When Should Exchange Enrollees Not Shop on Premium Price?

CoveredOpen enrollment began November 15th for consumers looking to purchase or renew health insurance on the Affordable Care Act’s state and federal marketplaces. While the second time around is likely to go more smoothly than the first, Drew Altman of the Kaiser Family Foundation reminds us that challenges still remain.

One of these challenges is the relatively complicated way the financial assistance consumers receive is calculated. Individuals and families that previously enrolled in marketplace plans will be automatically re-enrolled unless they choose a different plan. However, because the benchmark product used to calculate their initial level of financial assistance may have changed, the monthly cost to the consumer may also change.

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Physician-Hospital Integration in California

An article in this week’s JAMA examines the effect vertical integration between hospitals and physician groups has on spending.

Provider consolidation throughout the 1990s and 2000s has been well documented and is largely believed to be a significant factor in the steady price increases experienced throughout both decades. A 2012 paper from Catalyst for Payment Reform does an excellent job of providing background, documenting the rise in market concentration of hospitals, and laying out potential solutions.

While a significant portion of the literature has focused on consolidation among hospitals, there has also been a dramatic increase in the number of physicians and physicians groups employed by hospitals — essentially vertical integration. The author’s analysis seeks to provide data on what effect this level of vertical integration is having on expenditures in California.

The article finds that in 2012 physician-owned physician groups had mean expenditures of $3,066 per patient per year, versus $4,312 per patient per year for hospital-owned physician groups. After patient heath, regional variation, and organizational characteristics were controlled for the differential dropped, but was still significant: an additional $435 for local hospital owned groups and $704 for multi-hospital groups.

While physician-hospital integration is frequently seen as being associated with better quality, these results show it also comes with significantly higher costs.

Prop 45 threatens California’s health reform success story

Nearly one and a half million Californians signed up for health insurance coverage during the first year of health care reform. Consumers can now shop on our new marketplace, Covered California, without fear of discrimination based on pre-existing conditions and they receive financial assistance as needed. It is more important than ever to reject proposals that would turn back the clock on the progress our state has made in implementing federal health reform.

And yet Prop 45 — a poorly-drafted November ballot measure that would give one politician sweeping new powers to override decisions made by Covered California’s independent commission — would do just that.

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Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost

CA NP Cover

Granting full practice authority to nurse practitioners is one of the most effective steps that states can take to increase the supply of primary care while maintaining high quality and driving down costs.

Together with the Bay Area Council Economic Institute and through the generous support of AARP and the Robert Wood Johnson Foundation we took a look a what granting full practice authority to nurse practitioners means for states in dollars and cents. The first in a series of five, this brief quantifies the benefits to access, quality, and cost for the State of California that would stem from granting nurse practitioners full practice authority.

The results are eye-opening.

What needs to be fixed with health care reform

It seems that all we hear about health reform these days is hatred or hype. As usual, the truth is more complicated. We’ve laid a solid foundation for a much-needed national reform, but the challenges to date run deeper than the issues with the website. Successfully creating a functional, universal health care system for our country will require being entirely clear-eyed about what has worked and what needs to be fixed with the Affordable Care Act.

As we reach the end of the first period for individuals to enroll in health coverage, the number of people who have selected a health plan through the public exchanges may top 7 million nationally, more than 1 million in California.

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Talking Healthcare for Ex-Convicts on Fox News


Was on Fox News this morning talking about the prisoners being enrolled in Medicaid as a result of the Affordable Care Act.

I pointed out that this will improve public safety since healthcare coverage has been proven to reduce recidivism (people returning to prison for new crimes), for many reasons including improvements in mental health and financial security.

Have been on that show a number of times and respect host Jenna Lee for her fair moderation of the conversation.  Also respect my fellow guest Avik Roy, though I wish that he would join moderates like me in being constructive critics of the parts of the Affordable Care Act that need to be fixed.  It’s pointless to relitigate a debate that was over four years ago.

On the show, I mentioned two things: First that healthcare coverage helps reduce recidivism.  Good write-up of that here.  Also that that the Oregon Health Study showed improved mental health outcomes.  A good review of this study and a thorough debunking of the silly talking point that health coverage does not improve health outcomes can be found here.

(H/T The Incidental Economist http://theincidentaleconomist.com/)

Update on How Obamacare is Affecting My Family

In July of last year I first began planning to buy insurance for my family under the federal Affordable Care Act. Since then, I’ve reviewed my options on the Covered California website, chosen my plan, paid the insurer, received my card, and have begun accessing healthcare. The process has had some hiccups, but so far the results have been much better than what I anticipated.

Back when I began shopping, I predicted that I would end up purchasing a “silver” Blue Shield PPO product to cover my family of three in Sacramento for $997 per month. The actual prices when they came out were much lower. So we bought a “gold” level product for $972 per month. Continue reading

Off to the Races


2014 has arrived, and the Affordable Care Act is now in full swing.

I joined Fox News’ Happening Now to answer viewer questions about what the law means for them, employers, and our nation’s delivery system as a whole. The full segment can be found here.

I also had the chance to join Ray Suarez on Al Jazeera’s Inside Story to discuss the tragic case of Jahi McMath. Undoubtably a terrible tragedy, her case also presents a teachable moment for discussions surrounding end-of-life care. Watch here.