Viewpoints: Analyzing The Aetna-ACA Flap; Examining Accountable Care Organizations

Los Angeles Times: Smoking Gun? Aetna Threatened To Quit Obamacare If The Government Blocked Its Humana Merger
Aetna’s announcement this week that it was pulling out of most of the states where it was serving the Obamacare individual exchanges was a head-scratcher; after all, just three months earlier, Chief Executive Mark Bertolini was calling its participation in the market “a good investment,” despite near-term losses. Bertolini also had tried to tamp down speculation that its withdrawal was anything like a payback for the government’s move to block its $37-billion merger with Humana. That was “a separate conversation” from its evaluation of the exchange business, he said during an Aug. 2 conference call with Wall Street analysts. (Michael Hiltzik, 8/17)

Bloomberg: Aetna's Warning For Obamacare 
The news that Aetna will stop selling health insurance on the public exchanges in 11 states may not be catastrophic for the Affordable Care Act. The company covers only 8 percent of Obamacare enrollees, after all, and Aetna’s job-based health insurance business was perhaps never well-suited to building low-cost networks for individual customers. Nevertheless, after earlier defections by UnitedHealth and Humana, Aetna’s move suggests deterioration in the market for health-care coverage on state exchanges. (8/17)

The Wall Street Journal: The Aetna Mugging
Democrats claimed for years that ObamaCare is working splendidly, though anybody acquainted with reality could see the entitlement is dysfunctional. Now as the law breaks down in an election year, they’ve decided to blame private insurers for their own failures. Their target this week is Aetna, which has announced it is withdrawing two-thirds of its ObamaCare coverage, pulling out of 536 of 778 counties where it does business. The third-largest U.S. insurer has lost about $430 million on the exchanges since 2014, and this carnage is typical. More than 40 other companies are also fleeing ObamaCare. (8/17)

Los Angeles Times: Aetna’s Withdrawal From Obamacare Exchanges Isn’t The Start Of A Death Spiral
Giant insurer Aetna announced this week that it was withdrawing from the Obamacare exchanges in 11 of the 15 states it had been doing business, becoming the third major insurance company to scale back its offerings dramatically in the face of heavy losses. The news led to a chorus of “I told you so’s” from critics of the 2010 healthcare law, who have long predicted that it would collapse under its own weight. But they are confusing the growing pains of a new market with the death rattle of a failing one. (8/17)

The Charlotte Observer: What Aetna Forgot To Mention About Its Obamacare Losses
On Monday evening, one of the nation’s largest insurers released a statement announcing its intention to stop offering individual coverage in most Obamacare markets. Aetna’s announcement, just six paragraphs long, explained that it had lost more than $430 million on the public exchanges since 2014, thanks largely to too many high-cost (read: sick) enrollees. ... But earlier this year, Bertolini let slip another figure that didn’t make it into Monday’s six paragraphs: Aetna enjoyed a record $6.5 billion in government program premiums in the first quarter. In other words, doing business with the government isn’t so bad after all. (8/17)

New Hampshire Times Union: Sinking Ship: Aetna Bails On ACA
Could the last one out please shut off Obamacare? The fatally flawed health care program is slowly, and inevitably, succumbing to its wounds, but not before inflicting millions of Americans with mediocre, overpriced health insurance. The latest setback for the comically named Affordable Care Act was Aetna’s decision to withdraw from Obamacare exchanges in 11 of the 15 states it currently serves. (8/17)

JAMA: The ACO Experiment In Infancy—Looking Back And Looking Forward
Accountable care organizations (ACOs) have emerged as a prominent alternative to traditional fee-for-service payment. What was initially conceptualized as a pilot program for physicians to take responsibility for improving quality and slowing spending has become a national movement now covering more than 28 million Americans, 60% of whom are under commercial ACO contracts. Limited evidence on the effectiveness of the ACO model to date, however, has led some to question the merits of this approach to delivery system reform. However, it would be a mistake to reverse course so early in the life of this promising payment and delivery model. (Zirui Song and Elliott S. Fisher, 8/16)

JAMA: Reassessing ACOs And Health Care Reform
Accountable care organizations (ACOs) were the cornerstone of the novel payment strategies for Medicare reform under the Affordable Care Act (ACA). In an effort to move from fee-for-service medicine, the Centers for Medicare & Medicaid Services (CMS) aimed to encourage hospitals and physicians to collaborate by offering a bonus if they improved the quality and efficiency of care. The ACO concept appeared in 2 different initiatives under the ACA—the Pioneer ACO program and the ACO program under the Centers for Medicare & Medicaid Innovation (CMMI)—and was intended as an experiment in health policy. (Kevin A. Schulman and Barak D. Richman, 8/16)

