Blogs  
 
 
 

    Reining in Pharmaceutical Costs-- Karen Van Nuys, Dana Goldman, Ian Spatz
    Most Americans believe that President Trump and the Congress should make lowering the cost of prescription drugs a priority. Read more at The Evidence Base 

    Is investing in research to delay aging of value today?
    -- Dana Goldman

    Pitting himself against the ‘American immortal,’ Ezekiel Emanuel famously wrote an account in The Atlantic about why he hopes to die at age 75. His argument focuses on the decline (both mental and physical) that — he posits — inevitably occurs with age: there is despair, depression, and the social and economic costs on families, the healthcare system, and society-at-large. Why put your family through this when you have already lived a full, vibrant life up until 75, he asks? Read more at The Evidence Base

    How Would the Revised Senate Health Care Bill Affect Individual Market Premiums in 2026 and Over the Long Run?-- Matthew Fielder and Loren Adler
    On Thursday, the Congressional Budget Office (CBO) published an analysis of an updated version of the Better Care Reconciliation Act (BCRA), Senate Republicans’ health care legislation, including how the BCRA would affect individual market premiums. Read more at The Evidence Base

    Requirement to Maintain a “Single Risk Pool” Would not Contain Effects of Cruz’s Proposal-- Matthew Fiedler
    Last Thursday, Senate Republicans unveiled an updated version of the Better Care Reconciliation Act (BCRA), including a proposal from Senator Ted Cruz that would relax a range of regulations on individual market insurance plans introduced in the Affordable Care Act (ACA).  Read more at The Evidence Base

    On July 12, we examined how the Better Care Reconciliation Act of 2017 (BCRA) discussion draft would affect people’s total spending on covered health care services, with the goal of providing a full picture of health care costs for consumers purchasing coverage in the individual market under the BCRA as opposed to current law. The analysis that follows updates this examination for the revised legislation made public on July 20 (“BCRA 2.0”). Read more at The Evidence Base

    This is how Congress could create a bipartisan health-care bill-- Paul Howard and Dana Goldman
    With Republican hopes to quickly "repeal and replace" Obamacare dashed in the Senate, Congress and the Trump Administration can take a much-needed time out to consider a common-sense reboot that can unite the party's factions-- and even attract support from across the aisle. Read more at MarketWatch
     

    How the BCRA Would Impact Enrollee Costs, According to your Age-- Loren Adler and Paul Ginsburg

     Much attention has focused on how the recently-introduced Senate Republican health care bill – the Better Care Reconciliation Act of 2017 (BCRA) – would impact health insurance premiums, both before and after accounting for lower subsidies, and patient cost-sharing in the individual market. Read more at The Evidence Base


    Sen. Cruz’s Proposed Change to Senate Health Care Bill Would Undermine Protections for Enrollees with Significant Health Care Needs—Matthew Fiedler

     Senate Republicans are considering an amendment to the Better Care Reconciliation Act (BCRA) proposed by Sen. Ted Cruz that would relax a range of regulations on individual market insurance plans introduced in the Affordable Care Act (ACA).  While no formal legislative language has been introduced, Cruz’s proposal would allow insurers that offer at least one ACA-compliant plan to offer “non-compliant” plans that do not abide by ACA regulations. Read more at The Evidence Base

     


    Health Care's Crushing Lack of Competition-- Martin Gaynor, Farzad Mostashari and Paul Ginsburg
    No matter how it resolves, the fiercely partisan debate over repealing and replacing the Affordable Care Act will not solve America’s true health care crisis. Indeed, a key reason why expanding coverage is so hard is that health care services cost so much, making insurance premiums unaffordable to many. Read more at Forbes

    How Would the Senate's Health Care Bill Affect Individual Market Premiums? -- Matthew Fielder and Loren Adler
    On Monday, the Congressional Budget Office (CBO) published a comprehensive analysis of the Better Care Reconciliation Act (BCRA), Senate Republicans’ Affordable Care Act repeal legislation. While many reactions to the CBO analysis focused on how the BCRA would affect insurance coverage, the bill’s effects on individual market insurance premiums have also received considerable attention. Read more at The Evidence Base

    Changes to State Innovation Waivers in the Senate Health Bill Undermine Coverage and Open the Door to Misuse of Federal Funds-- Jason A. Levitis
    On June 22, Senate Republicans released their much-awaited health reform bill, the Better Care Reconciliation Act of 2017 (BCRA). Much attention has rightfully focused on the bill’s myriad changes to the Medicaid program and to subsidies for the purchase of private insurance. But the legislation also makes potentially highly impactful changes to state innovation waivers, which are included in section 1332 of the Affordable Care Act (ACA). Read more at The Evidence Base

