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  • $1.1 trillion spending bill and what it means for healthcare in 2014

    By Katie Ni
    Education & Outreach Coordinator, AMSA Health Policy Team

    Last Thursday, the Senate voted to pass the $1.1 trillion spending bill that will fund the government through this September. The bill passed easily in both the Senate and the House-- perhaps with the memory of government shutdown still fresh in representatives’ minds. Here is the short and sweet version of what this year’s budget has in store for health policy:

    1. Funding for the Affordable Care Act will be cut. The ACA will see cut funding in two places: $1 billion will be cut from Prevention and Public Health Fund, and $10 million will be cut from the Independent Payment Advisory Board (IPAB), the panel given the task of making changes to Medicare payment and program rules. IPAB was made to achieve savings for Medicare, but has been denounced by its critics as a “death panel” that will reduce access to care. A cut of $10 million from the IPAB’s former budget of $15 million may limit the board’s capabilities significantly.

    2. The NIH will recover funding lost from sequestration, BUT overall will see a decrease in funding. The NIH will receive $29.9 billion for 2014, which is $1 billion more than its post-sequestration value, but $714 million less than its original 2013 budget. While the research giant will at least be able to recover funds lost from sequestration, it is discouraging to see the government’s deemphasizing of biomedical research, which works on new vaccines and treatments, curing diseases like cancer and diabetes, and other projects that could profoundly improve human health.

    3. Funding for the FDA and CDC have increased. The FDA will receive $2.6 billion in 2014, a near-$100 million increase from its 2013 budget. The CDC will receive $6.9 billion, $369 million more than its 2013 budget. The FDA regulates food, medication, and other consumer products, while the CDC has an important role in monitoring and preventing diseases. Both will impact the health of a huge number of people based on their ability to carry out these tasks, and hopefully the extra funding will be used efficiently to help these important agencies function in the coming year.

    4. Federal funding is banned from being used for most abortions. The bill also bans foreign aid from being used toward abortions, and funds abstinence-only education in schools. Always a controversial topic, it would appear that the pro-lifers have made several gains through this spending bill. Some health plans available under the ACA could continue to cover elective abortion, but in general, this measure will make it more difficult for women to choose an abortion (for reasons other than rape, incest, or medical emergency), especially for women on subsidized health plans.

    For current and future physicians, the cut ACA funding will be the aspect of the spending bill that has the greatest impact. On paper, the spending decrease on the ACA represents a compromise made between the Republican and Democratic parties; however, in practice, the cut programs—reworking Medicare costs and implementing preventative health programs— are projects that have potential to decrease health expenditures in the future. Choosing to cut them now may translate to a net loss down the road. While it is encouraging to hear that Congress has finally successfully compromised on a budget and avoided a second government shutdown-level crisis, the spending bill represents a mixed bag in terms of health policy.

    Additional information/sources:

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  • How we pay for medical care in 2014: Paying for quality and efficiency

    Whitney McFadden
    AMSA Health Policy Chair

    Bodenheimer and Grumbach outlined in their book, Understanding Health Policy: A Clinical Approach, a view of health policy and the faults of our current healthcare system. It seems we are very familiar with the pitfalls of our current system. In order to be clear and not dwell too much on the obvious, our system struggles with overuse and underinsurance/lack of insurance that is being addressed with the Affordable Care Act. Today we pay for healthcare out-of-pocket, with individual private insurance, employment based private insurance, or government financing. Insurance plans for healthcare began in the depression due to unstable payments. Medicare was established to cover the elderly and lower income individuals. Currently physicians are paid in a multi-tier system including fee-for-service, episode illness grouping, capitation (per head fee to general practitioner and specialist), and salary.
    2014 will be a year of new payment methods for healthcare. The sustainable growth rate (SGR) has historically be underfunded requiring congressional intervention to avoid the reduction in payment to medical reimbursement that would make it unsustainable. This year, a bipartisan fix will change payments to value based on measure of better quality and efficiency instead of the current greater volume and intensity of services. Some evidence exists in community clinics that this method has been successful and alternative payment models (i.e. transitional care) have been attempted as possible solutions. McClellan makes the point that we currently do not know how to create a system that is cheaper and rewards improved health outcomes. 

    One solution is single payer healthcare, which addresses the funding source. However our problems with how payments will be made to increase efficiency would still remain. There are methods by which we can change the way our healthcare dollars are spent, but we will not find those solutions on the national stage. Instead, each clinic and hospital must look at their individual patient population, the diseases they treat, and the access to care in the community in order to develop a system that is financially viable. We would benefit from establishing a medical economics team at every health provider institution to allow for individualized services from technologic tools that we know work well. The team based approach to healthcare that is the foundation for our medical training should extent to healthcare funding. Instead of trying to find the rules that would apply to everyone, we need to establish the framework by which everyone can create their rules, and do it with ease, efficiency, and completeness.

