Category Archives: regulation

Government regulations on insurance and medical care, e.g., mandated benefits, community rating, guaranteed issue, price controls, licensing

Obamacare Medical Device Tax: Sending Research, Development and Innovation Overseas

From the National Center for Policy Analysis:

The effect of Obamacare on innovation within the health care sector is staggering. Scott Atlas, senior fellow at the Hoover Institution, explains how the law has begun to change research, development and innovation — activities which traditionally have taken place in the United States — thanks to the ACA’s $500 billion in new taxes, many of which fall on medical device and drug manufacturers. The result? Companies are moving overseas.

via Obamacare: Sending Research, Development and Innovation Overseas.

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Mark Sklar: Doctoring in the Age of #ObamaCare

In The Wall Street Journal, Mark Sklar writes about endlessly entering data or calling for permission to prescribe or trying to avoid Medicare penalties—when should I see patients? Sklar writes:

The patient should be the arbiter of the physician’s quality of care. Contrary to what our government may believe, the average American has the intellectual capacity to judge. To give people more control of their medical choices, we should move away from third-party payment. t may be more prudent to offer the public a high-deductible insurance plan with a tax-deductible medical savings account that people could use until the insurance deductible is reached. Members of the public thus would be spending their own health-care dollars and have an incentive to shop around for better value. This would encourage competition among providers and ultimately lower health-care costs.

Mark Sklar: Doctoring in the Age of ObamaCare – WSJ.

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Filed under Policy - National, regulation

As Expected, #ObamaCare Motivates Insurers to Shun the Sickest People

John R. Graham writes:

A patient with HIV/AIDS can expect to pay over $1,000 out of pocket for medicines, if he buys a policy on the ObamaCare health insurance exchange in Florida.

“woman-in-hospitalAffordable”? Surely not. This perceived injustice has caused legal activists to file a lawsuit against four insurers, which offer plans in the Florida exchange, alleging discrimination.

Readers of this blog know that we have long warned against this consequence of ObamaCare. Insurers are not allowed to charge premiums appropriate to applicants’ expected medical claims. …

An ObamaCare Silver policy must pay 70 percent of expected medical costs, while covering 100 percent of “preventive care” (as defined by the federal government). However, the plan is designed for the average patient. So, it is easy for a health plan to design a plan that imposes very high medical maintenance costs on very sick, chronically ill people. High co-payments or co-insurance for prescriptions is one obvious method.

Our prediction: There will be many more such lawsuits.

Read more: As Expected, ObamaCare Motivates Insurers to Shun the Sickest People | John Goodman’s Health Policy Blog | NCPA.org.

In February, Graham blogged about this article from The Hill, which reports: “Consumers who use specialty medications may face higher costs on ObamaCare’s marketplace plans, many of which include co-insurance rather than copayments for the drugs, a new analysis warned.”

Last week, Graham illustrated one more example of insurers avoiding sick patients, this time in relation to how insurers use ObamaCare subsidies:

[P]lans apply more of the subsidy to the deductible, somewhat less likely to apply it to specialist charges, and much less likely to apply it to the most expensive tier 4 drugs on the formulary. What this means is that generally healthy patients who go to see their primary-care physician occasionally, but need no specialist care or specialty prescriptions, are most likely to benefit from the cost-sharing reductions. Those who need specialist care and, especially,  tier 4 drugs will be less likely to benefit.

Back in 2010, Peter Suderman wrote about how insurers tailor their plans to attract the healthy & avoid the sick:

Indeed, because insurers will be limited in terms of how they can charge based on health risk factors, the new rules may encourage plan providers to avoid investing in resources that help the sick.

For example, a 1997 New England Journal of Medicine study looked at billing records for elderly Americans participating in Medicare HMOs in Florida. The study found that, despite exchange-like regulations guaranteeing access to any HMO plan and prohibiting insurer cherry picking (or “medlining,” as it’s sometimes called), insurance companies managed to lure in the healthiest—and cheapest—patients, while leaving the sickest, most expensive patients on publicly funded Medicare.

As does John Goodman, writing about community rating:

When premiums are regulated so that they cannot reflect expected costs, four things will happen:

  1. On the buyer side, people who are under-charged will over-insure and people who are over-charged will under-insure. This is basic economics. If the price you are asked to pay is artificially low, you will buy more than you otherwise would; if the price is artificially high, you will buy less. If you are sick and require a lot of medical care but can pay the premium ordinarily charged to a healthy enrollee, for example, you will likely choose the richest plan you can find.
  2. In order to avoid attracting high cost enrollees, health plans will respond by scaling back their benefits and their provider networks until the richest plans look pretty much like every other plan. In the individual market today, in most states you can buy a BlueCross plan that covers almost all doctors in your area and practically every hospital, including all the best hospitals. I predict those plans will never see the light of day inside the (ObamaCare) health insurance exchanges. See Monday’s Health Alert on the race to the bottom with respect to access to care.
  3. At the same time, health plans will seek to attract the healthy. Of course, to a certain extent they are doing that today. But with an electronic exchange in which healthy people tend to buy on price and sick people tend to buy on benefits and software that makes it easy to do those things, the insurers will be even more pressured to reconfigure their offerings to make them more attractive to the healthy and less attractive to people who need medical care.
  4. Finally, the perverse incentives do not end at the point of enrollment. They continue. Health plans will have perverse incentives to over-provide to the healthy (to keep the ones they have and attract more of them) and to under-provide to the sick (to avoid attracting more of them and encourage those they have to go elsewhere).