    Like the AHCA, the Senate's Health Care Bill Could Weaken ACA Protections Against Catastrophic Costs-- Matthew Fielder
    On Thursday, Senate Republicans unveiled the Better Care Reconciliation Act (BCRA), its Affordable Care Act (ACA) repeal bill. One provision of that legislation would greatly expand states' ability to waive a range of provisions of federal law that affect health insurance. Read more at The Evidence base

    Take Me Out to the Pill Game-- Dana Goldman and Darius Lakdawalla
    For perspective on the national angst over drug prices, let's pay a visit to the ballpark. The average Major League Baseball player earns an annual salary of more than $4 million (plus $100 a day in meal money)- far more than it takes to lead a comfortable, well-appointed life. Read more at The Wall Street Journal 

    Pricing Away the Cures-- Neeraj Sood
    As Senate Republicans prepare their version of healthcare reform, it appears unlikely that drug pricing will get that much attention. At a recent Senate health committee hearing on drug costs, for example, discussion quickly veered off into politically charged questions of insurance access and closed door negotiations over repeal of Obamacare. Read more at US News & World Reports

    Follow the Money: The Flow of Funds in the Pharmaceutical Distribution System-- Neeraj Sood,
    Tiffany Shih, Karen Van Nuys, and Dana Goldman
    About 10 percent of all health care spending is on prescription drugs, and the spending is growing at a rapid rate. This has prompted calls for government intervention to regulate drug prices or otherwise control their rapid increase. But any intervention should be predicated on a clear understanding of the economic forces that drive price increases, and the parties responsible for them. Read more at The Evidence Base

    Value-based drug pricing makes sense, but is difficult to pull off-- Dana Goldman and Anupam Jena
    It's hard to not like the notion of value-based pricing for prescription drugs. It aims to ensure that the prices we pay for drugs reflect the benefits they provide, either in terms of longer life or better quality of life. And what could be more American than letting the market determine the right price through the intersection of demand and supply? Read more at The Evidence Base

    Healthcare Reforms are Real Prescription for American Economic Growth-- Leonard Schaeffer, Dana Goldman
    Warren Buffet was at his oracle best during the recent Berkshire Hathaway annual meeting where he took on American business leaders' desire for tax cuts. Businesses are wrong to blame taxes for strangling American competitiveness, he said. The real culprit is healthcare costs. Read more at The Hill.

    Why America Needs a 'Do-Over' on Medicaid Reform-- Darius Lakdawalla
    One of the most important pieces of the newly passed House health care bill is a possible US$800 billion cut over 10 years to Medicaid, the federal program designed to provide insurance cover to the poor. Read more at The Evidence Base.

    Value-Based Pricing For Pharmaceuticals In The Trump Administration-- Rachel Sachs, Nicholas Bagley, and Darius Lakdawalla

    Everyone seems to agree: Drug prices are too damn high. Scandalous prices for new drugs and enormous price hikes on old drugs have focused public ire on the pharmaceutical industry. A bipartisan consensus has emerged that something must be done to tackle drug prices. Read more at Health Affairs Blog

    A Good Deal For Eliminating Hepatitis C: Saving Money And Lives-- Neeraj Sood, Gillian Buckley, and Brian Strom
    The conundrum of hepatitis C is well known. The virus kills more than 20,000 Americans each year, more, according to Centers for Disease Control and Prevention, than the other 60 infectious causes of death combined. A cure is in hand, but is out of reach for many because it costs tens of thousands of dollars per patient. The problem is most acute in state Medicaid programs and prisons, where 700,000 people need treatment but only 20,000 a year will get it. The price controls some have asked for would make treatment affordable, but would also be likely to chill innovation in pharmaceutical companies, the very innovation that benefits society by producing such remarkable drugs. Read more at The Evidence Base

    To Promote Stability in Health Insurance Exchanges, End the Uncertainty Around Cost-Sharing and Other Rules-- Erin Trish, Loren Adler, and Paul Ginsburg
    On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released its first set of regulations affecting the health insurance exchanges created by the Affordable Care Act (ACA) under the Trump administration. In the regulations, CMS indicated that the rule “finalizes changes that will help stabilize the individual and small group [health insurance] markets.” Read more at The Evidence Base

    How Should The Trump Administration Handle Medicare’s New Bundled Payment Programs?-- Tim Gronniger, Matthew Fiedler, Kavita Patel, Loren Adler, and Paul B. Ginsburg
    Secretary of Health and Human Services (HHS) Dr. Tom Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma face significant decisions across a range of programs in the first half of 2017. Read more at The Evidence Base

