Different Takes: Lessons On Work Requirements, Disability And Association Health Plans
Opinion writers express views on the health law and how to improve health care and lower costs.
The Washington Post:
Trump’s Work Requirements Have Been Successful Before — Under Bill Clinton
No, the Trump administration did not declare victory in the war on poverty, as recent media coverage and a chorus of mocking pundits have suggested. Instead, the White House, subsequently bolstered by the recommendations of its Council of Economic Advisers, moved to expand the sort of dignity-enhancing work requirements for welfare recipients that was pioneered — with bipartisan support and to wide acclaim — during the Clinton administration. Trump’s executive order gave secretaries in the appropriate departments 90 days to review existing programs and recommend changes. In 1996, President Bill Clinton and a Republican-controlled Congress collaborated on the Personal Responsibility and Work Opportunity Act. The law aimed to reduce dependency by requiring non-disabled working-age recipients to find a job within 24 months of starting to receive cash welfare payments. President Trump is taking a page from that welfare-reform playbook, seeking ways to add or strengthen work requirements for noncash benefits such as Medicaid, housing assistance and the Supplemental Nutrition Assistance Program, or SNAP, also known as food stamps. (Ron Haskins, 7/25)
The Wall Street Journal:
ObamaCare Is Robbing Medicaid’s Sickest Patients
ObamaCare made it more difficult for health insurers to turn a profit on individual plans, since it prohibited them from charging consumers more based on their medical risks. But the law also created a huge growth opportunity for insurers: Medicaid. Over the past decade, federal and state spending on Medicaid has nearly doubled to $570 billion—roughly as much as the revenues of United Health, CVS, Anthem, Aetna and Humana put together. California alone will spend nearly $100 billion on Medicaid this year. (Allysia Finley, 7/25)
The Hill:
Buyer Beware Of Association Health Plans
Business groups that have long advocated for association health plans (AHPs) just learned a valuable lesson: Beware of politicians bearing gifts. Recently, the Trump administration finalized a U.S. Department of Labor rule that will allow groups of businesses to band together to buy insurance across state lines. President Trump claimed this rule would save small businesses “massive amounts of money” and lead to better health coverage for small firms. Now that the rule is final, however, some longtime supporters of association health plans are disappointed.The National Federation of Independent Businesses (NFIB) said it won’t be making an AHP available to its more than 300,000 members, reportedly because it feels the plans would require too much financial investment for too little return. (John Arensmeyer, 7/25)
New England Journal of Medicine:
The Republican War On Obamacare — What Has It Achieved?
For nearly a decade, Republicans have opposed the Affordable Care Act (ACA). They have fought Obamacare in Congress, the courts, and the states and, since 2017, from the White House. Given the scope, intensity, and duration of this campaign, it is worth considering what it has achieved. ...The ACA is stuck in purgatory, beyond comprehensive repeal but subject to a war of attrition that jeopardizes its gains. Such a campaign poses risks for Republicans. The politics of health care have fundamentally changed. Tens of millions of Americans are ACA beneficiaries; taking away their coverage and consumer protections is difficult. And as the party in power, Republicans are now responsible for Obamacare’s problems, which the Trump administration’s policies may worsen. (Jonathan Oberlander, 7/25)
The New York Times:
Don’t Let Politics Come Between Me And My Patients
CHICAGO — For nearly five decades, the Title X family planning program has provided much needed funding for reproductive health care for millions of uninsured and underinsured people, covering basic services from cancer screenings to contraception to treatment for sexually transmitted infections. Now, the Trump administration is proposing a so-called domestic gag rule that would strictly limit how clinics that get this funding can refer patients for safe, legal abortions. Under the proposal, clinics will face a choice: either adhere to unacceptable restrictions on how they practice medicine or be cut off from funding that allows them to provide for millions of patients. As a board-certified obstetrician-gynecologist, I can attest that this proposal is bad medicine; as a medical ethicist, I can also affirm it is an assault on both the patient-provider relationship and the autonomy of patients and health care providers. (Julie Chor, 7/25)
The Hill:
The Decay Of Medicare Part D
The Trump administration recently floated ideas to cut the cost of drugs for those enrolled in Medicare. Among these was a proposal to shift some physician-administered drugs from Medicare’s Part B (which pays more for drugs that cost more, even if cheaper options exist), to its Part D (where price reductions for drugs can be negotiated, by steering patients to cost-effective alternatives). Part D’s payment structure has helped reduce the cost of Medicare’s prescription drug benefit well below the levels projected when it was established in 2003. Yet a reinsurance provision in the design of Part D is gradually eliminating incentives to control the program’s drug costs. (Chris Pope, 7/25)
New England Journal of Medicine:
Self-Insured Employers — The Payment-Reform Wild Card
Broad delivery-system restructuring requires changing the dominant method of health care payment. But many commercial health plans have been slow to adopt alternative payment models, largely because their biggest customers — self-insured employers — haven’t demanded it. (Robert E. Mechanic and Robert S. Galvin, 7/26)
Stat:
Paying For Therapies That Cure: Innovative Solutions Needed
The idea that we can give — over a course of days or weeks — a profoundly transformative medicine has radical implications for how we pay for therapies and create incentives for a new generation of cures. ...At the American Society of Clinical Oncology meeting, it became clearer than ever that we are already living in in the “tomorrow” of biomedical research. We must now create the tomorrow of health care financing to account for these innovations.(Robert W. Dubois, 7/25)