First, in a web exclusive, Health Affairs published an article “Cost Sharing In Medicaid And CHIP: How Does It Affect Out-Of-Pocket Spending?” which is further evidence that cost sharing is a delicate balancing act for Medicaid, especially given new flexibility from the Deficit Reduction Act of 2005. The notion of “skin in the game” sounds great but often has counter-intuitive effects in Medicaid/CHIP.
Next, the story “Florida has no data 3 years into Medicaid trial” from the Florida AP via Kaiser Health News notes that almost three years after beginning its Medicaid Reform effort, the state still does not have complete and accurate encounter data. Additionally, a new HHS/OIG report “Medicaid Managed Care Encounter Data: Collection and Use” states that Florida has no sanctions or incentives for the submission of complete and accurate encounter data.
Third course, another excellent Health Affairs article “Trends In Underinsurance And The Affordability Of Employer Coverage, 2004–2007,” which basically argues that the shield of employer-sponsored health insurance is eroding under an increasing burden.
The authors summarize with:
If history repeats itself, as the most recent recession plays out, employees are likely to experience further and more serious deterioration in financial protection from their health plans. Hence, it is imperative that the health care reform debate of 2009 address the underlying rise in health spending. Failure to do so will not only render health insurance and health care unaffordable to low- and middle-income Americans in the near future, but it will also leave health reform itself unaffordable.
Fourth course (related to the third), Ezra Klein’s post “Why Workers Aren’t Angrier About Health Care.” Mr. Klein accurately points out that most employees see health care as a “freebie” but in health care, there are no free lunches (especially now with the FDA cracking down – I guess I just made a funny).
Remember the old saying, “**** runs downhill?” Well, the same thing happens in the business world. Businesses pay taxes but they don’t really pay taxes, they pass them on to employees and customers. So, what may appear to be a freebie to employees is actually higher cost-sharing (see third course) and lower wages (see graphic). Someone has to pay the bill.
Fifth course (related to the third and fourth), the Business Roundtable’s report “Health Care Value Comparability Study” which headlines with “Health Care Costs Put U.S. Workers and Employers at a Significant Disadvantage Compared With Global Competitors.”
Sixth course, related to my earlier post “Medicaid Agencies are Public Health Agencies,” the new leaders at the Food and Drug Administration (FDA) wrote a perspective piece for the New England Journal of Medicine titled “The FDA as a Public Health Agency” where they reaffirm the Agency’s commitment to public health. In it, they write:
The Institute of Medicine has defined the mission of public health as “fulfilling society’s interest in assuring the conditions
in which people can be healthy.” To be healthy, people need access to a safe and nutritious food supply and to innovative, safe, and effective medical products. The FDA’s job is to support this access and, in doing so, to promote health, prevent illness, and prolong life. The ultimate measures of the FDA’s success should reflect its fundamental goals and go beyond such intermediate measures as the number of facilities inspected or drugs approved.
And finally, for dessert, we have one of my favorite blogs, Health Populi. Jane Sarasohn-Kahn does a wonderful job making complex policy attainable to everyday persons. If you haven’t read it before, take a look.
Oops, it looks like we have a digestif because I also want to add that HHS issued a press release today that Cindy Mann, J.D. has been appointed to lead CMS’ Center for Medicaid and State Operations (CMSO). ~BAA