    How Expanding the Role of Pharmacists Lowered Readmissions and Costs in One California Community-- Jeffrey McCombs
    Several factors suggest that expanding the practice of clinical pharmacy can significantly improve health care outcomes. Read more at The Evidence Base

    The Shifting Determinants of Young-Adult Homeownership Before and After the Great Recession-- Julie Zissimopoulos and Patrick Simmons

    The Great Recession and housing bust dramatically altered the course of U.S. housing and mortgage markets. After the recession, depressed residential construction, falling home prices, tight mortgage credit, and retreating homeownership replaced the ebullient conditions of the decade-long housing boom. Read more at Fannie Mae

    An Obamacare Replacement That Will Actually Work--Joel Hay
    Obamacare was never popular with most Americans, faces death spiral health plan premiums, is fiendishly complex, tries to do too much for too many people and has zero bipartisan support. But the Congressional Republican Obamacare replacement doubles down on precisely the part of the Affordable Care Act that is failing, the private individual health plans, while it phases out the part that seems to be working, the Medicaid expansion. Read more at The OC Register

    Sky-High Drug Prices for Rare Diseases Show Why Orphan Drug Act Needs Reform-- Dana Goldman and Jay Bhattacharya
    When Marathon Pharmaceuticals announced in February it would market a drug for treating Duchene muscular dystrophy for US$89,000 a year, the negative reaction was so intense that the company immediately suspended the rollout. Read more at The Conversation and The Evidence Base

    How will the House GOP Health Care Bill Affect Individual Market Premiums-- Loren Adler and Matthew Fiedler
    Earlier this week, the Congressional Budget Office (CBO) published a comprehensive analysis of the American Health Care Act, which is currently being considered by the House of Representatives. Read more at Brookings and The Evidence Base

    Expect the CBO to estimate large coverage losses from the GOP health care plan -- Loren Adler and Matthew Fielder

    On Wednesday a pair of House Committees began considering Republicans’ Affordable Care Act (ACA) repeal legislation, the first formal step toward consideration of that legislation by the full House of Representatives. Congressional Budget Office (CBO) estimates of the effects of this legislation are not yet available, and it appears they will not be available until after both committees have voted on the bill. Read more at The Evidence Base

    House plan to replace Obamacare 'has Republican DNA,' especially regarding mandate -- Geoffrey Joyce
    Among Obamacare’s many provisions, none was more galling to Republicans than the individual mandate, which required Americans above a certain income to buy insurance. It was the subject of a lawsuit that went to the U.S. Supreme Court – and survived. Read more at The Conversation

    How to Insure Everyone At A Reasonable Cost -- Kip Hagopian and Dana Goldman
    While Republicans are focused on repealing the Affordable Care Act (ACA), uncertainty swirls around its replacement. The ideas offered so far are complicated, quite difficult politically, and don't come close to achieving Donald Trump's goals of insuring everyone- including those with pre-existing conditions- at affordable prices. Read more at Forbes.

    How Republicans and Democrats can both keep their promises on health care-- Darius Lakdawalla and Anup Malani
    Republicans who want to repeal the Affordable Care Act (ACA) emphasize the importance of patient choice and market efficiency. Democrats opposing repeal focus on the need to protect the most vulnerable. As economists, however, we reject the false choice between efficiency and justice. Read more at The Conversation.

    Do you know what the Affordable Care Act does? Here's a primer to help -- Darius Lakdawalla and Anup Malani
    The Affordable Care Act (ACA), or "Obamacare," has generated controversy from its inception. Republicans vow to repeal it. Democrats vow to defend it. Yet, unfortunately, many ordinary Americans seem not to know what it does or why some people want to reform it. What does the ACA actually do? Read more at The Conversation.

    California provides model to replace the Affordable Care Act-- Leonard D. Schaeffer and Dana Goldman
    The new administration and Congress are under intense pressure to craft a market-based alternative to the Affordable Care Act. It won't be easy. To achieve the financial stability required to make the market work, reformers should heed some important lessons from California. Read more at the Sacramento Bee.