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  • My HealthCare.Gov Experience

    Brandon Sandine
    AMSA Local Health Policy Coordinator

    Amidst the media turmoil surrounding the website, developed to help citizens obtain health insurance through the Affordable Care Act, I decided to try my luck navigating the website and see if the media recounted the experience accurately.

    After opening up the webpage, I was immediately prompted to click the big orange link to begin the application. The new page that appears after clicking the apply link allowed me to choose whether or not I want to finish the application online or by phone. As my experiment was to determine if the website was functional I chose to finish online. The next steps were to create a profile and provide information to determine my financial eligibility.

    Impressively, when it was all said and done, the entire process did not take more than 15-20 minutes and was incredibly simple. Furthermore, before logging off I knew exactly what type of coverage I was eligible for. My hope with all of this is to inform people who have not applied for health insurance due to website issues to know that they can rest assured that progress has been made. My experience with was simple, quick and painless.

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  • ACA Coverage and the New Year

    Whitney McFadden
    AMSA Health Policy Chair

    As medical students, what should we expect for our healthcare system this year?

    The Department of Health and Human Services is closely tracking the number of people signing up for health insurance. This year’s resolution will be to follow how Obamacare is improving the health of our nation. First, 2.1 million Americans have signed up for private insurance in the exchanges and a new 3.9 million were found to be able to access coverage through medicaid. We do not know how many people had to change their current insurance, and how this coverage will affect doctor patient visits. In the end, we want to understand how these changes improve the health of our nation.

    How we prioritize and evaluate the measure of our national health will be a significant issue this year. Obamacare is covering more individuals and in order to measure its success, many are searching for ways to see the impact on healthcare. The National Bureau of Economic Research studied the Oregon Health Insurance Experiment published in 2011 to investigate how health insurance improves health care and outcomes. The study measured health care utilization, out-of-pocket medical expenditures, medical debt, and self-reported physical and mental health in randomly chosen low-income participants who qualified for coverage. The study found that those with coverage had statistically significant changes in their health. Participants were likely to have more healthcare utilization (hospitalizations, outpatient visits, prescription medications), less expenses, and better self-reported health. It seems these will be a few of the outcomes to follow after the ACA is in full swing.

    Listed are some of the noteworthy changes for the 2014 year:
    1. Insurance coverage will not be withheld for individuals with pre-existing conditions or premiums elevated based on age or gender.
    2. Insurance companies must share pricing and benefit information with consumers in a comparative way. 
    3. Private exchanges might be used more in the workplace.
    4. Employer mandate set for 2015 will give small companies time to prepare for covering their employees. 
    5. Price transparency. 
    6. Likely more regulations imparted by HHS.
    7. Insurance companies will begin to limit the number of healthcare providers they cover based better rates. 
    8. States will have the most impact on local price structure (i.e. Medicaid expansion). 
    We will likely see some great improvements in care as individuals access more preventive services, get connected with primary care physicians, and pay less for healthcare. However, some changes remain to be seen. Emergency room visits are not likely to drop off if we use the OHSE as a model, and some insurance plans have already increase their premiums to existing customers covering lost costs for sicker people. Following the progress of our healthcare system over the next few years will be essential to improving our health as a nation. As medical students we can help patients be aware of these changes and the effects on our overall healthcare.

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  • The Physicians’ Proposal

    By Brandon Sandine
    AMSA Health Policy State and Local Policy Coordinator

    It’s a simple proposal! And amidst the growing financial and human burden that our current healthcare system induces, it’s the most equitable and economically sensible proposal of all. Everybody in, nobody out. This was the idea that two emphatic physicians concluded some 25 years ago would help alleviate the growing health insurance disparity, and the problems that are associated with lack of insurance, in our country.

    Today the ranks of Physicians for a National Health Program (PNHP) are significantly larger than it was 25 years ago. Yet their realization is still the same. Our country desperately needs to improve access to medical care, for all of its residents, by implementing a universal health insurance program. While national healthcare reform has recently occurred, primarily through The Patient Protection and Affordable Care Act (ACA), approximately 30 million Americans will still remain uninsured. As such, it is imperative that the single-payer agenda passes into legislation.

    At the recent PNHP annual convention this was exactly the focu of discussion. Content at the convention introduced new and old members to changes that the ACA will have on their clinical practice, to how would the House of Representatives Bill 676 - single-payer health insurance - function in our country. For me, an aspiring future physician, it was profoundly influential to see primary care physicians, cardiologists and neurosurgeons all in one room agreeing that their career had fell short of their ideological expectations. Yet, they all knew that a national single-payer healthcare model would significantly decrease the problems most often cited, and increase their personal satisfaction in being apart of healthcare in America.

    This year’s convention was a short reprieve from the daily stresses of the classroom. However, I left with newfound empowerment. Past PNHP president Dr. Claudi Fegan led the concluding remarks from the convention with our paradigmatic slogan, “EVERYBODY IN, NOBODY OUT!”

    If you would like to learn more about Physicians for a National Health Program check out this link. For further information on H.R. 676 read this

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