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Kaiser Health News published some research showing the decline in the number of insurers participating in the exchanges for the Affordable Care Act. In the first year that the exchanges were operational, states on average had five participating. That average dropped to 3.5 in 2018, with eight states having only one participating insurer (in 2014, there were two). In 2015 and 2016, the average was higher than where it started in 2014.

Kaiser Health News published some research showing the decline in the number of insurers participating in the exchanges for the Affordable Care Act. In the first year that the exchanges were operational, states on average had five participating. That average dropped to 3.5 in 2018, with eight states having only one participating insurer (in 2014, there were two). In 2015 and 2016, the average was higher than where it started in 2014.

These few data points are not enough to draw a trend line, but the latest statistic is not encouraging. The interactive map gives a sense of how many more counties only have one option.

JAMA published a piece in which Dr. Ezekiel Emanuel, formerly a health policy advisor for the White House, proposed a pair of indexes to track how health expenses have changed as a percentage of the median household income. The paper goes into the merits and issues with the indexes (one looks at health insurance premiums, whereas the other also includes other out-of-pocket expenses such as deductibles), but the clear trend is that health expenses are rising relative to median income. In 1999, the average cost of an employer-sponsored insurance plan cost less than 15% of the median household income, whereas in 2016 (less than twenty years later), the percentage was more than 30%. Health costs have been rising rapidly, and it remains to be seen whether they are currently high enough that meaningful policy changes will be enacted.

JAMA published a piece in which Dr. Ezekiel Emanuel, formerly a health policy advisor for the White House, proposed a pair of indexes to track how health expenses have changed as a percentage of the median household income. The paper goes into the merits and issues with the indexes (one looks at health insurance premiums, whereas the other also includes other out-of-pocket expenses such as deductibles), but the clear trend is that health expenses are rising relative to median income. In 1999, the average cost of an employer-sponsored insurance plan cost less than 15% of the median household income, whereas in 2016 (less than twenty years later), the percentage was more than 30%. Health costs have been rising rapidly, and it remains to be seen whether they are currently high enough that meaningful policy changes will be enacted.

It should be noted that the paper did not say that families are spending about a third of their incomes on health insurance. For example, employers may have been absorbing most of the premium increases so that employees are often shielded from the underlying numbers. That does not mean that employees have not been affected, however, since employers paying more for health insurance often means that employees miss out on corresponding increases in pay.

A team recently published a study that found a correlation between gifts from the pharmaceutical industry and prescribing patterns. Prescribers who received gifts tended to prescribe more medications per patients, more expensive medications, and a higher proportion of branded medications. Larger gifts were reported to have a larger impact.

A team recently published a study that found a correlation between gifts from the pharmaceutical industry and prescribing patterns. Prescribers who received gifts tended to prescribe more medications per patients, more expensive medications, and a higher proportion of branded medications. Larger gifts were reported to have a larger impact.

While many outside of the medical community may view such findings as intuitive, many within the medical community oppose efforts to force disclosure of such gifts from industry. Given the information asymmetry between providers and their patients, it is helpful for patients to have tools to understand potential biases that their providers (or prospective providers) might have -- especially as patients increasingly directly shoulder the cost of their medical care.

We have been working on overhauling our website for about a year. For the technically minded, we are moving away from PHP towards Java/JSP. Although the look-and-feel remains largely the same, our hope is that this overhaul will enable us to develop future features much more quickly.

If all goes well, the new version of the website should be operational later on today. Our new website will undoubtedly introduce new quirks, so if you see any rough edges, feel free to let us know.

We have been working on overhauling our website for about a year. For the technically minded, we are moving away from PHP towards Java/JSP. Although the look-and-feel remains largely the same, our hope is that this overhaul will enable us to develop future features much more quickly.

If all goes well, the new version of the website should be operational later on today. Our new website will undoubtedly introduce new quirks, so if you see any rough edges, feel free to let us know.

Along with rolling out the new website, we are also planning on migrating the database from one server to another starting later tonight. The process will likely begin with our posting a message to indicate that the migration is in process and that user updates might be lost. Before the end of the weekend, we hope that the entire migration (both website and database) will have completed.

In a move likely to have many reverberations, the White House administration decided to end cost-sharing reduction payments initiated under the previous administration, claiming inadequate congressional authorization to make those payments. Insurers had been widely predicting increases in premiums should these payments not continue. On one level, the legal issue is whether Congress has actually authorized these payments. One federal judge had ruled in favor of those opposing these payments, but that ruling was appealed and until recently, the payments had continued.

In a move likely to have many reverberations, the White House administration decided to end cost-sharing reduction payments initiated under the previous administration, claiming inadequate congressional authorization to make those payments. Insurers had been widely predicting increases in premiums should these payments not continue. On one level, the legal issue is whether Congress has actually authorized these payments. One federal judge had ruled in favor of those opposing these payments, but that ruling was appealed and until recently, the payments had continued.

On another level, many believe the legal issue is not the impetus behind the decision. Rather, they might theorize that after multiple failed attempts to repeal The Affordable Care Act, this current White House administration is doing what remains in its power to derail the health insurance exchanges. The idea is that if the White House administration is able to cause premiums offered on the exchanges to rise even faster, then more healthy individuals would opt out, causing a death spiral. Those who take this view see this as a ruthless political move, adversely affecting the health of millions.