    Alzheimer's-preventing drugs may already exist---we just can't test them- Julie Zissimopoulos

    The search for drugs to prevent or delay Alzheimer’s disease has been a decades-long exercise in frustration, with promising candidate after promising candidate coming up short. A drug we already have on hand that’s highly effective at something else may stop Alzheimer’s — but we are nowhere close to getting it tested for that purpose and into the hands of patients. Read more at STAT

    We Can Change Medicare Without Hurting Americans-- The Answer Lies in this Plan- Neeraj Sood
    In the debate about the future of American health care, House Speaker Paul Ryan (R-Wisc.) and a few allies want to examine new payment methods for Medicare, including vouchers, as a way to hold down costs. Read more at MarketWatch

     

    Stopping Surprise Medical Bills: Federal Action is Needed- Paul Ginsburg
    Surprise medical bills occur when patients cannot avoid being treated by providers outside their health plan’s contracted network—either because the provider is not chosen by the patient, for example the emergency department physician or the anesthesiologist assisting a surgery, or because patients are not even aware that the provider is involved in their care, such as a pathologist examining a biopsy.  Read more at Health Affairs Blog


    What Medicare Advantage's Success in Delivery Post=Acute Care Means for Medicare Reform- Neeraj Sood
    When two patients with similar characteristics are admitted to the same hospital for the same health condition, but one has Medicare Fee-for-Service (FFS) coverage (where services are paid for à la carte) and the other is in a Medicare Advantage (MA) plan (private insurers who are paid a fixed amount per enrollee), it turns out that their hospitalization and post-hospitalization costs and outcomes are generally different. That’s what a recent study published in Health Affairs by Neeraj Sood and coauthors found. Read more at The Evidence Base

    Why Risk Adjustment is a Crucial Component of Individual Market Reform- Erin Trish
    The mantra of ‘Repeal and Replace’ has escalated in recent weeks, though what, specifically, the ‘Replace’ component might look like is still unclear. However, many of the current proposals include, at a minimum, some type of continuous coverage provision that allows people with chronic health conditions who have continuously maintained coverage to buy health insurance at standard rates. For example, Paul Ryan’s A Better Way proposal and Tom Price’s Empowering Patients First Act would each prohibit insurers from charging sicker patients more than standard premiums in the individual market as long as they have maintained continuous coverage since before becoming sick. Read more at The Evidence Base


    Health Insurance as Assurance: The Importance of Keeping the ACA’s Limits on Enrollee Health Costs- Loren Adler and Paul Ginsburg
    Protecting patients against catastrophic health expenses and medical bill-induced bankruptcy is often cited as the core purpose of health insurance. Yet lifetime limits on coverage and the lack of annual out-of-pocket (OOP) limits, which were commonplace in private insurance before the Affordable Care Act (ACA) banned the practices, negate this central function of insurance (traditional Medicare also lacks an annual out-of-pocket limit). Read more at The Evidence Base

    Why Academics Consulting with Industry on Health Care may be an Idea Whose Time has Come- Dana Goldman and Darius Lakdawalla
    Perhaps ironically, the advent of the Trump presidency could signal an even greater role for academics in shaping public policy. The president-elect has set out an ambitious agenda, but with many details left to fill in, and congressional Democrats are preparing their opposition. Read More at The Conversation

    Paying for an ACA replacement becomes near impossible if the law’s tax increases are repealed- Loren Adler and Paul Ginsburg
    The tax cuts that would be enacted if Congress models its ACA repeal on the legislation that was passed early last year through the budget reconciliation process would make it much more difficult to achieve a sustainable replacement plan that provides meaningful coverage without increasing deficits. Read more at The Evidence Base


    Why repealing the ACA before replacing it won’t work, and what might- Alice Rivlin, Loren Adler, and Stuart Butler
    Republicans have offered up no shortage of ACA replacement plans, but many are still in outline form or lack critical details. This post outlines why repealing with out a replacement won’t work and what policies should be considered.  Read more at The Evidence Base

    Key takeaways from the final MACRA rule, plus remaining challenges- Kavita Patel, Margaret Darling, and Paul Ginsburg
    In early November, the Centers for Medicare and Medicaid Services (CMS) published their final rule on implementation of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), providing the final word on how the law will be implemented for at least its first year.

    Read more at The Evidence Base

    Election verdict: Pharma Needs a New Prescription-- Dana Goldman and Darius Lakdawalla
    Tuesday’s election elated millions of Americans and disappointed millions more. Among the former were drug industry leaders, buoyed by the defeat of Proposition 61 in California.

    Read more at The Evidence Base

    Measuring Value in Clinical Trials: Patient Preference Doesn’t Equal Average Survival- Stephanie Hedt
    Though clinical trials most often rely on average survival rates as measures of value, these are not synonymous indicators. New research by the Schaeffer Center finds additional factors may weigh in patient’s treatment choice.  Read more at The Evidence Base

    Move Beyond Drugs to Manage Pain- Joan Broderick and Jason Doctor
    This summer, the normally deadlocked Congress overwhelmingly passed the Comprehensive Addiction and Recovery Act to attack the opioid dependency that is ravaging the country. If funding is forthcoming and the law takes full effect, most attention will be on provisions designed to reduce opioid prescribing and help patients get treatment for addiction. An equally vital element addresses what to do about the millions of Americans who will continue to suffer from chronic pain as their opioids are withdrawn. Read more at The Evidence Base

    How to Get Rid of Surprise Medical Bills- Mark Hall, Paul Ginsburg, and Steven Lieberman

    When something bad happens and you need an ambulance, the last thing you should have to think about is whether the ambulance company or hospital you end up with is in your insurer’s network. If it’s not, you could get socked with a huge surprise bill — far beyond what you would have paid in-network.

