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    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