RealClear Health: Bridging The Divide On Health Savings Accounts To Higher Value Health Care
Proponents of market-driven reform of U.S. health care agree that the worst solution to the problem of rapidly rising medical expenditures is government-imposed cost controls. They question the capacity of the federal government to manage something as complex as resource allocation in health care without unintended negative consequences. They propose instead to bring greater discipline to the health sector through market-based reforms and through innovation and cost-cutting driven by the private sector. (James C. Capretta, 8/17)

Dallas Morning News: Obamacare Solved Medicare Funding But Seniors Can Expect Less Care 
Here is something I bet you don't know. On March 23, 2010, President Barack Obama signed into law a bill that wiped out more than $50 trillion in Medicare's unfunded liability. That's not a misprint. That's trillion with a T. The savings are almost three times the size of our entire economy. Furthermore, in doing this he also solved the long-term budgetary problem of Medicare. Unless some future Congress and some future president change the law, Medicare's growth will stay in line with the growth of our economy, ensuring that the program will remain affordable  indefinitely. (John C. Goodman, 8/17)

Lexington (Ky.) Herald-Leader: Bevin Should Refocus Medicaid Plan On Improving Health Outcomes
Nonprofits are worried about the governor’s proposal to promote “community engagement” by requiring able-bodied, working-age adults to work or volunteer in exchange for Medicaid coverage. The requirement would be 20 hours a week of work or volunteering after a year on Medicaid and would be phased in slowly .... While volunteers are prized by many nonprofits, they must be trained and managed. Organizations employ volunteers a couple of hours a week, seldom more than 10 hours a week. Some organizations require and pay for background checks and medical and drug tests for volunteers. There’s no provision for reimbursing charities for any of these new costs under Bevin’s plan. (8/17)

Georgia Health News: Why I’m At Odds With My Party On Health Care
With a proven record of cutting waste and reducing spending, I am a fiscally conservative Republican, as well as a health care professional. But the Georgia GOP legislative leadership and I have reached very different conclusions about Medicaid expansion and the Affordable Care Act (ACA). (Jack Bernard, 8/17)

The Hill: Zika Is Here, While Congress Is On Vacation 
While Congress remains on recess, the Zika virus is now spreading on U.S. soil, right where every day Americans live and enjoy their own vacations. Yet Congress continues to play politics with this public health crisis. Emergency spending is for emergencies, and stopping the spread of Zika is a genuine emergency. Zika infection during pregnancy causes microcephaly and other significant disabilities. (Peter Berns, 8/17)

Los Angeles Times: Anabolic Steroids Taint Olympic Competition, But It's What They Do To The Human Brain That Is Terrifying
During the Olympic Games, the world gazes admiringly upon athletes with preternatural musculature and athletic ability — and then laments every tainted urine test, every revelation of doping. In the mind of the public, this is the problem with anabolic steroids: They undermine fairness in competition between elite athletes. Damaging the spirit of sport, however, is a minor concern compared with how anabolic steroids impair the health of those who use them — not only Olympians and professional athletes, but also high school football players and rank-and-file weightlifters. (Ruth Wood, 8/17)

The New York Times: Is Your Lipstick Bad For You?
You can’t legally buy a drug in the United States that hasn’t undergone rigorous testing, mandated by Congress, to prove that it’s safe and effective. By contrast, that lipstick, shampoo, or deodorant you use every day may have undergone no such testing. And there’s cause to wonder if those products are safe. More than 21,000 complaints of itching, rashes and hair loss, for instance, have been sent to the manufacturer and distributor of Wen Hair Care products. And hair-straightening products that contain formaldehyde, a known carcinogen, have caused allergic reactions, hair loss, rashes, blisters and other problems in salon workers and their customers. (8/17)

The Hill: Children’s Good Health: Not Just For Olympic Hopefuls 
In her hometown of Rio de Janeiro, Olympian Rafaela Silva, 26, was Brazil’s first gold medal this year. The winner in women’s judo, Silva was raised in poverty in one of the city’s infamous favelas. Olympian Mavis Chirandu, now 21, was years ago abandoned by the side of the road as an infant and grew up in an SOS Children's Village. She is today representing the nation of Zimbabwe as a member of the women’s soccer team at the 2016 Olympics. (Jessica Sager, 8/17)

The Atlantic: Modern Medicine Is Too Reliant On Short-Term Studies
It has been 30 years since the first findings that heart attacks are most common in the early morning. Since then, research has revealed that those first three hours after waking are also when a cardiac event is most damaging. In fact, the whole cardiovascular system is controlled by circadian rhythms that influence the likelihood of stroke, kidney failure, and heart attacks. (Jessa Gamble, 8/17)