    Read more at The Evidence Base

    Encouraging Integrative, Non-Opioid Approaches To Pain: A Policy Agenda


    The United States is struggling to deal with an opioid epidemic that is damaging lives, resulting in overdoses, and yet not reducing chronic pain. National initiatives are underway to dramatically reduce access to prescription opioids, but these efforts lack a systematic approach to provide alternative treatments for these patients. Policy changes are urgently needed to provide better care for patients with chronic pain, and in this post, we outline three feasible policy initiatives.

    Read more at The Evidence Base


    Can Shopping Around for Prescriptions Save Money?-  Arpita Sharma

    There is growing concern about health care prices in the United States. Though there is an increasing trend towards encouraging patients to shop around for health care, it is difficult in part because of a lack of transparency in terms of both prices and quality. 

    Read More at The Evidence Base

    Affordable Care Act Premiums are Lower Than You Think- Loren Adler and Paul Ginsburg

    Since the Affordable Care Act’s (ACA) health insurance marketplaces first took effect in 2014, news story after story has focused on premium increases for certain plans, in certain cities, or for certain individuals. Based on preliminary reports, premiums now appear set to rise by a substantial amount in 2017. 

    Read More at The Evidence Base


    5 Takeaways from the 2016 Medicare Trustees Report- Loren Adler

    This year’s Medicare Trustees report provides a look at Medicare’s financial picture, which the Chief Actuary at the Centers for Medicare and Medicaid Services (CMS), Paul Spitalnic, helped dissect at a joint Schaeffer Initiative / AEI event hosted at Brookings on Thursday. 

    Read More at The Evidence Base

    Scapegoating The Pharmaceutical Industry Will Not Solve the Healthcare Crisis And Might Even Make It Worse
    - Justin McGinnis

    Pick up any news source and it quickly becomes evident that “big pharma” is the low hanging fruit for all the healthcare critics these days. Of course it is, Wall Street talks about pharma, #pharma trends on Twitter, pharma is in vogue. But before you jump on the Down-with-Big-Pharma bandwagon it’s worth taking a broader look at healthcare spending, and more importantly, value.​

    Read More at Forbes.com
     
    Left And Right Give Way Too Much Credit To The Business Cycle -Tomas Philipson

    Austerity versus stimulus, raise taxes, cut taxes—with every recession and boom the opposing sides take up arms in the ideological fight over how to respond to the sudden reversal of good fortune. One side wants to bolster the economy with programs to put people back to work and pump money into the system. The other wants to slash government spending and tighten belts like a household out of work. But in the end, neither side is right, mainly because both are giving too much due to the business cycle.

    Read More at Forbes.com


    Where Obamacare Went Wrong (Or Did It?) - Dana Goldman
      

    By now, everyone has formed opinions of the Affordable Care Act (ACA). Ironically, the strongest opinions seem to come from people that know the least about it. Our research indicates that the best predictor of a favorable opinion is not a person’s age, gender, race, education, income, or even whether he/she is uninsured: what matters most is whether they voted for Mitt Romney in the last Presidential election.

    Read More on LinkedIn 


    What Health Care Can Learn from Netflix - Dana Goldman

    Watching Arrested Development with my kids, my mind started to wander after the eighth episode or so. How can Netflix let us gorge ourselves on so much television and – if it makes business sense – are there any lessons for the health care industry? The surprising answer turns out be yes, and it has to do with drugs.

    Read More on LinkedIn

    Don’t Be Fooled by Claims About the ACA Impact on Insurance Premiums - Dana Goldman

    A recent New York Times headline reported that health plan costs for New Yorkers will fall 50%. They were taking the bait from Governor Cuomo’s office, who crowed about “real competition that helps drive down health insurance costs.”

    Read More on LinkedIn

    Don’t Blame the Medical Innovators

    Health economists are fond of saying that medical technology is to blame for rising health care costs. Some – including me – have also pointed out that about 30% of health care spending is wasteful. Given that personal health care spending is more than $2 trillion annually, this suggests the capacity for enormous savings if we could limit technological growth.

    Read More on LinkedIn