 billion.

Today, we find that something similar to LBJ’s dishonesty has happened with President Obama’s Affordable Care Act. For years the president repeated the refrain, “If you like your plan, you can keep your plan.” Once it became clear that wasn’t true, the president apologized to the millions of Americans who lost their insurance plans because of Obamacare.

Click here to read the rest of this post at Utah Citizen Network.

Sutherland Institute supports Health Reform Task Force recommendations

Sutherland Institute today released the following statement regarding the legislative Health Reform Task Force’s actions regarding Medicaid expansion:

Sutherland Institute supports the decision of the Health Reform Task Force to recommend an approach to Medicaid expansion that focuses on the needs of the medically frail in Utah. Most importantly, the Task Force’s recommended approach addresses the human question by striking a prudent balance of meeting the most pressing health care needs of uninsured Utahns and protecting health care access for the disabled individuals, low-income single parents and children for whom Medicaid was designed.

Additionally, the Task Force’s recommended approach answers the human question in a fiscally reasonable and conservative way: making a significant investment of taxpayer dollars without relying on “promises” of federal funding that are mathematically unrealistic due to the federal debt situation. Given that other states which have adopted a full Medicaid expansion plan have faced unexpectedly high costs – requiring states to reallocate funds that would otherwise go to public schools, road and highways or criminal justice – taking a more cautious approach to Medicaid expansion is a reflection of wise fiscal stewardship.

Sutherland encourages policymakers to continue along the path the Task Force has recommended. We look forward to continuing to engage this decision-making process as it moves forward.

Sutherland commends Gov. Herbert for not calling Medicaid special session

Sutherland Institute commends Governor Herbert for his wise and prudent decision not to call a special session to consider his proposed Healthy Utah Medicaid expansion plan. The question of whether Utah should add a second, private-insurance tier to its Medicaid program for the sake of federal funding is a momentous one. This decision has significant implications and consequences for the most vulnerable Utahns – the single parents, disabled individuals, and children who would be left behind in the lower tier of traditional Medicaid coverage. Additionally, given the long-term fiscal implications of creating a new entitlement program such as Healthy Utah, this decision ought to be considered within a budget process that sheds light on whether future state funding for Healthy Utah could be better utilized if instead spent on essential roles of government such as higher education, transportation, and corrections.

Despite calls from some to short-circuit thoughtful consideration of the details and impacts of Healthy Utah because they believe the decision merits no further evaluation, Governor Herbert made the correct decision and should be commended for recognizing the importance of a thoughtful process for making sound public policy. Sutherland looks forward to continuing this important policy dialogue where it ought to be engaged: in a general session of the Utah Legislature.