See also this Reuters article: “Chronically ill facing high drugs costs under U.S. health law“:

Insurers say they had to move toward greater cost-sharing due to higher prices for new drugs, some of which can cost more than $100,000 annually per patient.

Researchers also say the higher rates help insurers bankroll low monthly premiums to attract healthy young enrollees.

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How the FDA promotes skin cancer

Do you use sunscreen or sunblock? The Washington Post explains how the FDA forces you to use inferior products:

The tourists flocking to the French Riviera or Spain’s Costa del Sol this summer will slather on sunscreen containing the latest ingredients for protecting against the sun’s most harmful ultraviolet rays.

But American beachgoers will have to make do with sunscreens that dermatologists and cancer-research groups say are less effective and have changed little over the past decade.

That’s because applications for the newer sunscreen ingredients have languished for years in the bureaucracy of the Food and Drug Administration, which must approve the products before they reach consumers.

“We have a system here that’s completely broken down, and everybody knows that it has broken down,” said Wendy Selig, president of the Melanoma Research Alliance, the largest private funder of melanoma research.

Via Marginal Revolution: Still Burned by the FDA.

It’s FDA policies like the above that validate my view of the agency as one run by paternalistic overlords.

See also: FDAreview.orgCato on the FDA, “Kill the FDA (Before it Kills Again)“, and this video by economist Dan Klein:

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Colorado Senate Bill 14-016 a boost to health care cronyism

In the Greeley Tribune, Linda Gorman writes:

Some Colorado legislators have shown impeccable timing in seeking to exacerbate the problem. Sen. Irene Aguilar, D-Denver, and Rep. Dominick Moreno, D-Commerce City, have introduced Senate Bill 016, which would force the closure of already existing freestanding emergency rooms unless they are owned by a hospital. SB 016 provides an exemption for emergency rooms more than 25 miles from a licensed hospital. Given the geographic structure of the Front Range corridor, however, the practical effect of the bill would be to give hospitals monopoly control of all emergency facilities. …

Colorado’s hospitals are big businesses. As the bill to close competitive emergency rooms shows, they would rather outlaw competitors than outproduce them. Colorado legislators need to remember that handing hospitals a monopoly over freestanding emergency rooms does not serve the best interests of their constituents. It will increase health care costs while reducing health care access, and increase the pain for ordinary citizens already suffering from Obamacare cost increases.

More: Gorman: Senate Bill 016 a boost to health care cronyism in Colorado | GreeleyTribune.com.

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John Lott: The Facts About Assault Weapons and Crime

Jon R. Lott, Jr. writes in the Wall Street Journal:

Yet despite being at the center of the gun-control debate for decades, neither President Obama nor Ms. Feinstein (the author of the 1994 legislation) seems to understand the leading research on the effects of the Federal Assault Weapons Ban. In addition, they continue to mislabel the weapons they seek to ban. …

Ms. Feinstein points to two studies by criminology professors Chris Koper and Jeff Roth for the National Institute of Justice to back up her contention that the ban reduced crime. [But these authors concluded just the opposite]. …

The large-capacity ammunition magazines used by some of these killers are also misunderstood. The common perception that so-called “assault weapons” can hold larger magazines than hunting rifles is simply wrong. Any gun that can hold a magazine can hold one of any size.  …

Ms. Feinstein’s new proposal also calls for gun registration, and the reasoning is straightforward: If a gun has been left at a crime scene and it was registered to the person who committed the crime, the registry will link the crime gun back to the criminal.

Nice logic, but in reality it hardly ever works that way. Guns are very rarely left behind at a crime scene. When they are, they’re usually stolen or unregistered. …

If we finally want to deal seriously with multiple-victim public shootings, it’s time that we acknowledge a common feature of these attacks: With just a single exception, the attack in Tucson last year, every public shooting in the U.S. in which more than three people have been killed since at least 1950 has occurred in a place where citizens are not allowed to carry their own firearms.

Read the whole article: John Lott: The Facts About Assault Weapons and Crime – WSJ.com.

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Is ObamaCare’s medical-loss ratio mandate increase health insurance premiums

From Peter Suderman at Reason.com:

Over the weekend, The New York Times published a report noting that health insurers across the nation are both “seeking and winning double-digit increases in premiums” — this despite the fact that “one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.” …

What’s going on? Why are these rates going up?

Suderman explains how mandated benefits explain some of the increase.  He then explains a less obvious culprit: mandatory medical loss ratios. Suderman writes:

The MLR is an accounting requirement which says that insurers have to spend at least 80 percent of their total premium revenue on medical expenses, leaving just 20 percent for administrative costs, marketing, and other non-medical expenditures. Any insurer that fails to meet this target must issue rebates to customers. This year, insurers rebated about $1 billion.

The MLR provision creates two incentives for insurers to jack up health insurance premiums. One is the plain fact that with profit and administrative costs capped as a percentage of premium revenue, the easiest way to generate larger profits is to charge higher premiums.

The other is that the rebate requirement means insurers may need to charge higher up-front premiums in order to protect themselves from the risk of a bad year.

Read more: Is ObamaCare Causing Health Insurance Premiums to Rise? – Hit & Run : Reason.com.

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