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January 3, 2017

Headlines in Health Policy 570dce7f-2262-4e5c-91e6-05a562e6e55f

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QUOTABLE

“The Obamacare repeal resolution will be the first item up.” 

—Senate Majority Leader Mitch McConnell

"The votes in early January are simple: Do you want to go back to the days when 20 million people didn't have insurance and insurance companies were running our health care system? Or do you want to fix what we have?" 

—Sen. Chris Murphy (D-Conn.)


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Repeal and Replace

  • Congress Ushers in New Era of All-Republican Rule: Associated Press by Donna Cassata—On Tuesday at noon, with plenty of pomp and pageantry, members of the 115th Congress will be sworn in, with an emboldened GOP intent on unraveling eight years of President Barack Obama's Democratic agenda and targeting massive legacy programs from Franklin D. Roosevelt and Lyndon B. Johnson such as Social Security and Medicare....First up for Republicans is repeal of the health care law, expediting the process for scrapping Obama's major overhaul but holding off on some changes for up to four years. The only obstacle to the far-reaching conservative agenda will be Senate Democrats who hold the power to filibuster legislation, but even that has its political limitations. Twenty-three Democrats are up for re-election in 2018, including 10 from states Trump won, and they could break ranks and side with the GOP

  • Dems, GOP Get Ready for Showdown on ObamacarePolitico by Jennifer Haberkorn & Rachana Pradhan—Republicans return to Washington with the power to make good on their nearly seven-year-old promise to repeal Obamacare. The long-standing fight over Obamacare's repeal is about to become a battle over messaging. Instead of doing a victory lap after they start dismantling the law in January, Republicans will not only have to rewrite a massive law, they'll have to quickly sell the public on the idea that their plan is cheaper and won't leave millions of Americans uninsured. An early look at the GOP's plans shows that they will be pushing the idea that "universal access" to health insurance is better than mandatory "universal coverage," which has been the foundation of Obamacare.

  • These Coal Country Voters Backed Trump. Now They’re Worried About Losing Obamacare: Washington Post by Greg Sargent—Last night, CNN aired a terrific segment on people from coal country who voted for Donald Trump — but are now worried that his vow to repeal Obamacare will deprive them of crucial protections that enable them to stay afloat financially. This dovetails with other reporting that suggests a lot of Trump voters may be harmed by repeal of the law….The Wall Street Journal recently demonstrated that rural, aging, and working-class counties that went overwhelmingly for Trump also showed large drops in the uninsured rate. Similarly, Gallup-Healthways data shows that among non-college, lower income whites—a Trump demographic—the uninsured rate has dropped 10 percentage points.

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The Potential Repercussions

  • After Obama, Some Health Reforms May Prove Lasting: New York Times by Abby Goodnough & Robert Pear—The Affordable Care Act is in extreme peril, and Mr. Obama will meet with congressional Democrats at the Capitol on Wednesday to try to devise a strategy that can stave off the quick-strike repeal of the health law that Republicans plan for the opening months of the Trump administration. But the transformation of American health care that has occurred over the last eight years — touching every aspect of the system, down to a knee replacement in the nation’s heartland—has a momentum that could prove impossible to stop. Expanding insurance coverage to more than 20 million Americans is among Mr. Obama’s proudest accomplishments, but the changes he has pushed go deeper. They have had an impact on every level of care—from what happens during checkups and surgery to how doctors and hospitals are paid, how their results are measured and how they work together.

  • Hospitals in Safety Net Brace for Health Care Law’s Repeal: New York Times by Abby Goodnough—Before the health law, the hospital had to absorb the cost of caring for many uninsured patients like Mr. Colston. Now, with President-elect Donald J. Trump and the Republican-controlled Congress vowing to dismantle the law, Temple and other hospitals serving the poor are bracing for harsh financial consequences that could have a serious effect on the care they provide. Since the election, hospitals have been among the loudest voices against wholesale repeal of the health law… Here in Pennsylvania, where the health law has brightened the financial outlook of hospitals statewide, many are scrambling to assess how repeal would affect their bottom line and the patients they serve. Still, even hospitals serving affluent populations have reason to be nervous about a future without the health law.

  • Under Obamacare, Fewer People Skipped Doctors’ Visits Because of Cost: Washington Post by Carolyn Y. Johnson—After the implementation of the Affordable Care Act, people in a majority of states were less likely to skip doctors' visits because of concerns about the cost of care, according to a new report that attempts to paint a snapshot of the effects of the law as its days are numbered.

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Health System Change

  • Cornerstone: The Rise and Fall of a Health Care Experiment: New York Times by Reed Abelson—HIGH POINT, N.C.—Cornerstone Health Care, a large physician group here, made a big bet a few years back: It would get paid based not on how many procedures its doctors performed, but on how effectively they treated their patients. There’s a term for this: an accountable care organization. The idea is to make doctors more mindful of costs—Is that test really necessary?—while keeping people healthier and away from pricey hospital visits. In recent years, several hundred accountable care experiments have sprung up nationwide. And by early 2015, Cornerstone’s bet looked like a winner. But the confirmation proved premature. Within weeks of Ms. Burwell’s announcement, an exodus of doctors had begun at Cornerstone. In the months that followed, nearly 70 of its 228 doctors left, many attracted by the chance to make more money at area hospitals. Cornerstone’s experience illuminates just how tough it can be to overhaul the way medical care is delivered, even when the change is a priority for doctors and the government. As Cornerstone learned, hospitals and doctors frequently fight the changes, because they believe they can make the most money under a fee-for-service model.

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Medicaid Overhaul?

  • With Trump's Victory, GOP Hopes to Overhaul Medicaid Associated Press by Christina A. Cassidy—When President-elect Donald Trump takes office in January, Republicans will have the opportunity to pull off something they have wanted to do for years—overhaul Medicaid, the program that provides health care to tens of millions of lower-income and disabled Americans. Any changes to the $500 billion-plus program hold enormous consequences not only for recipients but also for the states, which share in the cost. Trump initially said during the presidential campaign that he would not cut Medicaid, but later expressed support for an idea pushed for years by Republicans in Congress—sending a fixed amount of money each year to the states in the form of block grants. Backers say such a change in the Medicaid formula is one of the best ways to rein in spending, but critics say big cuts would follow

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High U.S. Health Care Spending

  • The U.S. Spends More on Health Care Than Any Other Country. Here’s What We’re Buying: Washington Post by Carolyn Y. Johnson—American health-care spending, measured in trillions of dollars, boggles the mind. Last year, we spent $3.2 trillion on health care—a number so large that it can be difficult to grasp its scale. A new study published in the Journal of the American Medical Association reveals what patients and their insurers are spending that money on, breaking it down by 155 diseases, patient age and category--such as pharmaceuticals or hospitalizations. Among its findings: Chronic—and often preventable—diseases are a huge driver of personal health spending. The three most expensive diseases in 2013: diabetes ($101 billion), the most common form of heart disease ($88 billion) and back and neck pain ($88 billion). Yearly spending increases aren't uniform: Over a nearly two-decade period, diabetes and low back and neck pain grew at more than 6 percent per year—much faster than overall spending. Meanwhile, heart disease spending grew at 0.2 percent.

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http://www.commonwealthfund.org/publications/newsletters/headlines-in-health-policy/2017/jan/january-3-2017