Mitt’s Moment of Reality, Er, Weakness

The most surprising health care story of the week has to be Mitt Romney not only acknowledging the connection between Romneycare and the ACA, but also actually taking some credit for the historic coverage expansion. Unfortunately, it was a weak moment for Mr. Romney who quickly fell back into step with the ACA attackers. As a result, the statement was merely a novelty and doesn’t represent any actual rethinking related to the ACA. In fact, it would be more than a little surprising to see any kind of détente prior to the 2016 election. (And the prospects for a thaw after that don’t look so hot if this recent poll of North Carolina Republicans is any indication.)

The Dog in the Nighttime—Still Not Barking

In some respects the week was as notable for what didn’t happen as for what did. Health care continued to be largely absent from yet another presidential debate. More substantively, it is now certain the US will not default on its debt or shut down the federal government (at least until 2017), and these modest successes were achieved without undermining Medicare, Medicaid or the ACA. In fact, the budget deal actually headed off whopping increases in Medicare Part D premiums that were going to hit almost one-third of beneficiaries (and state government) pretty hard.

Speaking of Dogs…

The folks trying to take down the ACA via the courts are like a dog on a bone despite the fact they have already used up their best arguments and come up short. The latest effort,  an attempt  to use the origination clause (which says that revenue measures must originate in the House) to argue that ACA passage was unconstitutional, is certain to go down in flames even if it reaches the Supreme Court, which it probably won’t.  Move along, nothing to see here.

A few stories that didn’t get much attention, but are worth checking out:

  • NPR reported the promising initial results in Maryland as hospitals moved from a volume-driven reimbursement system to living on a budget. The early success suggests the effort to shift from paying for volume to paying for value could actually pay off in better care and lower costs.
  • A new study released in JAMA found that a number of plans sold on the federal marketplace lack in network specialists, potentially exposing enrollees to thousands of dollars in out-of-pocket costs.  One also has to wonder if the exclusion of specialists is a deliberate back door effort by insurers to try to get around the ACA ban on medical underwriting. The findings underscore the need for HHS to more vigorously enforce network adequacy standards.
  • The ACA and voting rights—Several advocacy organizations including Demos, the League of Women Voters and Project Vote have sent a letter to the administration arguing that is in violation of the National Voter Registration Act (also known as the Motor Voter Law) for failing to provide enough support to help people register to vote.
  • Finally, more on the drugs wars (PhRMA style). A specialty pharmacy Valeant Pharmaceuticals (in the news recently for aggressive price hikes of existing medications) used to dispense its drugs has announced it will shut down amid allegations that it was just a front used by the manufacturer to inflate sales.