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To a wonderful 2019.

To a wonderful 2019.

From the team at DocSpot.

We hope you all had a merry Christmas this year!

We hope you all had a merry Christmas this year!

From the teams at DocSpot

Kaiser Health News published some anecdotes that highlight the cost of healthcare in the U.S. The specific stories are about families struggling with the cost of health insurance. However, underneath the cost of insurance is the cost of care. For decades, many Americans never saw the cost of insurance because their employers paid for most or all of their insurance. As health insurance costs continue to rise, businesses started to shift the cost of health insurance to their employees through higher deductibles or through larger employee portions of the premiums. While millions of Americans were still uninsured, with the passage of the Affordable Care Act, many of those uninsured could purchase health insurance through an insurance exchange. Many qualified for a subsidy and were still shielded from the true cost of insurance. The stories that were published in this article highlight how the high cost of care can affect those whose incomes are high enough to be ineligible for subsidies.

Kaiser Health News published some anecdotes that highlight the cost of healthcare in the U.S. The specific stories are about families struggling with the cost of health insurance. However, underneath the cost of insurance is the cost of care. For decades, many Americans never saw the cost of insurance because their employers paid for most or all of their insurance. As health insurance costs continue to rise, businesses started to shift the cost of health insurance to their employees through higher deductibles or through larger employee portions of the premiums. While millions of Americans were still uninsured, with the passage of the Affordable Care Act, many of those uninsured could purchase health insurance through an insurance exchange. Many qualified for a subsidy and were still shielded from the true cost of insurance. The stories that were published in this article highlight how the high cost of care can affect those whose incomes are high enough to be ineligible for subsidies.

One response to the story would be to try to raise the limits under which people are eligible for subsidies. Under that scenario, the government ends up subsidizing health insurance for more people. Another approach would be to try to reduce underlying cost of care through systematic reforms such as transparent pricing and quality information.

In a follow-up to a lawsuit filed earlier this year (which the Justice Department declined to defend), Kaiser Health News reported that a federal district court judge in Texas ruled that the Affordable Care Act, with the subsequent removal of the individual mandate, was unconstitutional. An earlier Supreme Court decision ruled that Congress does have authority to enact the Affordable Care Act because it can levy taxes, which the Supreme Court considered the Affordable Care Act to be. The removal of the individual mandate removes the part considered to be a tax, and hence the federal district court judge ruled that the legislation is no longer constitutional. The current White House administration, which opposes the Affordable Care Act recognizes that nothing should change in the short-term, since the Supreme Court will most likely hear the appeal.

In a follow-up to a lawsuit filed earlier this year (which the Justice Department declined to defend), Kaiser Health News reported that a federal district court judge in Texas ruled that the Affordable Care Act, with the subsequent removal of the individual mandate, was unconstitutional. An earlier Supreme Court decision ruled that Congress does have authority to enact the Affordable Care Act because it can levy taxes, which the Supreme Court considered the Affordable Care Act to be. The removal of the individual mandate removes the part considered to be a tax, and hence the federal district court judge ruled that the legislation is no longer constitutional. The current White House administration, which opposes the Affordable Care Act recognizes that nothing should change in the short-term, since the Supreme Court will most likely hear the appeal.

The Affordable Care Act was sweeping legislation that was approved by a very slim margin. Even though the political climate did not change enough to completely overturn the legislation, there was enough change for opponents to cast this uncertainty. The political instability makes it more difficult for either side to gain momentum.

In another sign of healthcare moving more towards value-based payments, Kaiser Health News reported on Medicare awarding bonuses to nursing homes whose residents' readmission rates to hospitals are low and issuing penalties to nursing homes whose residents more frequently end up back in the hospital. While the actual percentages may seem small (1.6% bonuses and almost 2% penalties), the article notes that the differences can be meaningful given that nursing homes often operate on very slim margins.

In another sign of healthcare moving more towards value-based payments, Kaiser Health News reported on Medicare awarding bonuses to nursing homes whose residents' readmission rates to hospitals are low and issuing penalties to nursing homes whose residents more frequently end up back in the hospital. While the actual percentages may seem small (1.6% bonuses and almost 2% penalties), the article notes that the differences can be meaningful given that nursing homes often operate on very slim margins.

The piece included one anecdote about one nursing home chain being disappointed with the penalties, noting that since most of the readmissions occurred after the residents left their facilities. If Medicare considered whether the residents had already left the nursing home, they would exacerbate an existing conflict of interest: an earlier return from the nursing home could mean more revenue for the nursing home at the expense of a less healthy patient. Instead, nursing homes now have an additional incentive to coordinate care to help the patients' transitions back to their own homes.